Information for North Carolina State Health Plan Members
Atrium Health and the State Health Plan Have Reached an Agreement
When the North Carolina State Health Plan announced changes that affected members receiving care at Atrium Health beginning Jan. 1, 2027, we heard from many State Health Plan members who were concerned about maintaining access to the doctors, hospitals and services they trust.
Throughout our discussions with the State Health Plan, we advocated on behalf of educators, police, firefighters, state employees and their families. All the proposals we submitted to the State Health Plan focused on preserving access to care and addressing concerns about affordability. Atrium Health and the State Health Plan have reached an agreement that preserves access to important healthcare services while providing greater clarity for members ahead of open enrollment.
Key Things to Know
- Most importantly, you can continue to see your primary care provider with no change in cost or benefits.
- Emergency care and behavioral health services can be accessed at the same benefit level members receive today.
- Levine Children’s Hospital, Jeff Gordon Children’s Hospital and Brenner Children’s Hospital will be included in the State Health Plan’s Access level.
- Atrium Health hospitals in rural counties will be included in the State Health Plan’s Access level.
- Pregnant members will not be asked to change their obstetrician or delivery plans for 2027.
- Preserved access to care for patients with complex medical needs, including treatment for cancer, cystic fibrosis, unique heart and transplant care.
Additional information about benefit exceptions and continuity of care will be provided by the State Health Plan.
FAQs
Atrium Health and the North Carolina State Health Plan have reached an agreement that preserves access to important healthcare services for members beginning Jan. 1, 2027. The agreement provides greater clarity for members and helps ensure continued access to primary care, emergency care, behavioral health services, children's hospitals, rural hospitals and care for patients with complex medical needs.
The agreement takes effect Jan. 1, 2027, and will apply to the State Health Plan’s 2027 coverage year.
Yes. State Health Plan members can continue receiving care at Atrium Health.
The agreement preserves access to a broad range of services and was designed to minimize disruptions for patients and families who rely on Atrium Health for their care. We remain committed to providing the compassionate, high-quality care our patients expect while helping ensure members can maintain important relationships with their care teams.
The State Health Plan's tiered provider program means the impact on members will depend on the type of care they receive and where that care is provided. Throughout discussions with the State Health Plan, Atrium Health focused on finding solutions that would minimize disruption for members and preserve affordable access to care.
As a result of those efforts, primary care, emergency care and behavioral health services will continue at the same benefit level members receive today. The agreement also adds three children's hospitals and rural hospitals to the Access level, which is a benefit level that will be almost identical to the benefit they have this year for out of pocket and deductible costs.
Members should review State Health Plan enrollment materials for details specific to their coverage.
No. The amount a patient pays for healthcare is influenced by many factors, including deductibles, copays, coinsurance, out-of-pocket maximums and network design decisions made by health plans. So for members, out-of-pocket costs under this program are driven by the State Health Plan's benefit design and provider-tier structure.
Recognizing the potential impact on members, Atrium Health worked with the State Health Plan to improve affordability and preserve access to care. Those discussions led to an agreement that maintains current benefit levels for primary care, emergency care and behavioral health services, while also adding children's hospitals and participating rural hospitals to the Access level and preserving access to important services for many members and families.
No. The agreement preserves access to important healthcare services, including primary care, emergency care, behavioral health services, care at children's hospitals and care for patients with complex medical needs.
Members should review open enrollment materials and coverage information for details related to their individual healthcare needs.
All Atrium Health hospitals are included for emergency care. If a member has an emergency, members should always go to the nearest emergency department, and the entire care event will be covered at the same benefit members currently have today.
The agreement adds three children’s hospitals and Atrium Health hospitals in rural counties to the Access level.
Members should review the State Health Plan’s open enrollment materials and confirm coverage for their specific hospital, physician and service.
All Atrium Health hospitals are included for emergency care. If a member has an emergency, members should always go to the nearest emergency department, and the entire care event will be covered at the same benefit members currently have today.
The agreement adds 13 Atrium Health hospitals to the State Health Plan's Access level beginning Jan. 1, 2027, including three children's hospitals and rural hospitals. Additional details about participating facilities will be available through State Health Plan enrollment materials.
Children’s hospitals
- Levine Children’s Hospital
- Jeff Gordon Children’s Hospital
- Brenner Children’s Hospital
Rural hospitals
- Alleghany Health
- Atrium Health Anson
- Atrium Health Cleveland
- Atrium Health Kings Mountain
- Atrium Health Lincoln
- Atrium Health Scotland
- Atrium Health Stanly
- Columbus Regional Healthcare System
- Hugh Chatham Health
- Wilkes Medical Center
No. Pregnant members will not be asked to change their obstetrician or delivery plans for 2027.
Yes. Behavioral health services will continue to be covered at the same benefit level members receive today.
The agreement protects access to advanced clinical care that may only be available locally, including care for cancer, cystic fibrosis, specialized heart conditions and transplants. Atrium Health and the State Health Plan will continue refining the list of qualifying services and benefit exceptions.
Members should review the State Health Plan’s open enrollment materials and confirm coverage for their specific hospital, physician and service.
Atrium Health will continue providing updates as additional information becomes available.
Members should also review State Health Plan open enrollment materials and benefit information when released for the 2027 plan year. Additional information will be posted to this page as details become available.