Frequently Asked Questions

Carolina Complete Health is a provider-led Medicaid Managed Care health plan, providing coverage to pregnant women, families with children, the elderly, adults with disabilities, and children with disabilities in Regions 3, 4, and 5. View the Carolina Complete Health coverage map.

An MCO is an insurance company that contracts with providers and medical facilities to provide health care services to its members.

Carolina Complete Health’s Benefits include provider/doctor visits, hospital coverage, preventive services, prescription drug coverage, and more.  A more comprehensive listing of Benefits is included in the Member Handbook that is posted on this website. Carolina Complete Health also offers members Value Added Services.

In addition to meeting certain income levels, applicants must meet specific eligibility requirements to receive Medicaid coverage. Eligibility for programs and services is determined by the Department of Health and Human Services (DHHS). For more information on North Carolina Medicaid eligibility, please contact the DHHS Contact Center at 1-800-662-7030.

No. There is no cost to enroll in Carolina Complete Health. Some members may pay minimal copayments for provider/doctor visits, emergency room care, and prescriptions.

No. Your Medicare services and providers/doctors will stay the same. It’s the responsibility of your Medicaid MCO to coordinate your services with your Medicare Primary Care Provider/Doctor.

Ask your providers/doctors if they are contracted with Carolina Complete Health. You can check the Find a Provider tool on our website to view our online Doctor/Provider Directory or consult our Provider Directory. If you have questions about our doctors, contact Carolina Complete Health Member Services at 1-833-552-3876 (TTY: 711).

Yes. You can change your Primary Care Provider/Doctor at any time.

You do not need a referral from your primary care provider for an office visit with any in-network specialist but it is important that your primary care provider is aware of any specialist you are seeing so they have a full view of your health and can help you coordinate care. If you would like additional information, you may contact Carolina Complete Health Member Services at 1-833-552-3876 (TTY: 711).

The “Community Benefit” is the name given to a set of services that help to keep people in their homes and communities. Some of these services include adult day health, respite care, and personal care services.

Yes. More North Carolinians will be able get health care coverage through Medicaid. Beginning December 1, 2023, NC Medicaid will cover people aged 19 through 64 years with higher incomes. Many North Carolinians who did not qualify for health coverage through NC Medicaid before, may soon qualify.

Health coverage through Medicaid is comprehensive. Because these services are covered by Medicaid, they are provided at no cost or low cost to you. Services include, but are not limited to:

• primary care so you go to a doctor for a check-up or when you are not feeling well
• hospital services when you need to stay overnight (inpatient) or when can go home the same day (outpatient)
• maternity and postpartum care if you are pregnant and after giving birth
• vision and hearing services
• prescription drug benefits
• behavioral health
• preventative and wellness services
• devices and other therapies

Beginning December 1, 2023, more North Carolinians will be able to get health coverage through NC Medicaid.

Most people can get health care coverage through Medicaid if they meet the criteria below. If you were eligible before, you still are. Nothing changes for you.

Eligibility criteria:

• You live in North Carolina
• Age 19 through 64
• You are a citizen. Some non-US citizens can get health coverage through NC Medicaid. (Answered separately.)
• And if your household income fits within the chart below:

The best way is to apply online through ePASS - a secure, self-service website at ePASS.nc.gov. When you apply online, you can avoid having to go in person to your local Division of Social Services (DSS) office. It’s also faster and you can access the site at any time. If you can’t apply online, you can apply in person at your local DSS office, by calling your local DSS office or by mailing in a paper application available at ncgov.servicenowservices.com. To find your local DSS office, go to ncdhhs.gov/divisions/social-services/local-dss-directory.

You can also apply for services:

By Phone:

DHHS Contact Center at 1-800-662-7030

It may take up to 45 days after you apply. It will take less time to process your application if you have provided all the required information. If your application is incomplete or we need more information, you will hear from your local DSS office requesting additional information. You may be contacted by mail, phone, email and/or text message, so it is important to make sure your contact information is up to date and complete to make sure that your caseworker can reach you.

