NC Medicaid Managed Care health plan assignments completed for beneficiaries

Staff report


RALEIGH — All Medicaid beneficiaries currently eligible to transition to managed care have selected or been assigned a health plan, with 97% enrolled in a plan that includes their current primary care provider in network, according to the North Carolina Department of Health and Human Services.

“As a result, nearly all current beneficiaries will keep the same health care provider they have today when managed care launches on July 1. That means more families can continue to visit the practices and doctors who know them best and are familiar with their specific health care needs,” an NCDHHS release reads in part.

Beneficiaries who did not select a health plan during open enrollment, which ended May 21, were auto-enrolled in a plan. The state health agency’s auto-enrollment process prioritized existing relationships between beneficiaries and their PCP and, where possible, a plan that has contracted with that provider was selected for the beneficiary. Confirmation notices and health plan welcome packets will be mailed to beneficiaries through June 12. Beneficiaries have until Sept. 30 to change plans for any reason.

“Ensuring beneficiaries have access to the health care they need on Day 1 of Medicaid Managed Care has been a key priority throughout this process,” said Dave Richard, deputy secretary of NC Medicaid. “This is an important step to ensuring continuity of care for the 1.6 million Medicaid beneficiaries who will begin receiving their care through health plans on July 1.”

Federally recognized tribal members living in the tribal service area who did not choose a health plan were enrolled into the Eastern Band of Cherokee Indians (EBCI) Tribal Option. The EBCI Tribal Option is primarily offered in five counties: Cherokee, Graham, Haywood, Jackson and Swain to federally recognized tribal members and others eligible for services through Indian Health Service.

Whether or not beneficiaries chose a plan during open enrollment or were auto-enrolled by NC Medicaid, everyone will have through Sept. 30 to change their health plan or primary care provider for any reason by contacting the NC Medicaid Enrollment Broker. After that, unless there is a special reason, beneficiaries must wait until their next Medicaid recertification date to change health plans.

Most beneficiaries in NC Medicaid must be enrolled in a managed care health plan. More information can be found on the “Do I Need to Choose a Health Plan?” fact sheet. Beneficiaries are encouraged to visit the NC Medicaid Enrollment Broker website at or call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588) for more information.