Most people get their NC Medicaid services through health plans.

A health plan is a group of doctors, hospitals and other health care providers. They work together to give you the health care you need. This includes physical health, behavioral health and medicine. Health plans provide added services like programs to help you quit smoking.

Health plans and providers

Health plans have a provider network (group). In most cases, you must get care from a provider in your health plan’s provider network, such as a primary care provider (PCP). A PCP is a doctor, nurse practitioner or physician assistant. They care for your health, coordinate your needs and refer you to specialists when you need them.

Your health plan will mail you a welcome packet after you enroll. The packet will have your Medicaid ID card and member handbook with information about your PCP, your benefits and how to access health care services.

To learn about the basic benefits and services all health plans offer and services that health plans do not cover, go to Benefits and services.

Five types of health plans

This section provides a brief overview of each type of health plan offered by NC Medicaid. For more details, go to Health plan types.

Standard Plans

Most people receiving NC Medicaid must get health care services from a Standard Plan. Standard Plans offer physical health, pharmacy (prescriptions), care management and basic behavioral health services for beneficiaries.

Tailored Plans

Tailored Plans started on July 1, 2024, for people who need services related to a serious mental illness, severe substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI). Tailored Plans offer physical health, pharmacy (prescriptions), care management and behavioral health services.

Tailored Plans offer added services for beneficiaries who qualify. For example, individuals receiving Innovations or TBI waiver services were enrolled in a Tailored Plan. Others may have the option to choose a Tailored Plan. If you are enrolled in the Tailored Plan or have the option to choose the Tailored Plan, you will get a notice in the mail to tell you.

EBCI Tribal Option

If you are a federally recognized tribal member or qualify for services through Indian Health Service (IHS) and live in Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain or Transylvania counties, you may qualify for the Eastern Band of Cherokee Indians (EBCI) Tribal Option. As a member of the EBCI Tribal Option, you can get services from any NC Medicaid provider.

Children and Families Specialty Plan

The Children and Families Specialty Plan (CFSP) is a new NC Medicaid Managed Care health plan managed by Blue Cross and Blue Shield of North Carolina under the name Healthy Blue Care Together.

Beneficiaries include NC Medicaid-enrolled children, youth and young adults currently and formerly served by Child Welfare. The Children and Families Specialty Plan launched December 1, 2025.

NC Medicaid Direct

Some people do not qualify for a health plan because of the type of health care services they need. They are enrolled in NC Medicaid Direct.