Pisgah Legal recommends NC Medicaid ombudsman

RUTHERFORDTON-For those with Medicaid Managed Care health plans, the deadline to change plans is Sept. 30. Pisgah Legal Ser vices is reminding people they still have a few days to make changes if needed.

Medicaid beneficiaries who selected, or were auto-enrolled, in health plans can change their plan for any reason by the Sept. 30 deadline, online at ncmedicaidplans.gov or by calling the NC Medicaid Enrollment Broker at 833-870-5500. After Sept. 30, beneficiaries will have to wait until their Medicaid recertification date or have a qualifying reason to change health plans.

Those who are having difficulty understanding their health plan or how to change it can contact the NC Medicaid Ombudsman for help online at ncmedicaidombudsman.org or by calling 877-201-3740.

"This year, North Carolina moved to a new ‘managed care' model of providing Medicaid care," said Pisgah Legal Ser vices managing attorney Anne Salter. "We want people in Western North Carolina to know that they have rights, and that if they are having issues with their care or if they need help, they should reach out to the NC Medicaid Ombudsman, especially before the September 30 deadline."

The option to change health plans is part of a major change in the way Medicaid beneficiaries receive healthcare called Medicaid Transformation, the N.C. Department of Health and Human Ser vices' move from fee-for-service delivery to managed care.

Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide health services. During the spring, most Medicaid beneficiaries enrolled, or were auto-en-rolled, in health plans. These plans went into effect July 1, 2021.

Beneficiaries can change their health plan for any reason, by Sept. 30, 2021.

After this deadline, beneficiaries can only change their plans at their Medicaid recertification date, or for a qualifying reason such as they moved out of the health plan's ser vice area or they have a family member in a different health plan.

Beneficiaries can also change plans if their current health plan cannot provide all the related services they need, or they have complex medical conditions. A list of acceptable circumstances appears under "Can I change my health plan after I enroll?" on ncmedicaidplans.gov/learn/get-answers.

Pisgah Legal Ser vices works to increase healthcare access for those in need by helping them enroll in Medicaid and other low-cost health insurances options, and by providing legal representation in cases of discrimination, denial of health care or denied/reduced/ terminated access to services.

Pisgah Legal Services is a nonprofit organization based in Asheville. Since 1978, it has provided free civil legal aid to help people with low incomes seek justice and meet their basic needs including preventing homelessness, stopping domestic violence and securing healthcare.

Pisgah Legal Services has a satellite office in downtown Rutherfordton, and provides ser vices in 11 Western North Carolina counties. The organization employs staff attorneys and also relies on pro bono legal ser vices from approximately 300 volunteer attorneys. For more information, visit www.pisgahlegal.org.