The Definitive Guide to Checking and Managing Your NC Medicaid Status

Introduction

Navigating the healthcare system can be a complex undertaking.

For residents of North Carolina who are applying for or are currently enrolled in Medicaid, understanding how to check the status of an application or verify active benefits is a critical need.

This report serves as a comprehensive, step-by-step guide designed to demystify the North Carolina Medicaid system.

It provides clear, actionable instructions for interacting with the various state, county, and private entities that administer these essential health benefits.

The recent expansion of NC Medicaid, effective December 1, 2023, has opened eligibility to many more North Carolinians, including adults aged 19 through 64 with higher incomes who may not have qualified previously.¹

This expansion makes a clear and thorough guide more timely and necessary than ever, as thousands of new individuals and families engage with the system for the first time.

This document is structured to guide a user directly to the information most relevant to their situation.

• Section 1 provides a foundational map of the NC Medicaid landscape, explaining the role of each key organization.
• Section 2 offers a focused guide for new applicants on how to check the status of a pending application.
• Section 3 is for current beneficiaries who need to verify their active enrollment and health plan details.
• Section 4 explains the crucial annual renewal process required to maintain coverage.
• Section 5 delivers a detailed procedural guide for appealing an unfavorable decision.
• Section 6 consolidates all essential contacts and online resources into a comprehensive directory for easy reference.

By providing this detailed information, this report aims to empower individuals and families with the knowledge and confidence to effectively manage their Medicaid benefits.

Section 1: Understanding the NC Medicaid Ecosystem: Who to Contact and Why

The North Carolina Medicaid program is not a single, monolithic entity.

It is a complex network of state agencies, local county offices, and private-sector health plans, each with a distinct and specific role.

A significant challenge for many beneficiaries is knowing which organization to contact for a particular issue.

Contacting the wrong entity can lead to redirection, delays, and frustration.

Understanding this structure is the essential first step to efficiently checking a status or resolving a problem.

The success of a beneficiary’s interaction with the system is often directly dependent on their ability to correctly identify the responsible entity for their specific need.

The NC Department of Health and Human Services (DHHS): The State-Level Authority

The North Carolina Department of Health and Human Services (DHHS) is the high-level state agency that oversees the entire NC Medicaid program.³

It is responsible for setting program policy, managing compliance with federal regulations, and holding ultimate authority over the system’s operation.

Beneficiaries will rarely interact directly with the main DHHS office for individual, case-specific status checks.

Its role is primarily one of administration and oversight.

However, the DHHS websites—ncdhhs.gov and the more specific medicaid.ncdhhs.gov—are the official and most reliable sources for program-wide information, printable application forms, policy updates, and official announcements.¹

For general questions about Medicaid policies and procedures, the

NC Medicaid Contact Center is the appropriate state-level resource, available at 888-245-0179.⁴

The general DHHS Customer Service Center can be reached at 1-800-662-7030.³

Your County Department of Social Services (DSS): Your Primary Local Contact for Eligibility

The local county Department of Social Services (DSS) office serves as the frontline for the Medicaid program.⁵

These offices are responsible for the entire eligibility process.

They accept and process new applications, review submitted documentation, request additional information from applicants, and ultimately make the initial determination of whether an individual or family qualifies for Medicaid benefits.⁸

The county DSS is the single most important point of contact for new applicants who wish to check the status of their pending application.

It is also the correct entity to contact for reporting any changes in circumstances that could affect eligibility, such as a change in income, household size, or address.⁸

The state provides a comprehensive

Local DSS Directory on the DHHS website, which lists the physical address, mailing address, and phone number for the DSS offices in all 100 North Carolina counties.⁷

The structure of these offices varies, with some larger counties like Mecklenburg ¹⁰ or Davidson ¹¹ having specialized staff or phone lines for different types of Medicaid.

The NC Medicaid Enrollment Broker: Your Navigator for Choosing a Health Plan

Once the county DSS has determined that an individual is eligible for Medicaid, the next step is to enroll in a specific health plan.

