NC Medicaid Managed Care deadline to change health plans is 9/30

Press release from Pisgah Legal Services 

As a community resource for North Carolinians who depend on Medicaid, Pisgah Legal Services reminds those with Medicaid Managed Care health plans that the deadline to change plans is Sept. 30, 2021.

Medicaid beneficiaries who selected, or were auto-enrolled in, health plans can change their plan for any reason by the Sept. 30 deadline online at ncmedicaidplans.gov or by calling the NC Medicaid Enrollment Broker at 833-870-5500. After Sept. 30, 2021, beneficiaries will have to wait until their Medicaid recertification date or have a qualifying reason to change health plans.

Those who are having difficulty understanding their health plan or how to change it can always contact the NC Medicaid Ombudsman for help online at ncmedicaidombudsman.org or by calling 877-201-3750.

Pisgah Legal Services Managing Attorney Anne Salter says, “This year, North Carolina moved to a new ‘managed care’ model of providing Medicaid care. We want people in Western North Carolina to know that they have rights, and that if they are having issues with their care or if they need help, they should reach out to the NC Medicaid Ombudsman, especially before the September 30 deadline.”

The option to change health plans is part of a major change in the way Medicaid beneficiaries receive health care called Medicaid Transformation, the NC Department of Health and Human Services’ move from fee-for-service delivery to managed care. Under managed care, the State contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide health services. During the spring, most Medicaid beneficiaries enrolled, or were auto-enrolled, in health plans. These health plans went into effect July 1, 2021. Beneficiaries can change their health plan for any reason by Sept. 30, 2021.

After the Sept. 30 deadline, beneficiaries can only change their plans at their Medicaid recertification date, or for a qualifying reason such as they moved out of the health plan’s service area or they have a family member in a different health plan. Beneficiaries can also change plans if their current health plan cannot provide all the related services they need, or they have complex medical conditions. A list of acceptable circumstances appears under “Can I change my health plan after I enroll?” on ncmedicaidplans.gov/learn/get-answers.

Pisgah Legal Services works to increase health care access for those in need by helping them enroll in Medicaid and other low-cost health insurance options, and by providing legal representation in cases of discrimination, denial of health care or denied/reduced/terminated access to services.  During the transition to Medicaid Managed Care, Pisgah Legal Services has referred many of their clients to the NC Medicaid Ombudsman for education, guidance and advocacy to ensure they have access to the health care and services they need.

NC Medicaid Ombudsman empowers Medicaid beneficiaries to maximize their coverage and access high-quality health care. The organization helps advocate for Medicaid beneficiaries who are not getting the care they need. The statewide network of ombudsman professionals provides Medicaid beneficiaries with guidance when they have not been able to resolve their issues by working with their health care provider or health plan. NC Medicaid Ombudsman educates individuals about their rights under managed care and answers their questions about the complaint or appeal process. Learn more at ncmedicaidombudsman.org.

Since 1978, nonprofit Pisgah Legal Services has provided free civil legal aid to help people with low incomes seek justice and meet their basic needs including preventing homelessness, stopping domestic violence and securing health care. PLS provides a broad array of free legal services in 11 WNC counties and offers immigration and ACA health insurance assistance in 18 counties. Last year PLS served more than 20,000 people across the mountain region.

PLS has offices in Asheville, Burnsville, Brevard, Hendersonville, Highlands/Cashiers, Marshall, Newland, Rutherfordton and Spruce Pine. Pisgah Legal employs staff attorneys and relies heavily on the pro bono legal services of approximately 300 volunteer attorneys. For more information visit www.pisgahlegal.org.