MM Curator summary
Open enrollment for NC Medicaid managed care has finally begun after years of delays.
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RALEIGH — The North Carolina Department of Health and Human Services on Monday announced the launch of statewide open enrollment for NC Medicaid Managed Care. Beneficiaries can enroll online, by calling the NC Medicaid Managed Care Call Center at 833-870-5500 (TTY: 833-870-5588) or through the free NC Medicaid Managed Care mobile app available on Google Play or the App Store. They can also use the mail-in forms sent to them in the enrollment packet.
“With the start of NC Medicaid Managed Care open enrollment, families now have the chance to make important decisions about their health care to prepare for managed care launch in July,” said NCDHHS Secretary Mandy Cohen, “There are many resources available to help families select the health plans and providers that best meet their specific needs.”
The NC Medicaid Managed Care website offers a wide variety of tools and information to assist beneficiaries in choosing a primary care provider (PCP) and a health plan for their families’ care. Tools include frequently asked questions, a chat function, the Medicaid and NC Health Choice Provider and Health Plan Lookup Tool with four categories of search capabilities, advanced search based on specialty and the ability to view all providers within an organization/location and by practice name.
Most people who receive Medicaid can choose from five health plans as part of the state’s transition to managed care. Some people will not need to choose a health plan because of the type of health services they need. All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans each have their own network of qualified doctors and health care professionals. Health plans also have added services such as educational assistance and programs to have a healthy pregnancy. People can choose a PCP from their health plan’s network to deliver their families’ Medicaid services.
The Eastern Band of Cherokee Indians (EBCI) Tribal Option is an additional managed care option, and the first Indian Managed Care Entity in the nation that is available for federally recognized Tribal members and individuals eligible to receive services through the Indian Health Service.
Open enrollment ends May 14, 2021. Beneficiaries who enroll with a health plan during open enrollment will have the opportunity to select a PCP from a list of contracted providers. If they do not choose a health plan before May 14, NC Medicaid will assign one to them. In the first 90 days after their coverage effective date, beneficiaries can change health plans for any reason. After that, unless there is a special reason, beneficiaries cannot change health plans until the next NCDHHS Medicaid recertification date.
For more information, beneficiaries can reference the enrollment packets that were mailed to them, visit the NC Medicaid Managed Care website or call the NC Medicaid Managed Care Call Center at 833-870-5500 (TTY: 833-870-5588).