This is the primary function of the NC Medicaid Enrollment Broker.⁵

The Enrollment Broker is a neutral entity contracted by the state to help new beneficiaries understand their health plan options, compare the different Managed Care Organizations (MCOs), and select a primary care provider (PCP).¹²

An individual should contact the Enrollment Broker after receiving their official Medicaid approval notice from the DSS but before they have been enrolled in a health plan.

The Enrollment Broker can also be contacted to change a health plan, either during the annual open enrollment period or due to a specific qualifying life event.

The Enrollment Broker can be reached by phone at 1-833-870-5500 or through their dedicated website, ncmedicaidplans.gov.⁵

Managed Care Organizations (MCOs) / Health Plans: Your Day-to-Day Healthcare Manager

Under North Carolina’s Medicaid Managed Care system, most beneficiaries receive their healthcare services through a private insurance company known as a Managed Care Organization (MCO), or health plan.¹²

Examples of these plans include Healthy Blue, WellCare, AmeriHealth Caritas, and United Healthcare.²

These MCOs are responsible for the day-to-day management of a beneficiary’s healthcare.

They maintain a network of doctors and specialists, issue their own member ID cards, provide case management, authorize or deny specific medical services, and handle member inquiries about benefits.⁵

Once enrolled in a specific health plan, the MCO’s Member Services department becomes the primary point of contact for nearly all healthcare-related questions.

This includes finding a doctor, asking if a particular procedure or prescription is covered, scheduling transportation to medical appointments, and initiating the first level of an appeal if a service is denied.⁵

Each MCO has its own contact information and member portal.⁵

The NC Medicaid Ombudsman: Your Advocate When Problems Arise

When a beneficiary encounters a problem that they cannot resolve directly with their MCO or their county DSS, the NC Medicaid Ombudsman program serves as a critical resource.¹

The Ombudsman is a free, confidential, and impartial advocate who helps beneficiaries navigate the complexities of the Managed Care system.

They can help individuals understand their rights and responsibilities, provide education on the appeals process, investigate complaints, and connect beneficiaries to other resources like social services or legal aid.¹³

The Ombudsman should be contacted when a beneficiary feels they are at an impasse.

If an individual has already contacted their health plan or DSS and is not receiving the necessary help or a clear answer, the Ombudsman is the appropriate next step.

The NC Medicaid Ombudsman can be reached by phone at 1-877-201-3750 or through their website, ncmedicaidombudsman.org.⁵

NCTracks: The Behind-the-Scenes System

NCTracks is the state’s comprehensive, multi-payer Medicaid Management Information System.¹⁸

It functions as the technological backbone of the entire program, primarily handling provider enrollment and the processing of medical claims.

While most of its functions are provider-facing, NCTracks also features a

Secure Recipient Portal.¹⁹

Beneficiaries can use this portal to perform a foundational check of their eligibility status as it exists in the state’s core database, separate from their enrollment in a specific health plan.¹⁹

Section 2: For New Applicants: How to Check Your Application Status

For individuals who have submitted an application for NC Medicaid and are awaiting a decision, the process can feel uncertain.

This section provides a focused, step-by-step guide to checking an application’s status, managing expectations regarding timelines, and understanding the meaning of different status notifications.

The Application Journey: Timelines and What to Expect

After an application is submitted, it enters a processing period at the local county DSS office.

It is important to have realistic expectations about how long this can take.

• Standard Processing Time: For most applications, the DSS has up to 45 days to make an eligibility decision.²
• Disability Applications: If an application requires a disability determination, the process is more complex and can take up to 90 days.²⁰

During this waiting period, a DSS caseworker will be actively verifying the information provided on the application, such as income, residency, and household size, using various electronic data sources.⁸

The most critical phase of this journey involves communication between the applicant and the DSS.

If the caseworker cannot verify information electronically, they will mail a formal

Request for Information (RFI).

