This means that you will now get care through your health plan. If you have questions about benefits and coverage, call your health plan. You can find the number on your new Medicaid ID card or visit View health plans. You can also contact the NC Medicaid Ombudsman if you have questions or problems your health plan or provider could not answer.
Call or visit ncmedicaidombudsman. The innovative health care system puts the health of consumers who need it most at the forefront and features payment structures that reward better health outcomes. Under this program, Medicaid consumers in the state will receive care from one of five commercial health plans managed by private insurance companies.
A sixth plan that is run by the Eastern Band of the Cherokee will be available for tribal members. This was a fee-for-service FFS structure designed to provide high-value care with predictable costs, but there was a lack of standardization. Over time, the North Carolina General Assembly became frustrated with the inability to accurately predict costs.
There was a large fluctuation in program costs that made it difficult for the state to budget appropriately. Once the legislation was passed in , North Carolina began its transition to managed care.
However, the program was tied up in court for over three years. Aetna, one of the companies that filed a challenge in court, lost out on being awarded the bid by a razor-thin margin in the scoring system implemented by DHHS. The motion requested that the contracts be tossed out and the procurement process started over, due to perceived conflicts of interest.
They argued that the contract award process gave a weighted bias to traditional health insurance companies. My Health is a consortium of major hospital systems in NC that serves over 1 million Medicaid consumers every year.
They argued in court that they are already in the state and familiar with the health needs. They were the highest PLE scorer in the bidding process but still were not awarded a contract. These may have been avoided with better award system design and stakeholder engagement from the start and are something for other states to take note of.
The program launched July 1, , and impacted approximately 1. Cohen, M. The program is designed for care to be managed by primary care providers. This allows the person closest to the patient to manage their care. Primary care providers can also coordinate any necessary mental and behavioral therapy for patients and ask them about social factors that affect their health, like whether or not they have transportation to medical appointments, safe housing, or enough food. North Carolina has resumed the implementation of Medicaid Managed Care, scheduled to launch July 1, More information, including when and how to choose a health plan, will be shared in the future.
Learn more about Medicaid Managed Care. The North Carolina Department of Health and Human Services announced the launch of a new online portal for North Carolinians receiving or looking to apply for Medicaid. The portal provides Medicaid resources in an easy-to-use web platform and includes information about Medicaid Managed Care, set to launch July 1, Children, families, pregnant women and single adults may qualify based on income. View the benefits below to see all that it offers.
This plan is available in all counties. Search for doctors, hospitals and specialists. Find medications covered by this plan. Get the care you need to stay healthy — or to get better if you are injured or sick. Member benefits include:.
Nothing is more important than the health and well-being of a mother and her baby. If you have asthma, diabetes or another long-term condition, you can depend on us. Our plan makes sure you get the care and services you need. Benefits include:. Non-emergency: UnitedHealthcare Community Plan of North Carolina can arrange and pay for your transportation to help you get to and from your appointments for Medicaid-covered care. This service is free to you.
If you need an attendant to go with you to your doctors appointment, or if your child 18 years old or younger is a member of the plan, transportation is also covered for the attendant, parent or guardian.
Non-emergency transportation includes personal vehicles, taxis, vans, mini-buses, mountain area transports and public transportation. How to get non-emergency transportation. Call , TTY up to 2 days before your appointment to arrange transportation to and from your appointment. Non-emergency transportation services via personal vehicles, taxis, vans, mini-buses, mountain area transports and public transportation are provided through our contracted transportation company ModivCare.
You can contact ModivCare to request or cancel a trip by calling Member Services at , TTY and choosing the option for Transportation. Rides for routine appointments should be scheduled at least 2 business days in advance by calling between a.
Rides for urgent appointments can also be made after hours by calling Member Services. Member no-shows: A no-show is when the member does not go to the medical appointment. NC HealthChoice members are not eligible to receive non-emergency transportation services. Sometimes you might need a little extra help using your health plan. For those times, you can rely on:. Behavioral health is as important as physical health. This includes:. Call the Behavioral Health Crisis Line at , at any time, 24 hours a day, 7 days a week.
If you are in danger or need immediate medical attention call Each member can choose a primary care provider PCP. Use the Doctor Lookup tool to see if your doctor is in our network. If you have chronic or high-risk illnesses, our disease management services are designed to support you. Our plan covers medical equipment ordered by your doctor or case manager.
This can include supplies like:. Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you. Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing. And after you leave the hospital, you are not alone.
We make sure you get follow-up care to continue healing at home. After surgery or a serious illness, you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:. You can get information in another language. Just ask. Then anything we write to you will only be in that language. This is provided at no cost to you.
And we make getting your child's medicine easy. We'll provide a list of covered drugs if you have questions about what prescriptions are covered. You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network. Sometimes you might need a little help understanding your health care options. Sometimes continued care is needed after leaving the hospital or urgent care.
For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:. Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.
Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices. Obesity is common and serious. It can also lead to other health problems.
To help our members be their best, our plan includes:. Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:. Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. After a serious illness, surgery or injury you may need extra nursing and therapy.
If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:. If so, we want to support their hard work too. Respite care offers caregivers time away from their loved one who is ill or has special care needs. Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:.
Speech therapy visits and exercises can help those who have difficulty speaking. Each text contains health and safety tips for topics like:. Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential. Our plan does not limit the number the number of times you can see your PCP. This way you get care need when you need it. And your doctor can see how your health is progressing.
You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:. Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:. An online meeting and resource community for pregnant members. Wellhop brings pregnant women together and matches them with clinically trained facilitators in group video conversations for education and support.
Well visits with your doctor are important for good health. Laboratory partners continue to maintain capacity to process tests quickly. The bulk of testing is supplied through pharmacies, retailers and private companies.
Hundreds of community-based events, testing locations and home kit options are listed at ncdhhs. If you know you need an appointment, book one in advance. Explore additional locations if your preferred location is busy.
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