Overview:

This guide explains how the upcoming WellCare and Carolina Complete Health merger affects local Medicaid recipients. It answers how families can navigate the changes and switch plans if they choose.

Late last month, Kelsey Beatty, a Burlington mom and assistant teacher, got the notice: her health care coverage was changing. She’s one of nearly 56,000 Alamance residents – nearly a third of the county’s population – who could see changes to their Medicaid coverage soon.

“My first thought was confusion,” she said in a message to The Alamance Fabric. “[I worried] it was going to affect my current doctor’s visits with it already being very challenging to find anyone that will take Medicaid as is.”

Starting April 1st, WellCare of North Carolina and Carolina Complete Health (CCH), two Medicaid plans, are merging into a single, statewide health plan under the Carolina Complete Health name. This creates the state’s largest Medicaid plan, covering over 775,000 members, according to CCH.

WellCare is the largest Medicaid coverage plan in the county, providing about 20% of the county’s Medicaid patients with coverage.

Under the change, current WellCare members do not need to take any action. Their plans will automatically transition to CCH. But if they want to elect different coverage, they have the right to opt out and switch to a different Medicaid health plan.

What stays the same

Medicaid benefits stay exactly the same under the new plan, and most members will keep their current primary care provider.

Because these two companies are merging, providers who previously accepted WellCare should be automatically considered “in-network” for the merged CCH plan.

To find a new provider, CCH recommends using its online Find a Provider Search Tool.

What changes 

WellCare members will receive a new Carolina Complete Health Member ID Card and Welcome Packet in the mail by April 1.

See the full list of extra services and benefits offered by CCH here.

“As a medical clinic, there are some positive outcomes we hope to see from the merger,” said Jordan Dawson, office manager and spokesperson for Burlington/Mebane Pediatrics. “For example, working with different Medicaid plans entails more effort and time from our staff as we navigate different clinical policies, prior authorization requirements, and billing processes.”

“We hope that the merger will result in more streamlined requirements for patients who are currently insured under the Wellcare and CCH plans,” she said.

How to change your plan

There are a few ways to switch plans online, by phone, on a mobile app, or mailing or faxing a change request form. Here’s a step-by-step guide:

When you can switch

In North Carolina, you have specific windows to change your Medicaid Managed Care Standard Plan:

  • The 90-day rule: You can change your health plan for any reason within 90 days of an automatic transition (like a merger) or your initial enrollment.
  • Annual recertification: You can switch plans once a year during your Medicaid recertification period.
  • “With cause:” You can request a change at any time if you have a valid, approved reason. For example, if you require multiple, related services at the same time, and some of those services are outside of your current plan’s network.
  • For PCP changes: You can generally change your primary care provider to another in-network provider at any time.

How to switch

There are a few ways to switch plans online, by phone, on a mobile app, or mailing or faxing a change request form. Here’s a step-by-step guide:

Step 1: Research your options
For WellCare members who don’t want to use Carolina Complete Health, North Carolina offers three other Standard Plans: AmeriHealth Caritas, Healthy Blue, and UnitedHealthcare Community Plan.

Before switching, verify that your preferred doctors and specialists accept the new plan. You can do this using the Find a Provider tool on the NC Medicaid website.

Step 2: Gather your information
Make sure you have the NC Medicaid ID card for each family member who needs to switch plans. You will need their ID numbers, dates of birth and Social Security Numbers.

Step 3: Submit your request via the enrollment broker
To change your plan or your PCP, do not contact the health plan directly. Instead, go through the NC Medicaid Enrollment Broker, which handles all enrollment changes. You have four options to submit your change:

  • Online: This is often the fastest option. Go to ncmedicaidplans.gov, log in to your account using your NCID, and file a “Standard Plan Change Request.”
  • By phone: Call the toll-free number at 1-833-870-5500 (TTY: 711 or RelayNC.com). Representatives are available Monday through Friday, 7 a.m. to 7 p.m.
  • Mobile app: Download the free NC Medicaid Managed Care app from Google Play or the App Store. Log in to choose a new PCP or enroll in a different plan directly from your phone.
  • Mail or fax: Download and print the “Standard Plan Change Request Form.”
    • Fax it to: 1-833-898-9655
    • Mail it to: NC Medicaid, PO Box 613, Morrisville, NC 27560

Step 4: Check your effective date
Once approved, a health plan change generally takes effect on the first day of the following month. If you are only switching your PCP within your current plan, that change is usually processed much faster.

What if I need a tailored plan?

If you or a family member has a serious mental illness, severe substance use disorder, intellectual/developmental disability, or a traumatic brain injury, a Standard Plan might not be the best fit.

You can ask to be moved to a Tailored Plan (like Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Health), which offers specialized services. You or your provider can submit a “Request to Move to a Tailored Plan” form through the Enrollment Broker.

Having issues switching plans?

If you’re having trouble getting your change approved or find you don’t get the care you need during this merger, you can contact the NC Medicaid Ombudsman – a free, confidential, nonprofit program to help Managed Care members facing issues with health plans or providers. They can also help understand notices and navigate appeals.

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Laura Brache is the Community Engagement Editor for The Alamance Fabric. Based in Burlington, she oversees the newsletter, community engagement events, and collaboration with local student journalists,...