This letter will detail exactly what documents are needed (e.g., recent pay stubs, a lease agreement) and will specify a deadline for submission.⁸

Responding to this request promptly and completely is essential; a failure to do so is one of the most common reasons for an application to be delayed or denied due to procedural reasons rather than ineligibility.

Regardless of the outcome, the final decision will be communicated via an official letter mailed to the applicant, stating whether the application has been approved or denied.²⁰

Primary Method: A Step-by-Step Guide to Using the ePASS Portal

The most efficient way to monitor an application is through North Carolina’s ePASS (Electronic Pre-Assessment Screening Service) portal.

• What is ePASS? ePASS is the state’s secure, self-service website where individuals can apply for various benefits, including Medical Assistance (Medicaid), and manage their case online.²²
• Creating an Account: To use ePASS to track an application, an applicant must first have an NCID account. NCID is a universal user ID and password system for accessing many North Carolina government services. If an applicant does not have one, they can create one through the ePASS login page.²⁰
• Logging In: The portal is accessible at epass.nc.gov. Login requires the NCID username and password.²⁵
• The “Enhanced” Account: While a basic account allows for application submission, the true power of ePASS lies in creating an “enhanced” account. This requires an additional identity verification step, typically performed online through a secure service like Experian.²⁶ This process is a soft inquiry and does not impact a person’s credit score.²⁶ An enhanced account provides full access to case details, allows the user to report changes in their circumstances, and, most importantly, enables the electronic upload of documents.²² This feature is invaluable for responding quickly to a Request for Information from the DSS, bypassing the potential delays and unreliability of postal mail.
• Finding Your Status: After logging into an enhanced ePASS account, the user can navigate to their case details page, which will display the current status of their pending application.²²

Alternative Method: Contacting Your County DSS Office

For those unable to use the online portal or who prefer to speak with a person, contacting the local county DSS office directly is the primary alternative.

• How to Contact: The NCDHHS website provides a Local DSS Directory with phone numbers and addresses for every county office in the state.⁷ When calling, it is best to use the main number and ask for the department or individual who handles Medicaid applications. Some larger counties may have dedicated phone lines or email addresses for Medicaid inquiries, such as Davidson County’s
  caseworker@davidsoncountync.gov email address.¹¹
• What to Have Ready: To facilitate the call, the applicant should have their full legal name, date of birth, and Social Security Number readily available. If a case number was provided upon application, that should also be shared with the caseworker.

Decoding Application Notifications: Understanding Your Status

The status displayed in ePASS or communicated by a DSS caseworker has a specific meaning.

• “Application Received” / “Submitted”: This is the initial confirmation that the application has been successfully entered into the system. It does not indicate that processing has begun. Anecdotal evidence suggests that the assignment of a requisition number (“Req. Number”) may be a sign of progress, but this is not an official indicator.²⁷
• “Pending” / “Under Review”: This status means that a DSS caseworker has been assigned the case and is actively processing it. During this phase, they are verifying the applicant’s information against various state and federal databases.⁸ This is the normal status throughout the 45-day (or 90-day for disability) processing window.
• “Request for Information” (RFI): This is the most critical status requiring immediate applicant action. It signifies that the DSS cannot complete the eligibility determination without additional documentation. The applicant must check their mail for an official letter that specifies the required information and the deadline for submission.⁹ Responding before the deadline is mandatory to prevent the application from being denied for being incomplete.
• “Approved”: This status indicates that the DSS has confirmed the applicant’s eligibility for NC Medicaid. An official approval letter will be mailed, and the next step in the process is to enroll in a health plan through the Enrollment Broker.²⁰
• “Denied” / “Terminated”: This status means the application was not approved. The official denial letter mailed by the DSS will explain the specific reason for the denial. Crucially, this letter will also contain information about the applicant’s right to appeal the decision and the form required to begin that process.⁹ A denial is not always the final outcome, as an appeal may be successful.

