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.
FAQ Category: Uncategorized FAQ
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: […]
Each health plan has its own set of doctors and health care providers, who make up its network. Most people were able to keep their same doctors when moving to managed care. The NC Medicaid Managed Care website also features a provider search tool that will tell you which health plans your providers have joined, […]
AmeriHealth Caritas (offered statewide) 855-375-8811 (TTY: 866-209-6421) 24 hours a day, seven days a week amerihealthcaritasnc.com Carolina Complete Health (only available in certain regions of the state) 833-552-3876 (TTY: 711) 7 a.m. to 6 p.m., Monday through Saturday carolinacompletehealth.com Healthy Blue (offered statewide) 844-594-5070 (TTY: 711) 7 a.m. to 6 p.m., Monday through Saturday HealthyBlueNC.com […]
The same services will continue to be covered. However, the doctors you can go to will be based on the health plan’s provider network. Your Medicaid copays will not change.
Each Standard health plan works with a network, or group of doctors, hospitals and other health care providers. You should choose a health plan that will let you keep going to your doctors and other health care providers. All health plans offer the same basic benefits and services. Some may also offer added services. When […]
