Effective July 1, 2021, NC Medicaid Transitions to Managed Care

The majority of North Carolina Medicaid members have selected or been automatically assigned to a managed care plan effective July 1. This means Medicaid members will need to use doctors and hospitals that are in network with their managed care plan.

At this time, WakeMed is participating with these Medicaid managed care plans:

• WellCare of North Carolina
• Carolina Complete Health, Inc.

We continue discussions with the other three Medicaid managed care plans available in our area. If we sign an agreement and become an in network provider with these other plans, we will post this information on our web site at www.wakemed.org/insurance.

What this Means for Medicaid Patients

• Emergency services are covered regardless of Medicaid managed care plan at any emergency department.
• Patients will be required to seek non-emergency care from specific doctors, hospitals and health care organizations that are in-network with their Medicaid managed care plan.
• WakeMed must get prior authorization to be paid for almost all services. If WakeMed is out of network, it is unlikely that we will receive authorization. This means patients may not be able to receive non-emergency care from WakeMed hospitals and providers.
• While our hospitals and emergency departments are in-network with the two plans listed above, not all of our physician practices accept Medicaid. Patients should contact their health care providers’ office before scheduling an appointment to confirm your Medicaid plan is accepted.

Out of Network with WakeMed? Consider Changing Plan Enrollment

If a patient is out of network and wishes to continue using WakeMed services and providers for non-emergency care, they should consider changing enrollment to one of the Medicaid managed care plans WakeMed is in network with. This will help reduce any confusion and potential disruptions to care.

According to NC Medicaid guidelines, Medicaid members have until September 30, 2021, to change their plan enrollment. We recommend making this change as soon as possible to ensure continued access to care at WakeMed.

How to Change Plan Enrollment

Visit, https://ncmedicaidplans.gov/enroll and follow the step-by-step process. If you don’t have internet access, you can call a Medicaid Enrollment Broker to enroll. The call is toll free. Phone: 1-833-870-5500 (TTY: 1-833-870-5588). Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday.