NC Medicaid (and NC Health Choice) is Changing!

Updated 1 September 2021

As of 1 Sept 2021 Sandhills Pediatrics is participating with Medicaid Health Plans Carolina Complete Health, Wellcare and NC Medicaid Direct

Comparison website between Carolina Complete Health and Wellcare

This new system of paying for healthcare for NC Medicaid and NC Health Choice beneficiaries in NC started 1 July 2021.

IF you have received a letter saying you are signed up with AmeriHealth Caritas, Healthy Blue, or United HealthCare Community Plan, and would like to still see Sandhills Pediatrics, THEN please call the enrollment broker 1-833-870-5500  and ask to switch to Carolina Complete Health or Wellcare.  (with Sandhills Pediatrics as the PCP). You will still be able to see us regardless of what plan is on your card until 30 November 2021) BUT best to get this fixed ASAP while you are thinking about it!

If your plan is Carolina Complete Health or Wellcare and your Primary Care Provider (PCP) is someone other than Sandhills Pediatrics and you us to be your child’s doctor, please call them and tell them you want to switch PCPs.

  • Carolina Complete Health 833-552-3876 and follow the prompts for member services
  • Wellcare 866-799-5318

You can also contact the enrollment broker to pick a plan at:

  • 833-870-5500 (TTY: 1-833-870-5588) Hours of operation: 7 a.m. to 8 p.m., Monday through Sunday

Our group NPI (National Provider Identifier) is 111-499-8150

Our central office address is: 195 W ILLINOIS AVE
SOUTHERN PINES, NC 28387-5808

Our primary care doctors are:

  • LINDSEY BELLAMY, DO
  • ANDREA BENNETT-CAIN MD
  • JOSEPH BOALS, MD
  • SARAH LOCKLEAR BREWINGTON, MD
  • SARAH CARR, MD
  • CHRISTOPH DIASIO, MD
  • NATALEE FRENCH, MD
  • FREDERICK HARRISON MABRY, MD
  • JENNIFER MABRY, MD
  • NORA “CATE” MASON, MD
  • SCOTT SEXTON, MD
  • REBECCA SIMPKIN, MD
  • WILLIAM “BILL” STEWART, MD

Our primary care NP/PAs are:

  • NIKKI ETEO, CPNP
  • GWEN GARCIA-LEACH, CPNP
  • JESSICA HAYWOOD, FNP
  • ELIZABETH HODGIN, CPNP
  • AMY IVEY, CPNP
  • HATTIE MCCALL, PA-C
  • KIM NIEMEYER, CPNP
  • KAMERON SPERDUTO, CPNP
  • MATTHEW THOMPSON, MSN, FNP-C

FAQs

What should I do right now to get ready?

The first way to get ready is to make sure Sandhills Pediatrics is listed on your Medicaid or NC Health Choice card. If it is not, and you still want to see Sandhills Pediatrics after 1 July 2021, call your local DSS office to have us added to your card. Please make sure they have your current address!

If you can’t reach your county DSS, you can also call the Medicaid Contact Center 1-888-245-0179

Press 1 for English
Press 1 for English again
Press 1 if you currently have Medicaid.
Press 1 to change your healthcare provider.
If you want to be seen at any of the Sandhills Pediatrics offices, you can give the central office address at 195 West Illinois Ave, Southern Pines, NC 28387. 910-692-2244

Comparison website between Carolina Complete Health and Wellcare

If I get a letter saying my children stay in Medicaid Direct, do I need to do anything?

No

Why is this change happening to NC Medicaid and NC Health Choice?

The NC General Assembly passed the first of three medicaid transformation laws in 2015.  Link to Bill

Background from https://medicaid.ncdhhs.gov/transformation

“In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services. The Department was on track to go live Feb. 1, 2020; however, new funding and program authority were required from the General Assembly to meet this timeline and Medicaid Managed Care was suspended in November 2019. In July 2020, legislation authorized the restart of Medicaid Managed Care transformation efforts with a July 1, 2021, launch date for Standard Plans and a July 1, 2022, launch date for Behavioral Health I/DD Tailored Plans. “

NC Medicaid FAQ

Please let our staff know if you have any questions!

Anything Else?

If your child is enrolled in free and reduced lunch, make sure you don’t miss out on the P-EBT benefit.  The Pandemic Electronic Benefit Transfer (P-EBT) program helps families purchase food for children whose access to free or reduced-priced meals at school has been impacted by COVID-19 because students are learning virtually, outside of brick-and-mortar schools.

English One Page Explanation of P-EBT Benefit

Spanish One Page Explanation of P-EBT Benefit

Child Tax Credit

On 11 March 2021 President Biden signed into law the American Rescue Plan Act of 2021. This new stimulus package includes major changes to the child tax credit of up to $3600 per child <6yo and $3000 per child 6-17 yo , Many families will begin to receive some of this money as a monthly payment in July 2021.  The fastest way for the government to send you money is electronically, so please make sure to list your children when you file your taxes  and include a current checking account!

Taxes are complicated- more info here.  Child tax credit calculator here.