Which Medicaid managed care plans do home care agencies contract with in North Carolina?

North Carolina delivers some long-term services and supports through 4 managed care plans in NC Medicaid Managed Care (Standard Plans and Behavioral Health I/DD Tailored Plans); CAP/DA and most dual eligibles remain in NC Medicaid Direct, and pays for the rest fee-for-service. In North Carolina, personal care services for members enrolled in a Standard Plan or Tailored Plan are paid by that health plan, so agencies contract with each plan. Many people who use long-term services, including most dual eligibles and CAP/DA waiver participants, remain in NC Medicaid Direct, where agencies bill the state as enrolled providers. North Carolina has not yet moved long-term services and supports fully into managed care.

Which plans are there?

• AmeriHealth Caritas North Carolina, Inc.
• Healthy Blue of North Carolina
• UnitedHealthcare of North Carolina, Inc.
• Carolina Complete Health, Inc. (Regions 3, 4 and 5)

AmeriHealth Caritas, Healthy Blue and UnitedHealthcare are statewide Standard Plans; Carolina Complete Health serves Regions 3, 4 and 5. Tailored Plans (Alliance, Partners, Trillium, Vaya) serve people with serious behavioral health needs or I/DD.

For the programs that pay for home care, see North Carolina Medicaid waivers.

What should you confirm with the state?

Agencies usually need both NC Medicaid enrollment and health plan contracts to serve all personal care clients.