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?



View or download the Transition of Care: What to Expect infographic

Medicaid Transformation is changing the way people receive Medicaid coverage in North Carolina—in a good way. In 2021, North Carolina will begin the 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 types of health plans.

These changes help combine services for 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 your overall health needs.

Your Medicaid eligibility is not changing, but the organization that covers your Medicaid services may change in the future depending on your needs.
 

Two ways to receive Medicaid in North Carolina

The Medicaid Transformation process will require all current Medicaid recipients to confirm enrollment under one of two health plan options: Tailored (NC Medicaid Direct with an LME/MCO like Cardinal Innovations) or Standard (Medicaid Managed Care). This process will also require 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.

Tailored Plan

NC Medicaid Direct

A specialized health plan for services currently covered through LME/MCOs. For people who have a mental illness, substance use disorder, intellectual and/or developmental disability (IDD), or a traumatic brain injury (TBI) that requires specialized services and support.

Call 833-580-1965 to learn about how Cardinal Innovations can help you.

Standard Plan

Medicaid Managed Care

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 about Standard Medicaid Managed Care benefits.

What does this mean for members covered by Cardinal Innovations?

Today, most Medicaid recipients receive coverage directly from the state of North Carolina or receive behavioral health or IDD coverage from an LME/MCO, like Cardinal Innovations.

If you are currently an Innovations Waiver member, your services and coverage are not changing—you will stay with your current LME/MCO.

Cardinal Innovations will also continue to cover services for its members with serious mental health conditions, severe substance use disorders, intellectual and developmental disabilities, or traumatic brain injury.
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When does this transformation take place?

On July 1, 2021, the Medicaid Managed Care Standard Plan will go into effect. In 2022, the new NC Medicaid Direct Tailored Plan will go into effect.

Again, if you’re under an LME/MCO plan with Cardinal Innovations (or another LME/MCO), you will stay on the same plan. It will just officially be known as the NC Medicaid Direct Tailored Plan moving forward.

All Medicaid recipients can find more help about Medicaid Transformation on the Medicaid enrollment website or by calling 1-833-870-5500.

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What should providers know?

Are you a provider who accepts Medicaid? All health providers enrolled in Medicaid are still part of the program and will continue to bill the state through NCTracks. Providers should continue to work with their health plans as the Medicaid Transformation takes place.

Learn more about the Crossover to NC Medicaid Managed Care for LME-MCO Providers.

Learn more about North Carolina's Medicaid Transformation

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.

Contact the NC Medicaid Contact Center at 1-888-245-0179 for more information regarding Medicaid eligibility and Medicaid Transformation.

Upcoming Training

View any upcoming Medicaid Transformation events and trainings on our events calendar.

What's next?

For the latest updates, please continue to check this page and our News page.

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