Section 3: For Current Beneficiaries: Verifying Your Enrollment and Plan Details

Once an individual is approved for NC Medicaid, their focus shifts from application status to enrollment status.

Being eligible for the program is the first step; being enrolled in a specific health plan is the second, and it is the key to actually accessing healthcare services.

There is a critical distinction between these two states, and a person can be eligible but not yet fully enrolled, creating a potential gap in their ability to access care.

This section provides clear instructions for approved beneficiaries to verify their active coverage, confirm their health plan details, and understand the tools at their disposal.

Confirming Active Coverage: The NC Medicaid Managed Care Portal

The central hub for beneficiaries enrolled in NC Medicaid Managed Care is the website ncmedicaidplans.gov.¹²

This portal is managed by the NC Medicaid Enrollment Broker.

• “Check Enrollment Status” Tool: This website features a prominent and easy-to-use tool specifically for checking if a health plan is active.¹² This tool can be used by both beneficiaries and healthcare providers to confirm coverage and see the start and end dates of that coverage.²⁹
• Information Needed: To use this public-facing tool, one must enter the beneficiary’s full First Name, Last Name, and one of two identifiers: their Social Security Number (SSN) or their NC Medicaid ID number.²⁹
• Member Account Login: For more advanced actions, such as changing a health plan or primary care provider, a beneficiary must log into their personal account on the portal.³⁰ The first time logging in, the user must link their NCID account to their Medicaid case by providing their name, date of birth, and SSN or Medicaid ID.³⁰

Accessing Detailed Records: The NCTracks Recipient Portal

The NCTracks system, accessible at nctracks.nc.gov, serves as the state’s core Medicaid database.¹⁸

While primarily used for provider functions, it includes a

Secure Recipient Portal where beneficiaries can check their fundamental eligibility status with Medicaid and other DHHS programs.¹⁹

This portal is a good resource for a foundational data check to confirm that the state’s main system correctly lists the individual as eligible, which is separate from their enrollment in a specific MCO.

Your Health Plan’s Member Portal: A Gateway to Specific Benefits

Once a beneficiary is enrolled in a specific MCO, such as Carolina Complete Health ¹⁴, WellCare ³¹, or Healthy Blue ¹⁵, that company will provide access to its own secure member portal.

This portal is the best source for day-to-day, plan-specific information.

Through their MCO’s portal, members can typically:

• View their claims history.
• Search for doctors, hospitals, and specialists who are in the plan’s network.
• Request a replacement for their health plan ID card.
• Access information on value-added services and wellness programs offered by the plan.¹⁴
  
  A beneficiary must register for a new account on their MCO’s website to access these features.

Verifying Status by Phone: A Directory of Key Numbers

For those who prefer or need to verify status by phone, it is crucial to call the correct entity:

• NC Medicaid Contact Center (888-245-0179): This number is for general policy questions or for beneficiaries enrolled in NC Medicaid Direct, which is the state’s fee-for-service plan for specific populations not in a private MCO.⁴
• NC Medicaid Enrollment Broker (1-833-870-5500): This is the number to call to check plan enrollment status, choose a plan for the first time, or request to change plans.⁵
• Your Health Plan’s Member Services: This is the number to call for any questions about specific benefits, claims, or finding care within the plan. The contact numbers for all MCOs are available through state resources.²

Your Medicaid ID Card vs. Your Health Plan ID Card: What’s the Difference?

New beneficiaries are often confused by receiving two different ID cards.

It is vital to understand their distinct purposes.

• Medicaid ID Card: Sometimes called the “blue card,” this card is issued by the state through the county DSS. It serves as proof of eligibility for the overall NC Medicaid program. If this card is lost, the beneficiary must contact their local DSS office for a replacement.⁵
• Health Plan ID Card: This card is issued by the specific MCO the beneficiary is enrolled in (e.g., a WellCare or Healthy Blue card). This is the primary card that should be presented at a doctor’s office or pharmacy when receiving services. It proves enrollment in a particular health plan with a specific network of providers. If this card is lost, the beneficiary must contact their MCO’s member services department for a replacement.⁵

After receiving a Medicaid approval letter from the DSS, the beneficiary’s immediate next action should be to engage with the Enrollment Broker to select a health plan.

