North Carolina

Medicaid in NC is changing — but not how some people want

A big change to Medicaid has arrived in North Carolina — no, not expansion — that will affect thousands of people who get their health coverage through the government-run program.

Previously called Medicaid transformation by the General Assembly, the Department of Health and Human Services has opened enrollment for Medicaid Managed Care to the entire state starting Monday.

Negotiations over Medicaid expansion, largely divided along party lines with Democrats for it and Republicans against it, is still at a stalemate in the General Assembly.

Under managed care, which the state government passed in 2015 and is now starting, most people who receive Medicaid need to enroll in a health plan and choose a primary care provider by Dec. 13. Coverage is scheduled to start on Feb. 1, according to DHHS, though that could change depending on when the budget passes. The governor vetoed a mini budget bill in late August that funded the transformation.

DHHS contracts with insurance companies to provide a predetermined set rate per person for all health care services. The five insurance companies chosen by DHHS are Blue Cross and Blue Shield of North Carolina, AmeriHealth Caritas North Carolina, UnitedHealthcare of North Carolina, WellCare of North Carolina and Carolina Complete Health.

There has been controversy over Blue Cross Blue Shield being awarded the contract over Aetna Better Health of North Carolina, WRAL-TV reported.

DHHS mailed packets that include information and an enrollment form to residents of all 100 counties in the state. They can also visit the DHHS enrollment website at, call the Medicaid Managed Care Call Center at 833-870-5500 or email

Medicaid expansion up in the air

While Medicaid transformation is a done deal policy-wise, Medicaid expansion in North Carolina is still a controversial topic with no solution in sight.

Democratic Gov. Roy Cooper vetoed the state budget this past summer primarily because the Republican-written version did not include Medicaid expansion. As the budget standoff dragged on all summer, Republican leaders in the Senate did not change their position. However in the House, Republicans proposed an expansion compromise that includes a 2% premium and a work requirement. The compromise, called NC Health Care for Working Families, was rolled out the same time as the budget veto override and stayed on the House calendar along with the override all summer. On Sept. 11, the House overrode Cooper’s budget veto, and the Medicaid expansion compromise bill was revived in committee, where it remains.

The General Assembly is on a break this week and is expected to pass less controversial mini budget bills when lawmakers return. The Senate could also hold a budget veto override vote before its anticipated adjournment on Oct. 31.

Rep. Donny Lambeth, a Winston-Salem Republican, acknowledged that the expansion compromise would be a hard sell to other Republicans, but said he hoped he had the votes in the House to pass it. However, even if it passes the House, it still needs to get through the Senate.

Senate majority leader Phil Berger told reporters recently that his party does not support the compromise plan, saying it throws people off private coverage and creates uncertainties in state budgets down the road.

“Make no mistake, the House bill is Medicaid expansion,” Berger said. “I do not support it.”

If the Senate votes to override the budget veto, then the budget will pass without Medicaid expansion but with plans for a separate legislative session focused on health care.

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Dawn Baumgartner Vaughan covers North Carolina state government and politics at The News & Observer. She previously covered Durham for 13 years, and has received six North Carolina Press Association awards, including a 2018 award for investigative reporting.