Community Council Announcements

NC Medicaid Changes

7/8/2019

Q: What is NC Medicaid Managed Care?
A: NC Medicaid Managed Care helps you get the most out of your Medicaid benefits. Instead of one Medicaid program there are many health plans to choose from.
All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans also have added services such as programs to help you quit smoking, eat healthier and have a healthy pregnancy. Health plans work with different doctors and health care professionals. Each plan has its own network of qualified doctors and health care professionals. To keep you doctor, clinic or other provider, find out which plans they work with. Then choose one of those plans.

Q: Is Medicaid eligibility changing?
A: No. Medicaid eligibility rules are not changing. If you have questions about your eligibility, please contact your local Department of Social Services office.

Q: What is a primary care provider?
A: Your primary care provider (PCP) is your family doctor, clinic or health care provider. Your PCP will help you with your health care needs. They will also coordinate your care with other health providers.

Q: What is a health plan?
A: A health plan is a group of doctors, hospitals and other health care professionals. They work together to give you the health care you need.

Q: Do I have to choose a health plan?
A: It depends. Most people in NC Medicaid must choose a health plan. Some people can choose to stay in NC Medicaid Direct. To find out if you must enroll, go to Who must enroll in NC Medicaid Managed Care? at ncmedicaidplans.gov/learn/who-must-enroll-nc-medicaid-managed-care. If you still have questions, call an enrollment specialist toll free at 1-833-870-5500 (TTY: 1/833-870-5588). Or use the chat tool to chat with an enrollment specialist online.

Q: What is NC Medicaid Direct?
A: Some people will be in NC Medicaid Direct because it provides services that meet specific needs. For example, it provides the same services currently covered for developmental disability, mental illness, traumatic brain injury and substance use disorder. To learn more about NC Medicaid Direct, call 1-88-245-0179

Q: What do I need to do?
A: 1. Choose a primary care provider (PCP)
2. Choose a health plan – compare the plans and choose the best one for you
3. Enroll online at ncmedicaidplans.gov, use the NC Medicaid Managed Care mobile app, call the enrollment specialist toll free at 1-833-870-5500 (TTY: 1-833-870-5588) or fill out and mail back the
enrollment form sent to you.

Q: When can I call to get help?
A: The enrollment specialist is available from 7am to 5pm, Monday through Saturday at 1-833-870-5500 (TTY: 1-833-870-5588). The call is free. You may need your Medicaid ID number when you call or go to the website. If you do not speak English, the call center is still available to help you with language assistance services.

Q: What is the deadline to enroll?
A: Open enrollment ends on September 13, 2019. If you do not select a plan by this time, a plan will be selected for you.

Q: What happens after I enroll?
A: After you enroll, your health plan will mail you information and your new Medicaid card. You will use this Medicaid card to get health care services beginning November 1, 2019.

Q: Can I change my health plan after I enroll?
A: Yes. In the first 90 days, you can change your health plan for any reason. After that, unless you have a special reason, you cannot change your health plan until your Medicaid recertification date. Reasons are listed on the Health Plan Change Request Form. For a copy of the form, go to Member resources at ncmedicaidplans.gov/member-resources.

Q: Can I keep my current primary care provider?
A: Yes, if your PCP is in the health plan you choose.

Q: What if I move, get a new job, or if my life changes in another way?
A: Changes to your household to include changes in income, household composition etc. should be reported to your local Department of Social Services.

Q; How can I apply for Medicaid benefits?
A: There are three ways to apply:
1. Apply online at ePass.gov
2. Mail a paper application or drop it off at your local Department of Social Services
3. Apply in person at your local DSS.

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