North Carolina

Four Standard Plans hold NC Medicaid Managed Care contracts under a master Prepaid Health Plan Services contract, originally issued in 2018. Per NCDHHS, AmeriHealth Caritas North Carolina, Healthy Blue of North Carolina, and UnitedHealthcare of North Carolina operate statewide, and Carolina Complete Health operates in Regions 3, 4, and 5. The Children and Families Specialty Plan, a single statewide plan for Medicaid-enrolled children, youth, and young adults currently or formerly served by the child welfare system, launched Dec. 1, 2025, managed by Blue Cross and Blue Shield of North Carolina under the name Healthy Blue Care Together, serving roughly 32,000 beneficiaries. Carolina Complete Health's current service area is unsettled: some industry sources describe it as operating statewide, while NCDHHS's own regional listing still shows it limited to Regions 3, 4, and 5.

• AmeriHealth Caritas North Carolina: Standard Plan, statewide
• Healthy Blue of North Carolina (Blue Cross NC): Standard Plan, statewide
• UnitedHealthcare of North Carolina: Standard Plan, statewide
• Carolina Complete Health: Standard Plan, Regions 3, 4, and 5 per NCDHHS's official listing; some sources describe a broader statewide footprint (see summary)
• Healthy Blue Care Together (Blue Cross NC): Children and Families Specialty Plan, statewide
• Alliance Health, Partners Health Management, Trillium Health Resources, Vaya Health: the four LME/MCOs administering the Behavioral Health I/DD Tailored Plan
• Eastern Band of Cherokee Indians (EBCI) Tribal Option: Primary Care Case Management entity created by the Cherokee Indian Hospital Authority, for federally recognized tribal members and other IHS-eligible individuals

Mixed, not cleanly one or the other. Long-stay institutional nursing facility care remains carved out and fee-for-service under NC Medicaid Direct for beneficiaries in a nursing facility more than 90 days. The state's principal I/DD and TBI home- and community-based waivers (the NC Innovations Waiver and the TBI Waiver, both 1915(c)) are integrated into managed care specifically through the Tailored Plan structure: access requires Tailored Plan enrollment, and day-to-day waiver services are administered by the same four LME/MCOs that run the Tailored Plans.

Not integrated into managed care

• Alliance Health
• Partners Health Management
• Trillium Health Resources
• Vaya Health

Two-tier structure, not a single carve-in or carve-out. Standard Plans include 'basic' behavioral health and substance use services as part of their standard benefit package for members with lower-acuity needs. Members with more serious or complex behavioral health needs, severe substance use disorder, I/DD, or TBI are instead enrolled in the separate Behavioral Health I/DD Tailored Plan, which launched statewide July 1, 2024 for roughly 210,000 beneficiaries and covers physical health, pharmacy, and specialty behavioral health together. Four regional LME/MCOs (Alliance Health, Partners Health Management, Trillium Health Resources, Vaya Health) administer the Tailored Plan and also run a separate prepaid inpatient health plan covering behavioral health, I/DD, and TBI services for NC Medicaid Direct members.

Carved out

• Alliance Health, Partners Health Management, Trillium Health Resources, Vaya Health (Tailored Plan / specialty behavioral health only)

Dental is generally an in-plan benefit under the Standard Plans and Children and Families Specialty Plan, particularly for children under EPSDT. Adult dental coverage is limited for most enrollees, consistent with the broader pattern of optional-benefit limitations for adults. North Carolina has no single statewide dental administrator vendor; dental is managed per-plan rather than through one carved-out statewide vendor.

Hybrid structure. For NC Medicaid Managed Care (Standard Plans and the Tailored Plan), pharmacy is carved in: each health plan administers and pays its own members' pharmacy claims directly, but every plan must follow a single, state-maintained NC Medicaid Preferred Drug List (PDL) and cannot apply different prior-authorization criteria than NC Medicaid Direct uses, so formulary policy is centralized even though claims processing is not. For the separate NC Medicaid Direct (fee-for-service) population, Prime Therapeutics State Government Solutions LLC became the Pharmacy Benefit Administrator effective May 2, 2026, taking over point-of-sale pharmacy claims processing that NCTracks itself had handled directly before that date.

• Prime Therapeutics State Government Solutions LLC (NC Medicaid Direct fee-for-service only)

Non-emergency medical transportation (NEMT) is carved into managed care but the delivery mechanism differs by plan type. The four Standard Plans (AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, UnitedHealthcare) have contracted with ModivCare as a shared statewide NEMT broker since PHPs began providing NEMT on July 1, 2021. Tailored Plans arrange NEMT directly through their own LME/MCO structure rather than through ModivCare; for NC Medicaid Direct and EBCI Tribal Option members, NEMT remains carved out entirely and is provided fee-for-service by local county Departments of Social Services.

• ModivCare (Standard Plans only)

NCTracks (nctracks.nc.gov) is North Carolina's multi-payer Medicaid Management Information System, operated by NCDHHS with GDIT as the Department's current fiscal agent.