Medicaid Eligibility Information
Types of NC Medicaid Include:
Standard Plans are integrated health plans that provide:
• Physical health, pharmacy, care coordination and basic behavioral health services.
• Added services, such as wellness programs.
Standard Plans have a provider network that includes doctors, therapists, specialists, hospitals and other health care facilities to provide health care services to their members.
Standard Plan benefits or to change your primary care provider (PCP): Call your Standard Plan:
• WellCare: 1-866-799-5318 (TTY: 711)
• UnitedHealthcare Community Plan: 1-800-349-1855 (TTY: 711)
• HealthyBlue: 1-844-594-5070 (TTY: 711)
• AmeriHealth Caritas: 1-855-375-8811 (TTY: 1-866-209-6421)
• Carolina Complete Health: 1-833-552-3876 (TTY: 711 or 1-800-735-2962)
NC Medicaid Direct is North Carolina’s health care program for Medicaid beneficiaries who are not enrolled in a health plan or EBCI Tribal Option.
Beneficiaries in NC Medicaid Direct receive care management from two entities:
• Community Care of North Carolina (CCNC) provides care management for physical health services
• Six Local Management Entity/Managed Care Organizations (LME/MCOs) coordinate services for mental health and substance use disorders, I/DD or TBI and Tailored Care Management (TCM)
Beneficiaries may receive physical health services from all NC Medicaid-enrolled providers and behavioral health, I/DD, substance use disorder and waiver services from providers contracted with their LME/MCOs.
To change your PCP if you are in NC Medicaid Direct: Call the NC Medicaid Contact Center at 1-888-245-0179
Plans will provide the same services as Standard Plans but will provide additional services that serve individuals with serious mental illness and substance use disorders, I/DDs and TBIs as well as people using State-funded Services. The plan is responsible for managing two of the State’s Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waivers: the NC Innovations waiver for individuals with I/DD and the TBI waiver. TAILORED PLAN SERVICE AREA
Your Local Management Entity/Managed Care Organization (LME/MCO) or Tailored Care Management (TCM): Call your LME/MCO:
• Alliance Health: 1-800-510-9132 (TTY: 711 or 1-800-735-2962)
• Partners Health Management: 1-888-235-4673 (TTY: 1-800-735-2962)
• Trillium Health Resources: 1-877-685-2415 (TTY: 711)
• Vaya Health: 1-800-962-9003 (TTY: 711)
NC Medicaid may help pay for:
Doctor bills, Hospital bills, Prescriptions (excluding Medicare beneficiaries), Vision care, Dental care, Medicare premiums, Nursing home care, Personal care services (PCS), medical equipment, and other home health services.
Frequently Asked Questions
You can apply online through ePASS — a secure, self-service website at ePASS.nc.gov. You can also apply online by completing a general health insurance application on HealthCare.gov. When you apply online, you can avoid having to go in person to your local Department of Social Services (DSS) office. If your application is complete, it may be processed faster. If you cannot apply online, you can apply in person at your local DSS office, by calling your local DSS office or by mailing, emailing or faxing in a paper application available at medicaid.nc.gov/print-application. To find your local DSS office, go to ncdhhs.gov/localDSS.
It may take up to 45 days after you apply. Incomplete applications may take longer. If your application is incomplete or we need more information, you will hear from your local DSS office requesting additional information. You may be contacted by mail, phone, email and/or text message, so it is important to make sure your contact information is up to date and complete so your caseworker can reach you. You will receive a letter in the mail that will tell you if you are approved or denied. Authorized Representatives will receive the same communication.
It takes time to complete the application. Here is some of the information you will be asked to provide for each person applying:
- Full legal name
- Date of birth
- Social Security number (or immigration documents)
- North Carolina residency
- Income information (from paystubs, W-2 forms, tax returns or business records) North Carolina uses external resources to verify the information you provide. If more information is needed, you will receive a letter in the mail from your local DSS
Health coverage through Medicaid is comprehensive. Because these services are covered by NC Medicaid, they are provided at no cost or low cost to you. Services include, but are not limited to:
- Primary care so you can go to a doctor for a check-up or when you are not feeling well
- Hospital services when you need to stay overnight (inpatient) or when you can go home the same day (outpatient)
- Maternity and postpartum care if you are pregnant and after giving birth
- Vision and hearing services
- Prescription drug benefits
- Behavioral health
- Preventive and wellness services
- Dental and oral health services
- Medical-related devices and other therapies
Call your local Department of Social Services (DSS). To find your local DSS, use this directory or call the NC Medicaid Contact Center at 1-888-245-0179 (TTY Relay Services: Call 711) to find the DSS closest to you. Help is available in other languages.