Instead of a single medicaid program run by NC state government, private insurance Managed Care companies will be processing the medicaid and NC Health Choice claims as well as the current system of medicaid which will now be renamed NC Medicaid Direct.
As of 9/2/2019 Sandhills Pediatrics will be participating with NC Medicaid Direct, Wellcare, Carolina Complete Health/Centene. Once the Medicaid transition goes live for our region 2/1/2020, patients will only be able to continue to see Sandhills Pediatrics if they enroll with NC Medicaid Direct, Wellcare or Carolina Complete Health/Centene.
You will be mailed a packet with instructions by NC Medicaid when it is your time to choose–please make sure your address is correct with your local county DSS office!
The change will roll out across NC in two phases. The first phase will be for Region 2 & 4 (basically north and west NC) and will go live Nov 1, 2019. This should NOT affect most of our Sandhills Pediatrics patients.
The rest of the state, including our counties of Moore, Lee, Montgomery Hoke, and Robeson will go live Feb 1, 2020 and our patients will have to enroll (i.e., pick NC Medicaid Direct, Wellcare or Carolina Complete Health/Centene if they wish to continue seeing us) by 12/13/2019. The enrollment will not open until October 14–December 13, 2019 so no action is required if you live in one of these phase 2 counties until October 14.
The map of phase 2 counties and a list of the available health plans is available here.
Patients who do not pick a certain health plan will be auto assigned by an enrollment computer. The program is supposed to pay attention to who the patient has seen before but we would encourage our patients who want to still see us to make an active choice to pick a plan we are signed up with rather than relying on a computer program we have never seen operate before.
Some patients will be excluded from managed care and will stay in “regular Medicaid’/NC Medicaid Direct and will not pick a health plan until the “tailored plans” start in 2021- this will mostly be for patients who will need enhanced coverage for behavioral health problems. If you receive a letter stating you are excluded and can stay in NC Medicaid, you don’t need to do anything to remain a Sandhills Pediatrics patient.
You make the choice by “enrolling”. Enroll in one of these ways:
- Go to ncmedicaidplans.gov
- Use the NC Medicaid Managed Care mobile app
- Call us toll free at 1-833-870-5500 (TTY: 1-833-870-5588)
- When you receive an enrollment form (sample form), fill it out and mail or fax it back
After you enroll, your health plan will mail you a welcome packet and Medicaid card. You will use your Medicaid card to get health services.
The most important thing you can do until open enrollment starts for your region is to make sure your address is up to date with your local county DSS!
Please let our staff know if you have any questions!