This ensures the prompt issuance of the health plan ID card, which is the essential key to accessing medical care.

Section 4: The Annual Renewal: How to Navigate Recertification and Maintain Coverage

Maintaining NC Medicaid coverage is an ongoing process that requires an annual eligibility review.

This process, known as recertification, renewal, or redetermination, is a primary point where eligible individuals, especially children and those with unstable housing, can lose coverage due to procedural issues.⁹

This phenomenon, often called “procedural churn,” is not typically a result of ineligibility but rather a breakdown in communication.

Understanding this process and how to manage it proactively is crucial for ensuring continuous health coverage.

The Recertification Process Explained

Every 6 or 12 months, depending on the specific Medicaid program, the county DSS must review a beneficiary’s case to confirm they still meet the eligibility requirements.⁹

This review follows one of two paths:

• Automatic (“Ex-Parté”) Renewal: The DSS will first attempt to renew coverage automatically. They use secure, electronic data sources to verify income and other eligibility factors without needing to contact the beneficiary.⁹ If all information can be verified this way, the beneficiary’s coverage is renewed, and they will receive a letter in the mail confirming this. In this scenario, no action is required from the beneficiary.⁹
• Manual Renewal: If the DSS cannot confirm eligibility through electronic sources, they will initiate a manual renewal. This is the point that requires direct action from the beneficiary. The DSS will mail a renewal form or a letter requesting specific information and documentation.⁹

Staying Alert: The Importance of Monitoring Your Mail and ePASS Account

The manual renewal process relies heavily on communication from the DSS, making it imperative for beneficiaries to be vigilant.

• Check Your Mail: Beneficiaries should be on high alert for mail from their county DSS office in the months leading up to their Medicaid anniversary date.³² This mail is not junk mail; it is an official and time-sensitive request that determines the future of their health coverage.
• Update Your Contact Information: The single most important step a beneficiary can take to ensure a smooth renewal is to keep their contact information—especially their mailing address and phone number—up to date with their local DSS. If the DSS cannot reach a beneficiary because of an old address, their coverage will likely be terminated.⁸
• The ePASS Advantage: The most effective way to manage contact information and the renewal process is through an enhanced ePASS account. This portal allows beneficiaries to update their address and phone number at any time without needing to call or visit the DSS office.⁸ It also provides a channel for receiving electronic notifications and uploading required documents, which is a more reliable and immediate method than relying on postal mail.

How to Respond to a Request for Information to Prevent a Coverage Gap

If a manual renewal packet is received, a swift and complete response is critical.

• Strict Deadlines: The notices from DSS come with firm deadlines. Typically, a beneficiary has 30 days to respond to the initial renewal letter. If a follow-up letter is sent, the response window may be as short as 12 days.⁹
• Provide All Requested Information: The renewal forms must be filled out completely, and copies of all requested documents (such as recent pay stubs to verify income) must be provided.
• Consequences of Non-Response: Failure to return the required information by the deadline will result in the termination of Medicaid coverage.⁹

Confirming Your Renewal Status

After the renewal period, the DSS will mail a final notice explaining the outcome.

• “Renewed”: The notice will confirm that coverage is continuing. No further action is needed.⁹
• “Changed Program”: In some cases, a beneficiary’s eligibility may shift them to a different Medicaid program with a different set of benefits. The notice will explain this change. Action is only required if the beneficiary disagrees with the new program assignment.⁹
• “Terminated”: This means coverage has ended. The notice will state the reason for the termination. The individual has the right to appeal this decision. They can also reapply for Medicaid at any time or explore other health coverage options on the federal Health Insurance Marketplace at healthcare.gov.⁹

Section 5: The Appeals Process: A Step-by-Step Guide to Contesting an Unfavorable Decision

Receiving a notice that Medicaid eligibility or a requested medical service has been denied, reduced, or terminated can be distressing.

