Standard plans provide integrated physical health, behavioral health, pharmacy and long-term services and support to most Medicaid beneficiaries, as well as other programs and services that address unmet health-related resource needs
FAQ Category: Uncategorized FAQ
Tailored Plans are a new kind of NC Medicaid Managed Care health plan. They start July 1, 2024. Tailored Plans cover your physical care, prescription drugs, and services for serious mental illness, severe substance use disorders, intellectual/developmental disabilities (I/DD) and traumatic brain injury (TBI) in one health plan. Tailored Plans will also serve people on […]
Some people can change their health plan at any time. You can change your health plan at any time for these reasons: * You need services to address a mental health disorder, substance use disorder, intellectual/developmental (I/DD) or traumatic brain injury (TBI) * You are a federally recognized tribal member or qualify for services through […]
You can call us at 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday except for State holidays. We do our best to answer every call, but if we are unable to answer, please leave a message with your name and phone number. We’ll call you back by the next business day. You can […]
The NC Medicaid Ombudsman is contracted by the State of North Carolina but operates as an independent organization serving as a resource to Medicaid beneficiaries.
The NC Medicaid Ombudsman cannot provide legal advice or represent you in your appeal. However, if you have already talked with your health plan and were not able to resolve your issue, we can contact your health plan to try to resolve your issue informally. For example, we can give your health plan new information, […]
We will start by asking your name, how to reach you, what county you live in and what health plan you are enrolled in (or trying to enroll in). We will ask you if you have attempted to resolve your issue directly with the entity at issue. We will then ask you for other information […]
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 […]
Under Medicaid Managed Care, the new health plans must provide non-emergency medical transportation (NEMT) services for all Medicaid eligible individuals who need and request assistance with transportation. Health plans may use transportation brokers to arrange and provide transportation or contract directly with transportation providers. For beneficiaries in NC Medicaid Direct and the Eastern Band of […]
You can change your health plan for up to 90 days after the start date shown on your health plan enrollment letter. After 90 days, you must wait until your next recertification date to change health plans unless you have a special reason. You can change your health plan at any time for these reasons: […]
