What problems can NC Medicaid Ombudsman help address?

The Ombudsman can help with these issues and more if you have been unable to resolve them by working with your health plan or the Enrollment Broker:

Enrolling in a health plan, if:

  • You think you should not have to enroll in a health plan
  • You have trouble enrolling in a health plan
  • You can’t find any health plan that includes the doctors you need to see
  • The State has denied your request not to enroll in a health plan

Accessing care, if:

  • You can’t continue getting the services you are getting now
  • Your health plan denies care that you need
  • Your health plan won’t cover services from a provider who is not in your health plan’s network, when the service is not otherwise available
  • It takes too long before you can get the care you need
  • Your plan says you have to travel too far to get the care you need
  • You have trouble getting transportation to your doctor appointments
  • You need services for behavioral health or an intellectual/developmental disability your health plan won’t cover

Changing care, if:

  • You have problems changing to a different health plan
  • You have problems changing to a different primary care provider

Experience barriers to care and coverage, if:

  • You can’t access material or information in your preferred language
  • You feel a health plan, provider or enrollment representative has discriminated against you

The NC Medicaid Ombudsman can also help you understand information you receive, explain your rights, and connect to the right people at health plans and the Enrollment Broker.