However, this “adverse benefit determination” is not necessarily the final word.

The law provides a formal, multi-level appeals process to contest these decisions.

Navigating this process requires a clear understanding of the steps, rights, and strict deadlines involved.

The appeals system in North Carolina operates on two distinct tracks, and the correct path depends entirely on which entity made the decision.

Identifying the source of the denial—the county DSS or a Managed Care Organization (MCO)—is the first and most critical step.

A procedural error at this stage, such as filing with the wrong agency or missing a deadline, can result in the forfeiture of appeal rights.

Receiving an “Adverse Benefit Determination”: Understanding the Notice

An adverse benefit determination is the official notice from a beneficiary’s MCO or county DSS communicating a negative decision.²⁸

This notice is a legal document and is required to contain specific information:

• The specific decision being made.
• The reason for the decision.
• The specific form and detailed instructions needed to initiate an appeal.¹⁷

The Bifurcated Path: Identifying Your Appeal Type

The appeals process diverges based on the origin of the adverse decision.

• Path A: Decision by County DSS (Regarding Eligibility or Renewal): If the county DSS denies an initial application for Medicaid or terminates coverage at renewal, the appeal is filed directly with the state’s Office of Administrative Hearings (OAH). The beneficiary must complete and return the “Medicaid Services Recipient Hearing Request Form” included with their notice. The deadline for this is strict: it must be received by the OAH within 30 days of the date the decision was mailed.²⁸
• Path B: Decision by Managed Care Organization (MCO) (Regarding a Service): If an MCO denies or reduces a specific service (e.g., a surgery, therapy, prescription drug), the first step is an internal appeal directly to the MCO itself. This is often called a “Reconsideration Review”.³³ Beneficiaries have
  60 calendar days from the date on the MCO’s notice to file this first-level appeal.¹⁵ A State Fair Hearing can only be requested after this internal MCO appeal process is completed and the MCO upholds its denial.

Level 1: The First Appeal (MCO Reconsideration)

For service denials by an MCO, the first appeal happens internally.

• How to File: The appeal can be filed with the MCO via mail, fax, phone, or the MCO’s online portal.³¹ The specific Appeal Request Form provided in the denial letter should be used.
• Timeline: For a standard appeal, the MCO must provide a written decision within 30 calendar days of receiving the request.¹⁵
• Expedited Appeals: If waiting 30 days could cause serious harm to the beneficiary’s health, the beneficiary or their doctor can request an “expedited appeal.” In this case, the MCO is required to make a decision within 72 hours.¹⁵
• Continuation of Benefits: This is a critical right. If a beneficiary is appealing a decision to reduce, suspend, or terminate a service they are already receiving, they can request that the service continue unchanged until the appeal process is complete. This request must be made within 10 days of the date on the notice to be eligible for continuation of benefits.³¹

Level 2: Requesting a State Fair Hearing with the Office of Administrative Hearings (OAH)

A State Fair Hearing is a formal proceeding before an Administrative Law Judge (ALJ).

• When to File:

• For DSS eligibility denials (Path A), the request is filed directly with the OAH within 30 days of the denial notice.²⁸
• For MCO service denials (Path B), the request is filed with the OAH only after receiving the MCO’s final decision on the internal appeal. The beneficiary then has 120 days from the date on the MCO’s decision notice to request the State Fair Hearing.²⁸
• How to File: The “State Fair Hearing Request Form,” which is included with the final denial notice, must be completed and sent to the OAH. It can be submitted by mail or fax to the contact information provided on the form.¹⁵ A hearing can also be requested by calling the OAH Clerk of Court at
  984-236-1850.¹⁵

The Optional Mediation Step

After a State Fair Hearing is requested, the Mediation Network of North Carolina will contact the beneficiary within five business days to offer a voluntary mediation meeting.¹⁷

