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North Carolina Medicaid

Tailored Plans

Tailored Plans are designed to provide specialized health and medical services for Medicaid members with specific needs.

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Medicaid health coverage includes no-cost or low-cost doctor visits, annual wellness visits, emergency care, dental care, behavioral health and more. NC Medicaid saw 2 big changes recently: recertification (or renewal) and expansion.

Recertification

During the COVID-19 pandemic, Medicaid participants were automatically re-enrolled instead of having to reapply each year, but that has ended. Since April 2023, participants have to renew their eligibility. If the state has questions, it will try to contact participants by mail, email or text. Anyone who does not respond to the state’s request for information within 30 days will lose their benefits (although they can reapply).

Steps you can take today include:

  • Make sure your mailing address and other contact information are up to date.
    With an enhanced ePASS account, you can update your address and other information for Medicaid online without having to call or visit your local Department of Social Services (DSS) office. Sign up for an ePass account.
  • Check your mail
    DSS will mail you a letter if you need to complete a renewal form.
  • Complete the renewal form
    If you receive a renewal form, fill it out and return it within 30 days to help avoid a gap in Medicaid coverage.

Find your local DSS office.

Expansion

North Carolina Medicaid expansion went into effect December 2023, and it now covers people ages 19-64 with higher incomes than previously allowed. Even if you did not qualify before, you might be able to get health coverage through Medicaid if you:

  • Live in NC
  • Are between ages 19-64
  • Are a US citizen (there are some exceptions)
  • Have a household income up to 138% of federal poverty line (for example, a single person making approx. $20,000/yr, or a family of 3 making approx. $34,000/yr)

The best way to apply is online through ePASS, but you can apply in person, by phone or by mailing an application. The processing time for applications can be up to 45 days. Applications submitted online may be processed faster.

To find out if you are eligible or to apply, visit Medicaid.NC.gov.

How do I know if my Atrium Health doctor is in an NC Medicaid health plan?

Atrium Health doctors and hospitals in the Charlotte Metro Area are in all NC Medicaid health insurance plans:

If you have any questions, please contact your health plan.

 Important: If you have a medical emergency, go to the closest hospital emergency room. Atrium Health hospitals provide services to all patients seeking treatment for an emergency medical condition, regardless of what health insurance plan you have or if you can pay for emergency services.

Frequently Asked Questions

Medicaid covers mandatory benefits plus services North Carolina has added for its citizens. Benefits may be different depending on age, income and health care needs. In general, Medicaid may cover the following services:

  • Doctor visits, including OB/GYNs, health departments and rural health clinics
  • Emergency care
  • Lab tests and X-rays
  • Hospital/surgical center services, including anesthesia
  • Prescriptions
  • Vision and hearing
  • Dental services
  • Mental and behavioral health
  • Medical equipment, such as wheelchairs

Medicaid beneficiaries were not required to renew their coverage during the COVID-19 Public Health Emergency (PHE). The COVID-19 Public Health Emergency ended in May 2023.

This means Medicaid patients must regularly renew their eligibility for Medicaid coverage. The recertification (renewal) process started April 2023. Some people may no longer have coverage. For other people, benefits may change.

Don’t miss a request for information. You could lose your benefits and not know it. The best way to prevent that is to make sure your contact information is correct in ePass or at your local Department of Social Services office.

If you are no longer eligible to receive Medicaid benefits, you can enroll in a health plan through the Affordable Care Act’s Health Insurance Marketplace®. Choosing a plan can feel overwhelming but having coverage protects you from very high, unexpected medical costs.

Atrium Health is proud to work with the most affordable1 Health Insurance Marketplace plans to provide quality coverage with access to a level of care you won’t find anywhere else.

Take time to compare your options and make sure to choose a plan that includes Atrium Health doctors and hospitals.

Learn more

1Based on 2024 Silver/bronze, age 50 rating, regions 4 and 5.

There are 4 ways to apply:

  • Online: Apply online at ePass.
  • Phone: Call your county’s Department of Social Services (DSS). Find your local agency online or by calling the NC Medicaid Contact Center at 888-245-0179.
  • Mail, email, fax or drop off: Fill out a paper application and send it to or drop it off at your local DSS agency. Get a copy of the paper application.
  • In person: Apply in person at your local DSS.

Call your local DSS if you cannot apply one of these ways. See a list of local DSS locations.

Learn more about how to apply for NC Medicaid.

ePASS is a way to apply for benefits and services, view case details and renew your Medicaid in North Carolina. New applicants and existing beneficiaries can create an account.

  • A recent move or change of address
  • If you are pregnant or your household size has changed
  • A new job or a change in income

If there have been no changes to your personal information, no action is needed.

Find your local DSS office

Most people can change their health plan within 90 days of health plan enrollment.

When you enroll in a health plan, you can change your health plan for any reason within 90 days. After that, you can change your health plan:

  • At your Medicaid recertification date
  • If you are required to change health plans
  • If you have a special or “with cause” reason, such as:
    • You moved out of your health plan’s service area
    • You have a family member in a different health plan
    • You cannot get all the related services you need from providers in your health plan, and there is a risk to getting the services separately
    • A different health plan may be better for your complex medical conditions
    • Your Long-Term Services and Supports (LTSS) provider is not in your health plan
    • Your health plan does not cover a service you need for moral or religious reasons
    • Other reasons (poor quality of care, lack of access to covered services, lack of access to providers experienced in dealing with your health care needs)

If you want to change your health plan outside of the 90 days, you can request to change your health plan in one of the following ways:

NC Medicaid will send you a letter telling you when you can choose a new health plan without a special reason. To learn more, call at 833-870-5500 (TTY: 711 or RelayNC.com) or use the NC Medicaid chat tool to chat online.

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 disability (I/DD) or traumatic brain injury (TBI)
  • You are a federally recognized tribal member or qualify for services through Indian Health Service (IHS)

To change your primary care provider (PCP) within your current health plan’s provider network, please contact your health plan. Below are the health plans and their contact information.

 
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