Questions and Answers About NC Medicaid Transformation

North Carolina’s Medicaid program is changing, and most Medicaid patients will be impacted. Here’s what you need to know about the changes and how to know which of the new health insurance plans include Atrium Health doctors and hospitals.

North Carolina’s Medicaid program is changing from a state-run program to a managed care model that will include five new Medicaid health insurance plans, called Prepaid Health Plans (PHP).

Under the new Medicaid Managed Care program, most but not all Medicaid patients will need to pick one of the new health insurance plans and select a primary care provider (PCP)/doctor office. All of the plans offer the same basic healthcare benefits and services. However, the doctors and hospitals included in each health insurance plan may be different. The PHPs also offer different non-healthcare related services.

Atrium Health cannot recommend a specific plan to you. You may want to enroll in a NC Medicaid health plan that enables you to continue getting care from your preferred doctors and hospitals.

  • Call your doctor’s office when it’s time for you to enroll in a new Medicaid health plan to confirm which NC Medicaid health plans your doctor is in.
  • Visit our website for updates on Atrium Health’s participation in the new NC Medicaid health insurance plans.
  • As always, if you have a medical emergency, go to the closest hospital emergency room. Atrium Health hospitals provide services to all patients seeking treatment for an emergency medical condition, regardless of their health insurance plan or ability to pay for emergency services.

Open enrollment for most NC Medicaid patients in the Charlotte Metro area begins October 14 and runs through December 13, 2019. Open enrollment for those in the Triad and Triangle areas also runs through December 13, 2019. New coverage for patients required to select a new NC Medicaid health plan is scheduled to begin February 1, 2020.

  • You can change your new Medicaid health plan until December 13, 2019.
  • Then, in the first 90 days after your new Medicaid health plan begins, 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 anniversary date.
  • To change your new Medicaid plan, call 1-833-870-5500.

If you have questions now, contact the North Carolina Department of Health & Human Services by:

  • Calling toll free at 1-833-870-5500 (TTY: 1-833-870-5588), 7 a.m. to 5 p.m., Monday through Saturday.
  • Visiting the gov website and using the “chat” tool to ask questions.

It depends. Most people in NC Medicaid must choose a new Medicaid health plan. Some people can stay in NC Medicaid Direct. They will not need to choose a new plan. To find out if you must enroll, go to “Who must enroll in NC Medicaid Managed Care? Or go to NC Medicaid website. Members who need to enroll in a new health insurance plan will also receive an enrollment packet in the mail sometime shortly after October 1, 2019. 

  • If you need to enroll in a new Medicaid health plan and do not select one, the state will select a new Medicaid health plan for you.
  • If you still have questions, call toll free at 1-833-870-5500 (TTY: 1-833-870-5588). Or use the chat tool to chat with an enrollment agent online.