NC Medicaid Direct
Please note that this section of the website is under construction. The information contained here is awaiting State approval.
WHAT IS NC MEDICAID DIRECT?
NC Medicaid Direct is North Carolina’s health care program for Medicaid members who are not signed up for a health plan.
Sandhills Center coordinates NC Medicaid Direct services as a Prepaid Inpatient Health Plan (PIHP) for:
- Mental health disorders
- Substance use disorders
- Intellectual/developmental disabilities (I/DD)
- Traumatic brain injuries (TBI)
Care management through NC Medicaid Direct is offered by Community Care of North Carolina (CCNC). CCNC is the primary care case management entity for physical health services.
WHAT KINDS OF NC MEDICAID DIRECT SERVICES CAN YOU GET?
Services you get through Sandhills Center and NC Medicaid Direct must be medically necessary. These services also must be coordinated or referred by your Primary Care Provider (PCP). If you need NC Medicaid Direct services to stay healthy, Sandhills Center offers:
- Medicaid-covered behavioral health, intellectual/developmental disabilities (I/DD) and TBI services.
- Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) services (for people who qualify).
- NC Innovations Waiver services (for people who qualify).
- Care management and care coordination services. A care team will make sure your services are coordinated. This may include additional care beyond medical needs, such as help with housing or food. We will work with you and your healthcare providers to meet your needs.
A complete list of services can be found here:
- Sandhills Center NC Medicaid Direct Member Handbook (English) - PDF
- Sandhills Center NC Medicaid Direct Member Handbook (Spanish) – PDF
DO YOU QUALIFY FOR NC MEDICAID DIRECT?
People living in North Carolina may be able to sign up for NC Medicaid Direct if they are:
- Children/youth in foster care.
- Children /youth who get adoption assistance.
- Children who get Community Alternatives Program for Children (CAP/C) services.
- Federally recognized tribal members or others who qualify for services through Indian Health Services (IHS).
- Former foster care youth.
- People in the Health Insurance Premium Payment (HIPP) program.
- People in the Program for All-Inclusive Care for the Elderly (PACE).
- People who are medically needy.
- People who get Community Alternatives Program for Disabled Adults (CAP/DA) services.
- People who get Family Planning Medicaid only.
- People who get Medicaid and Medicare.
- People who may have a mental health disorder, substance use disorder, intellectual/developmental disabilities (I/DD) or traumatic brain injury (TBI).
FIND A PROVIDER
The NC Medicaid Direct services you get must be from providers that are in the Sandhills Center network. We work with a group of healthcare providers (doctors, therapists, specialists, hospitals and other healthcare facilities) that make up our network.
To ask for a paper copy of the Provider Directory or to seek help, call Sandhills Center Member & Recipient Services: 1-800-256-2452 (TTY: 1-866-518-6778)
NC ENROLLMENT BROKER
Do you want to sign up for NC Medicaid Direct? Are you interested in another plan? Do you want to learn more to help you make the health plan choice that is right for you? You may have many questions. The NC Medicaid Enrollment Broker can answer them and help you understand your healthcare choices. The Enrollment broker also can guide you to find a Primary Care Provider (PCP).
You may call the Enrollment Broker toll-free: 1-833-870-5500 (TTY: 711, or RelayNC.com [active link]). The Enrollment Broker is available from 7 a.m. to 5 p.m., Monday through Saturday. The Enrollment Broker can speak to you in other languages, if needed.
HOW CAN SANDHILLS CENTER HELP YOU?
Sandhills Center can talk to you about non-emergency issues and answer your questions. You can ask us about benefits and services. We can help with referrals or changes that might affect you or your family’s benefits.
Call Member & Recipient Services any time 24 hours a day, 7 days a week: 1-800-256-2452 (TTY: 1-866-518-6776). This is a free call.
If English is not your preferred language, we can talk with you in the language of your choice at no cost to you.
If you are having thoughts of hurting yourself or others, or are in emotional pain or distress, Sandhills Center can help. Call the Behavioral Health Crisis Line at 1-833-600-2054. You can call 24 hours a day, 7 days a week, including holidays. This is a free call. We are here to help you with problems like stress, depression or anxiety. We can get you the support you need to feel better. If you are in danger or need medical help right away, call 911.