• Mediation is an informal and confidential process where a neutral mediator facilitates a discussion between the beneficiary and a representative from the DSS or MCO to try and reach a mutually agreeable solution.
• This process is often faster and less adversarial than a formal hearing. A beneficiary is not required to accept any offer made during mediation and can still proceed with their State Fair Hearing if a resolution is not reached.¹⁷

Preparing for Your Hearing and Beyond

• The Hearing: The State Fair Hearing is typically conducted by telephone for convenience, though an in-person hearing can be requested (these are generally held in Raleigh).²⁸ The ALJ will review all evidence and hear testimony from both sides before issuing a final written decision.
• Getting Help: A beneficiary has the right to represent themselves in a hearing. However, they may also be represented by an attorney, a legal advocate, a friend, or a family member.²⁸ Free legal assistance may be available for those who qualify from organizations such as
  Legal Aid of North Carolina (1-866-219-5262) and Disability Rights North Carolina (1-877-235-4210).³⁵
• Final Step: Appealing to Superior Court: If the beneficiary disagrees with the final decision of the Administrative Law Judge, the last avenue of appeal is to file a petition with the North Carolina Superior Court in their county of residence. This must be done within 30 days of receiving the Fair Hearing decision, and the assistance of an attorney is strongly recommended for this step.³³

Section 6: Comprehensive Resource and Contact Directory

This section consolidates the critical contact information and online resources discussed throughout this report into easy-to-use reference tools.

These tables and lists are designed to be problem-oriented, helping users quickly identify the correct resource for their specific need.

Table 1: Master Contact List: Who to Call for Your Specific Problem

This table acts as a quick diagnostic tool, matching common problems to the correct entity and contact method.

If Your Problem Is…	The Correct Entity to Contact Is…	Primary Phone Number	Relevant Website / Portal
Checking the status of a NEW application	Your County Department of Social Services (DSS)	Varies by county (See DSS Directory)	epass.nc.gov
Confirming ACTIVE ENROLLMENT in a health plan	NC Medicaid Enrollment Broker	1-833-870-5500 5	ncmedicaidplans.gov
Asking if a medical service or drug is covered	Your Managed Care Organization (MCO) / Health Plan	Varies by plan (See MCO Directory below)	Your MCO’s member portal
Finding a doctor or hospital in your network	Your Managed Care Organization (MCO) / Health Plan	Varies by plan (See MCO Directory below)	Your MCO’s member portal
Replacing your Health Plan ID Card	Your Managed Care Organization (MCO) / Health Plan	Varies by plan (See MCO Directory below)	Your MCO’s member portal
Replacing your state-issued Medicaid ID Card	Your County Department of Social Services (DSS)	Varies by county (See DSS Directory)	epass.nc.gov
Filing an appeal for a SERVICE DENIAL	Your MCO (1st step), then Office of Administrative Hearings	Varies by plan, then 984-236-1850 31	Your MCO’s portal, then oah.nc.gov
Filing an appeal for an ELIGIBILITY DENIAL	Office of Administrative Hearings (OAH)	984-236-1850 31	oah.nc.gov
You are stuck and can’t resolve a problem	NC Medicaid Ombudsman	1-877-201-3750 5	ncmedicaidombudsman.org
General questions about Medicaid policy	NC Medicaid Contact Center	888-245-0179 5	medicaid.ncdhhs.gov
You forgot your NCID password or are locked out	NCDIT Service Desk	800-722-3946 21	ncid.nc.gov

Table 2: Online Portal Guide: Your Digital Gateways to NC Medicaid

This table clarifies the purpose of each primary website, preventing users from trying to perform an action on the wrong platform.