Some non-US citizens can get health coverage through Medicaid. To be eligible you must be:

• A person living in North Carolina
• A qualified non-citizen for at least five years
  • This means a person must wait five years after receiving “qualified” immigration status before they can get Medicaid.
  • There are exceptions. For example, refugees, asylees, or lawful permanent residents who used to be refugees or asylees don’t have to wait five years.

Non-citizens without documents who do not qualify for full health coverage under Medicaid may be able to get temporary coverage for emergency conditions that need to be treated in an emergency room.

If you currently have full Medicaid coverage, nothing will change for you.

You do not have to pay any monthly premiums. Medicaid pays the cost for most health care services. The highest copay is $4 and that is only required for some services.

Everyone who qualifies under the new rules will get their health coverage through a Standard Plan, NC Medicaid Direct, Tribal Option, or through Tailored Plans in the future, depending upon their individual needs, just like other Medicaid beneficiaries.

No. Some people who have Medicare coverage may be eligible for other existing Medicaid programs. For example, people who are disabled and are age 64 and under may be eligible for Medicaid through disability coverage.

Yes. You may qualify for subsidized health coverage offered on HealthCare.gov. Contact a North Carolina health insurance navigator for enrollment assistance. Community health centers also provide low-cost care through a sliding scale based on one’s income and insurance status.

Yes, people already enrolled in Medicaid’s limited Family Planning program who are eligible will be automatically moved to full Medicaid expansion benefits. Those who are eligible for full Medicaid benefits will receive communication in the mail from the state informing them that they enrolled in full Medicaid benefits and a new Medicaid insurance card that they can use to access health care services.

You will get a letter from the NC Department of Health and Human Services letting you know that you will start getting full Medicaid coverage. You will then be assigned a health plan. If you want to change your health plan, you have 90 days to pick a new one. Your health plan will send you a packet in the mail. It will include a new Medicaid ID card. Your ID card also has the name of your primary care doctor. You can change your doctor through your health plan. Medicaid will pay for doctor visits, yearly check-ups, emergency care, mental health services and more – at little or no cost to you.

Yes, if eligible for full Medicaid benefits, you will receive communication in the mail from the state informing you that you were enrolled in full Medicaid benefits and a new Medicaid insurance card that you can use to access health care services.

Some people may have income that exceeds the Medicaid eligibility levels. If your income has recently changed and you think you may be eligible, update your information in ePASS (epass.nc.gov) or by contacting your local Department of Social Services (DSS). Also, please use ePass or contact your local DSS office to make sure your contact information is up to date so that you do not miss important information about your benefits.

Federal law allows states to expand who can get health coverage through Medicaid, known as Medicaid expansion. Since 2014, 40 states and Washington, DC have expanded Medicaid.

Research shows that expanding Medicaid coverage increases access to health care, improves health outcomes, creates jobs and strengthens the economy. It means that people with low incomes can work, earn more and keep themselves healthy. Expansion is also good for the state. Other states that have expanded Medicaid have increased state revenues, created jobs and saved state funding. It has also helped prevent rural hospitals from closing. Most people who qualify for Medicaid under these new rules are working adults in important service industries across the state. Keeping them healthy keeps them on the job.

Everyone benefits when more people have access to affordable health care and can live healthier lives. Taxpayers will also benefit because federal funds will help the state cover more people, keep our health systems strong and reduce the cost of care.

Yes. In states that have expanded Medicaid, suicide rates decreased and access to substance use disorder treatment increased. About 2 million North Carolinians will experience a mental illness and substance use disorder. In 2019, more than 55% of people who needed treatment did not receive it because of cost. Untreated mental illness can lead to homelessness, involvement in the justice system and trauma to children.

Many hard-working people can finally afford to take care of their health while providing for their families. Most of those who don’t have insurance are working people with low incomes in important service industries and small businesses. By raising income limits so more people are eligible for Medicaid, more people can work without losing their healthcare coverage. Medicaid expansion also helps more people with disabilities enter the workforce because without it, many people with disabilities must live in poverty to maintain their Medicaid eligibility. Medicaid expansion can build a healthier workforce for businesses like childcare, restaurants and the service industry by helping more employees have access to affordable health insurance.