RHA Health Services - NC Start

Understanding North Carolina Medicaid Transformation

NC DHHS Sending Letters on Medicaid Managed Care Suspension to 900k Beneficiaries

On December 6, 2019, NC Department of Health & Human Services (DHHS) began mailing notices to over 900,000 Medicaid beneficiaries.

For now, North Carolina will not change Medicaid to Managed Care. You will keep getting your Medicaid services from the State the way you do now. Your coverage will stay the same. You can go to the primary care provider (PCP) you have now. You do not need to choose a health plan.

Learn more at ncmedicaidplans.gov.

NC Medicaid Transformation Put on Hold

November 19, 2019

NC Medicaid Transformation has been put on hold by the NC Department of Health and Human Services.  As facts and timelines become more clear, we’ll work to keep the people we support and our community partners updated.  Read the NCDHHS announcement

Get Help Enrolling In A NC Medicaid Standard Plan

Visit ncmedicaidplans.gov  or call 1-833-870-5500 (TTY: 1-833-870-5588)

NC Medicaid Transformation Fact Sheet – English

NC Medicaid Transformation Fact Sheet – Espanol


What is Medicaid Transformation?

– The intent of North Carolina Medicaid Transformation is an effort to provide more ‘whole-person’ care that includes physical and behavioral health.
– All while offering services in as cost-effective way as possible.
– Medicaid services will be delivered in a new way – through a health insurance plan that Medicaid participants will need to sign up for.
– Participants will need to sign up for a Standard Plan in 2019/20 OR a Tailored Plan (2021/22 estimate).
– Participants currently receiving more specialized behavioral health (including services for people with intellectual and/or developmental disabilities) will continue receiving services coordinated by their current North Carolina LME/MCO, and will sign up for a Tailored Plan when they become available.

Keep reading to learn more about plans, enrollment windows, help through an enrollment broker, and more.

Will Your Services With RHA Be Impacted?

– Our goal is that you are not impacted.  RHA is working diligently to ensure you will still receive the same high-quality services and supports that you do today, regardless of your insurance.
– RHA is working to be an approved provider for all NC Medicaid insurance plans.
– As of mid-July 2019, RHA Health Services may not be showing up as an approved provider when you contact the Enrollment Broker.  This is because agreements with these health plans are not yet finalized.

Standard Plans vs. Tailored Plans

Click to view 2-page printable overview of NC Medicaid Transformation, Standard Plans and Tailored Plans
Click image to view 2-page printable overview

Standard Plans:  Enrollment Suspended Until Further Notice
– The Standard Plan covers physical health, as well as some basic behavioral health services and will cover ~1.6 million Medicaid managed care beneficiaries.

Tailored Plan: Starting in 2021
Tailored Plans will cover specialty behavioral health (including intellectual/developmental disabilities) services in future years.
– Tailored Plans, designed for certain populations with more specialized behavioral health needs, won’t be available for a few years.
– For a list of services available in the future Tailored Plans, view the Frequently Asked Questions – PHP member enrollment (PDF).
– For now, these services will be coordinated by your current North Carolina LME/MCO.

Sample Enrollment Packet Mailed to NC Medicaid Beneficiaries

Below are items in the NC Medicaid Beneficiaries Packet, mailed to beneficiaries.
Scroll down for specific enrollment windows, depending on which county you live in.
Enrollment packets include:
Mandatory Notice – Letter explaining change, beneficiaries covered, and enrollment tips
Information Sheet – Covers steps beneficiaries should take
– Enrollment Form SAMPLE – A SAMPLE enrollment form
Comparison-Chart – Shows information on the 4 different health plan options

NC Enrollment Broker and How it Works for Medicaid

NC Medicaid held a statewide webinar (view the Recording or the Presentation slides) on Tuesday, June 25, 2019, 1-2:30 p.m. regarding the NC Enrollment Broker Maximus, who will be helping with the implementation of Medicaid Managed Care.  Topics covered in the webinar include:
The NC Medicaid Managed Care transition and its impact on beneficiaries
– The timeline for open enrollment for Standard Plans and what to expect in terms of communication to beneficiaries
– How you can partner with the Enrollment Broker to educate beneficiaries.

Enrolling in a Standard Plan

What Is The Open Enrollment Window to Select A Standard Plan?

ALL Regions 1, 2, 3, 4, 5 and 6 | Enrollment Suspended Until Further Notice

– If beneficiaries doesn’t enroll, they will be auto-assigned to a plan.

Prepaid Health Plan (PHP) Enrollment Letters

– Frequently Asked Questions – PHP member enrollment (PDF)
– Understand letters sent to NC Medicaid members.  This letter should tell you whether you are qualified on the Standard Plan or the Tailored plan.
– Contact info for Maximus, company responsible for helping members select and enroll in a health plan
– Guidance in choosing the right plan for you
– List of services covered: 1) Exclusively by Tailored Plans or 2) Covered by BOTH Standard Plans and Tailored Plans

3 Important Steps For Persons Receiving Services

If you currently receive NC Medicaid, you will receive communications to walk you through 3 steps:
1) Choose your Primary Care Provider (family doctor clinic, etc.) for each NC Medicaid member
2) Choose a Health Plan (you can pick a plan that your current doctor works with)
3) Enroll online, by phone or mail.

3 Way To Enroll in a Standard Plan

1) Online – Visit ncmedicaidplans.gov  – Learn | Choose | Enroll.  Use the NC Medicaid Managed Care mobile app. To get the free app, search for NC Medicaid Managed Care on Google Play or the App Store.
2) Call 1-833-870-5500 (TTY: 1-833-870-5588)
3) Mail the enrollment form in the envelope that came in your initial letter, or fax it to 1-833-898-9655

Other Resources


Information On This Page Supplied by our North Carolina Partners, including

NC Department of Health & Human Services
i2i Center for Integrative Health
North Carolina Providers Council

North Carolina LME/MCO Partners, including:
Vaya Health
Cardinal Innovations Healthcare Office
Partners Behavioral Health Management Office
Alliance Health Office
Sandhills Center Office
Trillium Health Resources Office
Eastpointe Office

Disagree with a Decision Related to Your NC Medicaid Care?

Get free legal assistance by contacting one of the following organizations:

Disability Rights NC
(Statewide for persons with disabilities)

Legal Aid of NC
(Statewide except counties served by Charlotte and Pisgah Legal groups below)
1-866-219-LANC (5262)

Charlotte Center for Legal Advocacy
(Cabarrus, Mecklenburg, and Union counties)

Pisgah Legal Services
(Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, and Yancey counties)

Translate »