Portal Name	Website URL	Primary Purpose	What You Need to Log In
ePASS	epass.nc.gov 22	Apply for benefits (Medicaid, FNS); Check application status; Report changes to DSS; Renew benefits.	NCID Username and Password 24
NC Medicaid Managed Care	ncmedicaidplans.gov 12	Check active enrollment status; Compare and choose a health plan; Change your plan or PCP.	Public tool requires Name + SSN/Medicaid ID. Account login requires NCID.29
NCTracks Recipient Portal	nctracks.nc.gov 18	Check your core eligibility status in the state’s main database.	Requires setting up access through the portal.
Your Health Plan Portal	Varies by plan (e.g., healthybluenc.com)	View claims; Find in-network providers; Request new plan ID card; Access plan-specific benefits.	A separate username/password created on the plan’s website.

Directory of NC Medicaid Managed Care Health Plans

The following are the primary health plans operating under NC Medicaid Managed Care.

Contact the Member Services line for questions about benefits and care.²

Standard Plans:

• AmeriHealth Caritas: 1-855-375-8811 (TTY: 1-866-209-6421)
• Carolina Complete Health: 1-833-552-3876 (TTY: 711)
• Healthy Blue: 1-844-594-5070 (TTY: 711)
• United Healthcare Community Plan: 1-800-349-1855 (TTY: 711)
• WellCare: 1-866-799-5318 (TTY: 711)

Tailored Plans (for individuals with significant behavioral health needs or I/DD):

• Alliance Health: 1-800-510-9132 (TTY: 711)
• Partners Health Management: 1-888-235-4673 (TTY: 1-800-735-2962)
• Trillium Health Resources: 1-877-685-2415 (TTY: 711)
• Vaya Health: 1-800-962-9003 (TTY: 711)

Other Options:

• EBCI Tribal Option: 1-800-260-9992 (TTY: 711)
• NC Medicaid Direct: 1-888-245-0179 (TTY: 711)

Guide to Finding Your Local County DSS Office

Your county DSS office is your local partner for all eligibility-related matters.

The official and most up-to-date directory is maintained by NCDHHS.

• Official Directory: The complete directory for all 100 counties can be found at the NCDHHS Local DSS Directory website.⁷
• Example – Mecklenburg County (Urban): 301 Billingsley Road, Charlotte, NC 28211. Phone: 704-336-3000.¹⁰
• Example – Cabarrus County (Suburban): 1303 S. Cannon Blvd., Kannapolis, NC 28083. Phone: 704-920-1400.⁷
• Example – Alleghany County (Rural): Doctor St., Sparta, NC 28675. Phone: 336-372-2411.⁷

Contact Information for Essential Support Services

When facing complex issues or an appeal, these organizations provide critical support and legal assistance.

• NC Medicaid Ombudsman: For help resolving issues with your health plan or provider. Phone: 1-877-201-3750.⁵
• Legal Aid of North Carolina: Provides free legal services to low-income residents, including assistance with Medicaid appeals. Phone: 1-866-219-5262.³⁵
• Disability Rights North Carolina: Provides legal advocacy for people with disabilities, including assistance with Medicaid appeals. Phone: 1-877-235-4210.³⁵

Conclusion

Successfully managing NC Medicaid benefits requires an understanding that the system is a partnership between the beneficiary and a network of state, local, and private entities.

The key to navigating this landscape is knowledge: knowing which entity to contact for a specific issue, understanding the timelines and requirements of applications and renewals, and being aware of the formal rights and procedures for an appeal.

The analysis reveals that the most common points of failure are often procedural rather than based on ineligibility.

A missed piece of mail during renewal, a failure to respond to a request for information, or filing an appeal with the wrong agency can lead to a loss of essential health coverage.

Therefore, the most effective strategy for any applicant or beneficiary is proactive communication management.

Creating and maintaining an enhanced ePASS account is the single most powerful tool for this, as it shifts critical communications from the unreliability of postal mail to a direct and immediate electronic channel.

By using the tools outlined in this guide—from the online portals to the Master Contact List—and by understanding the distinct roles of the county DSS, the Enrollment Broker, and the Managed Care Organizations, North Carolinians can take control of their healthcare journey, ensuring they receive and maintain the benefits for which they are eligible.

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