Information for North Carolina State Health Plan Members

The North Carolina State Health Plan recently announced a new provider-tier program that will take effect Jan.1, 2027. Under this program, Atrium Health was placed in the non-preferred provider tier. Like many of you, we were surprised by this decision and understand the uncertainty and concern it has created.

More than 133,000 State Health Plan members and their families currently receive care through Atrium Health. As a result of the State Health Plan's decision, many members may face higher out-of-pocket costs if they choose to continue receiving care at Atrium Health. We are also concerned about potential downstream impacts such as reduced appointment availability, additional travel burdens and disruptions in ongoing treatment, particularly for patients with complex healthcare needs and those in rural or underserved communities.

We remain committed to working toward solutions that help you maintain the relationships you have built with your healthcare providers and care teams while reducing unnecessary financial burdens. Most importantly, we are committed to caring for you and your family with the same compassion, excellence and dedication you have come to expect from Atrium Health. 

The State Health Plan's new tiered healthcare provider program takes effect Jan. 1, 2027.

The State Health Plan covers approximately 750,000 employees, retirees and dependents across North Carolina. More than 133,000 of those members and their families currently receive care through Atrium Health.

Yes. State Health Plan members can continue receiving care at Atrium Health.

Whether you rely on us for primary care, specialty care, maternity services, cancer treatment, children's care or other healthcare needs, our goal is to work with the State Health Plan to find a path forward that allows you to continue receiving care at Atrium Health without being penalized for choosing your preferred provider.

Most importantly, we are committed to caring for you and your family with the same compassion, excellence and dedication you have come to expect from Atrium Health.

The State Health Plan's new provider program does not take effect until Jan. 1, 2027. Patients can continue scheduling and receiving care as they do today. If additional information becomes available, Atrium Health will share updates with patients as appropriate

Patients should continue working with their healthcare provider and consult the State Health Plan regarding coverage, benefits and any potential cost implications related to future services.

We understand that patients receiving ongoing treatment may have concerns about what these changes could mean for their care. Atrium Health believes continuity of care is important, especially for patients managing complex or chronic conditions. Patients with questions about their specific care plan should talk with their healthcare provider and contact the State Health Plan regarding coverage and benefits.

Unfortunately, Atrium Health was not involved in the decision-making process and still does not have a clear understanding of the methodology behind these designations or how their potential impact on patients and families was evaluated. 

As one of North Carolina's largest providers of care for members, we remain willing to engage with the State Health Plan and believe any solution should prioritize affordability, access and patient choice.  

Many members who continue receiving care at Atrium Health are expected to face higher out-of-pocket costs beginning in 2027 because of the State Health Plan’s decision to place Atrium Health in the non-preferred provider tier. 

The exact impact will depend on your State Health Plan benefits, healthcare needs and cost-sharing requirements. 

For information about your specific coverage and benefits, please contact the State Health Plan administrator. 

Yes. We believe the State Health Plan's new approach could affect access to care for many patients. By directing a large number of patients to seek care from a smaller group of preferred providers, the program could contribute to reduced appointment availability, additional travel burdens and disruptions in ongoing treatment, particularly for patients with complex healthcare needs and those in rural or underserved communities.   

These concerns may be especially pronounced during peak demand periods, such as flu season and back-to-school season, when primary care, pediatric and urgent care services are already under increased pressure.

Absolutely not. Preferred, access and non-preferred provider designations are based on network and contracting arrangements similar to a health insurance company, not clinical quality ratings. 

Not only does Atrium Health remain one of North Carolina's largest healthcare providers, serving hundreds of thousands of patients each year across hospitals, physician practices and community-based care locations, it is also home to nationally recognized clinical programs, including an NCI-designated comprehensive cancer center and nationally recognized children's hospitals. 

Atrium Health also leads North Carolina with the most Leapfrog Hospital Safety Grade "A" ratings of any health system in the state and ranks among the nation's leading health systems for patient safety. In addition, Atrium Health is routinely recognized by U.S. News & World Report as one of the top health systems in North Carolina. Most recently, Atrium Health earned two nationally ranked specialties, and Atrium Health Carolinas Medical Center has been named the #1 hospital in the Charlotte region by U.S. News & World Report for nine consecutive years. 

Patients choose Atrium Health because of the quality of care they receive, the relationships they have built with their care teams and the services available in their communities. 

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. 

In this case, the higher out-of-pocket costs many members are expected to face are tied to the State Health Plan’s provider-tier designations, benefit design and the agreements associated with those designations. 

Simply put, these higher out-of-pocket costs are a result of the State Health Plan’s network structure and benefit design — not a result of Atrium Health determining what members pay for care.  

State Health Plan officials have publicly stated that they are leveraging their position as one of the state's largest purchasers of healthcare services to negotiate new arrangements with healthcare providers. They have also said it is using preferred contracts as part of an effort to address the plan's historic financial challenges and resolve a projected nearly $1 billion deficit by the end of 2027.

Atrium Health recognizes the importance of ensuring the long-term sustainability of the State Health Plan. However, we believe decisions of this magnitude deserve careful consideration and collaboration, and that there remains a meaningful opportunity to work together with the State Health Plan on a program that preserves affordability, access to care and meaningful patient choice while supporting the long-term sustainability of the Plan.

For additional information about the State Health Plan's decision-making process, members should contact the State Health Plan directly.

No. The State Health Plan and Atrium Health have different perspectives on the process that led to these designations. But like many of you, we were surprised by the State Health Plan's decision and would have absolutely welcomed the opportunity to compete in the full process that determined these tier designations while helping ensure the impact on patients and families remained front and center.

What is not disputed is that patients will face higher costs and difficult decisions about where they receive care beginning in 2027 if we are to remain in the non-preferred provider tier. Atrium Health remains willing to engage with the State Health Plan and believes any solution should prioritize affordability, access and patient choice.