What are my rights under NC Medicaid Managed Care?

You have the right to:

  • Get free advice over the phone from the NC Medicaid Enrollment Broker Call Center, where someone can inform you whether you have to enroll in a health plan, and help you decide which health plan is the best choice for you and your family.
  • Get information in your preferred language for free.
  • Switch health plans for any reason within 90 days of being enrolled. After 90 days, unless you have a special reason, you must wait until your next NC Medicaid recertification date to change health plans.
  • Choose a health plan or stay in NC Medicaid Direct if you require services to address a developmental disability, behavioral health, traumatic brain injury or substance abuse disorder.
  • Continue to receive the same NC Medicaid coverage and services you receive now.
  • Get care from a provider outside your health plan’s network if medically necessary services are not available in the health plan’s group of providers.
  • Receive care without interruption when transitioning between health plans or into or out of managed care.
  • Ask for an appeal from your health plan if they deny, reduce or stop coverage for health care you need.