Which NC Medicaid health plan is right for me? What is the latest news on NC Medicaid? More resources for members, families, and providers.

What is Medicaid Transformation

Medicaid Transformation is changing the way people receive Medicaid coverage in North Carolina—in a good way. In 2020, North Carolina will transition to a Medicaid Managed Care model. The services you receive today will still be covered by Medicaid, but they'll be managed under one of two new health plans.

These changes help combine services for mental and behavioral health care, physical health care, and pharmaceutical coverage under one plan. It simplifies how you receive coverage so you can get better and more coordinated care for all of your health needs.

Two new ways to receive Medicaid in North Carolina

The Medicaid Transformation process requires all current recipients to confirm enrollment under one of two health plan options. It also requires all Medicaid recipients to choose a primary care provider. The right choice in health plan and provider will depend on your unique health needs or diagnosis.

Medicaid Managed Care

Standard Plan

A comprehensive health plan for most health services including physical health, behavioral health, and pharmacy. This plan will be managed by commercial health insurance providers like Blue Cross Blue Shield of North Carolina, and others.

Learn more

NC Medicaid Direct

Tailored Plan

A specialized health plan for services currently covered through LME/MCOs. For people who have a mental illness, substance use disorder, IDD, or a TBI that requires specialized services and support.

Learn more

What does this mean for members with services covered by Cardinal Innovations?

Your Medicaid eligibility is not changing, but the organization that covers your Medicaid services may change.

Cardinal Innovations will continue to cover services for our members with mental health, substance use, IDD, or TBI. Enhanced and specialized services for these diagnoses is only available through the LME/MCO system (NC Medicaid Direct).

Did you receive an enrollment letter in the mail?

If you receive an enrollment form for a Standard Plan, you can request to stay in a tailored plan with your LME/MCO by filling out this Beneficiary form. Your provider and/or care coordinator can help you with this form. They can also explain which services are covered by which plan.

If you receive an enrollment form, you can also choose to move to an NC Medicaid Managed Care Standard Plan. Research which Standard Plan is right for you and speak with the enrollment broker and your current providers before December 13, 2019. If you don’t confirm your choice in a health plan by this deadline, your plan could be automatically assigned to you.

Members and families can choose to stay with Cardinal Innovations or their current LME/MCO on the NC Medicaid Plans website, NC Medicaid mobile app, or by calling a Medicaid enrollment broker at 1-833-870-5500 (TTY: 1-833-870-5588).

When does this transformation take place?

On February 1, 2020, the Medicaid Managed Care Standard Plan will go into effect for all North Carolina Medicaid beneficiaries enrolled under this new plan.

Enrollment for the Standard Plan has already begun in certain counties and will open for the entire state October 14, 2019. Enrollment closes December 13, 2019.

If you receive services that are coordinated through an LME/MCO, and you also receive an enrollment letter for a Standard Plan, please speak with your provider or care coordinator about what plan is best for you. 

During the open enrollment period for a Standard Plan, you may choose a primary care provider and pick a health plan that works with that provider. If you don’t choose a provider or don’t choose a plan, one will automatically be assigned to you.

Medicaid recipients can find more help on the Medicaid enrollment website.

Learn more about North Carolina's Medicaid Transformation

For members & families

Call us at 1-833-287-0808 or our 24/7 Access and Crisis line at 1-800-939-5911.

View frequently asked questions

Watch the NC Medicaid Managed Care video

For providers

Enrollment extension for Medicaid open enrollment

A message from our CEO about Medicaid Transformation

North Carolina's data strategy for tailored care management
Explore the following resources to learn more about Medicaid Transformation, enrollment, and the latest news. As NC Medicaid continues to evolve, we’re here to help you find support and stay informed.

Upcoming Events

There are no upcoming Medicaid Transformation events at this time.

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