There will be a new way to get Medicaid health care
Most people will get the same Medicaid services in a new way – through health plans. You will be able to choose the health plan that is best for you. A health plan is a group of doctors, hospitals and other providers. They work together to give you the health care you need. Everything will come from the same health plan. This includes physical health, behavioral health, and medicine. Some health plans provide added services like programs to help you quit smoking.
You will also choose a primary care provider (PCP). A PCP could be your family doctor, clinic or other health care provider. They will help you with your health care needs. Most people receiving Medicaid must choose a health plan. To learn more, go to Who must choose a health plan?
If you are a federally recognized tribal member or qualify for Indian Health Services (IHS) and live in Cherokee, Haywood, Graham, Jackson or Swain County or in a neighboring county of the 5-county region, you may choose to enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option. As a member of the EBCI Tribal Option, you can still get services from any Medicaid or NC Health Choice provider. To learn more, go to Get answers.
Some people will not need to choose a health plan because of the type of health services they need. They will stay enrolled in NC Medicaid Direct. Or, they can choose the EBCI Tribal Option if they qualify. To learn more, go to NC Medicaid Direct services.
If you have behavioral health, substance use, intellectual and developmental disability (I/DD) or traumatic brain injury (TBI) support needs, you may ask to stay in NC Medicaid Direct to keep getting services through your Local Management Entity-Managed Care Organization (LME-MCO). Use the Request to stay in NC Medicaid Direct and LME-MCO: Beneficiary form.
If you are a provider, you may ask for a person to stay in NC Medicaid Direct. Use the Request to stay in NC Medicaid Direct (Fee for Service) and LME-MCO: Provider form.
You can use this website to submit your form. It is the fastest and best way to submit a form. To learn more, go to Submit forms online.
To learn about the basic benefits and services that all health plans offer and services that are not covered, go to Benefits and services.