What Is Carolina Complete Health

Navigating the complexities of healthcare can often feel overwhelming, especially when trying to understand the various plans and programs available. If you're a North Carolina resident looking into Medicaid options, you've likely come across the name "Carolina Complete Health." But what is Carolina Complete Health exactly, and how does it fit into your healthcare journey?

This comprehensive guide will demystify Carolina Complete Health, shedding light on its purpose, who it serves, the benefits it offers, and how you can become a member. By the end of this article, you'll have a clear understanding of this important healthcare option in North Carolina.

What Exactly Is Carolina Complete Health?

At its core, Carolina Complete Health (CCH) is a physician-led health plan specifically designed to deliver Medicaid Managed Care services in North Carolina. Think of it as one of the health plans you can choose from once you qualify for North Carolina Medicaid. But what makes it unique?

CCH is a collaborative effort, formed as a joint venture between the North Carolina Medical Society (NCMS) and Centene Corporation, a major player in managed healthcare programs, working in conjunction with the North Carolina Community Health Center Association (NCCHCA). This unique partnership means that local doctors and healthcare providers have a significant role in the governance and direction of the plan, aiming to put patients' needs first and improve the overall health and well-being of North Carolinians.

The overarching goal of Carolina Complete Health is to provide high-quality, affordable healthcare to low-income populations across the state, focusing on a "whole-person" approach that considers both medical and non-medical factors influencing health.

Who Can Benefit from Carolina Complete Health? (Eligibility)

Carolina Complete Health primarily serves Medicaid beneficiaries in North Carolina. So, the first step to potentially enrolling in CCH is to determine your eligibility for North Carolina Medicaid.

Medicaid is a health insurance program designed for individuals and families who cannot afford healthcare costs. In North Carolina, it typically serves:

Low-income parents and children
Pregnant women
The elderly
Individuals with disabilities

Did you know? North Carolina recently expanded its Medicaid program. This means that more people now qualify, including those aged 19 through 64 years with higher incomes who might not have been eligible before. If you're unsure whether you qualify, it's always recommended to apply, as eligibility is usually based on your household income and assets.

Comprehensive Care: What Services Does CCH Offer?

As a Carolina Complete Health member, you gain access to a wide array of healthcare benefits and services, all designed to meet the diverse needs of families and individuals. These go beyond just doctor visits.

Standard Medicaid benefits covered by CCH include:

Primary Care: Regular check-ups and ongoing care from your chosen primary care provider.
Specialty Care: Referrals to specialists when needed, covering a broad range of medical fields.
Behavioral Health Services: Support for mental health and substance abuse concerns, including counseling and therapy.
Preventive Services: Crucial screenings and vaccinations to keep you healthy, such as annual check-ups, blood pressure screenings, cancer screenings (breast, cervical, colorectal), flu vaccines, and immunizations for children and adults.
Chronic Disease Management: Support and resources for managing long-term health conditions.
Acute Care: Services for immediate medical needs.

Beyond these essential services, Carolina Complete Health also offers "Value-Added Services" (VAS). These are extra benefits designed to enhance your overall health and well-being, which might include:

Extra vision coverage
Special programs for pregnant and new mothers
Dollar rewards for engaging in healthy activities
Telemedicine services, allowing you to connect with doctors remotely

These additional benefits underscore CCH's commitment to a "whole-person" system of care, addressing various aspects of your health journey.

How to Enroll in Carolina Complete Health: A Step-by-Step Guide

If you're ready to explore Carolina Complete Health as your Medicaid managed care option, here's a general guide to the enrollment process:

Step 1: Apply for North Carolina Medicaid

Before you can choose Carolina Complete Health, you must first apply for and be determined eligible for North Carolina Medicaid. You can do this in several ways:

Online: Apply through the secure ePASS website or Healthcare.gov. You may need to create an NCID account for ePASS.
By Phone: Call the NC Medicaid Managed Care enrollment helpline.
By Mail or Fax: Fill out an enrollment form and send it in.
In Person: Visit your local Department of Social Services (DSS) office.
Mobile App: Download the free NC Medicaid Managed Care mobile app.

It's important to provide accurate information regarding your date of birth, Social Security number, income, and any existing benefits to ensure a smooth application process.

Step 2: Choose Your Health Plan

Once your Medicaid application is approved, you'll typically be given the opportunity to choose a managed care health plan. This is where you can select Carolina Complete Health. You'll receive information about the available plans and how to make your choice.

Step 3: Receive Your Welcome Packet

After enrolling, your chosen health plan, including Carolina Complete Health, will mail you a welcome packet. This packet is crucial as it contains your Medicaid ID card and a member handbook. The handbook is your go-to resource for understanding your benefits, how to access services, and finding providers.

Making the Most of Your Carolina Complete Health Membership

Once you're a member, how do you get the most out of your CCH plan?

Create an Online Account: Carolina Complete Health offers a secure online member portal. Creating an account allows you to manage your health benefits, view claims, change your Primary Care Provider (PCP), and access important resources.
Download the Mobile App: For on-the-go access, download the Carolina Complete Health mobile app. While app functionality can vary, it typically allows you to view your ID card, find healthcare providers, and receive health alerts.
Find a Provider: Use the online provider search tool or the mobile app to find doctors and other healthcare professionals within the CCH network. Your PCP will play a key role in coordinating your care and making referrals when necessary.
Contact Member Services: If you have questions about your benefits, need help finding a doctor, or require free translation services, don't hesitate to call Carolina Complete Health Member Services at 1-833-552-3876 (TTY: 711). They are there to help!

Conclusion

Understanding what is Carolina Complete Health is the first step toward taking control of your healthcare in North Carolina. As a physician-led Medicaid managed care plan, CCH offers comprehensive benefits, including valuable extra services, to eligible residents. By providing access to quality care and focusing on the overall well-being of its members, Carolina Complete Health aims to simplify your healthcare experience.

Are you a current Carolina Complete Health member, or are you considering enrolling? Share your experiences or questions in the comments below! Your insights could help others on their healthcare journey.

Frequently Asked Questions (FAQ)

Q1: Is Carolina Complete Health the same as North Carolina Medicaid?

No, Carolina Complete Health is not the same as North Carolina Medicaid. Medicaid is the state and federal program that provides health coverage to eligible low-income individuals and families. Carolina Complete Health is one of the managed care health plans that eligible Medicaid beneficiaries in North Carolina can choose to receive their Medicaid benefits through.

Q2: What extra benefits does Carolina Complete Health offer beyond standard Medicaid?

Carolina Complete Health offers "Value-Added Services" (VAS) in addition to standard Medicaid benefits. These can include extra vision coverage, special programs for pregnant and new moms, and dollar rewards for participating in healthy activities. They also offer telemedicine services.

Q3: How do I know if I'm eligible for Carolina Complete Health?

Eligibility for Carolina Complete Health is tied to your eligibility for North Carolina Medicaid. Generally, Medicaid serves low-income parents, children, pregnant women, the elderly, and people with disabilities. With the recent Medicaid expansion in NC, individuals aged 19-64 with higher incomes may also now qualify. The best way to confirm your eligibility is to apply for North Carolina Medicaid through the NCDHHS.

Q4: Can I change my doctor if I'm a Carolina Complete Health member?

Yes, as a Carolina Complete Health member, you can typically choose or change your primary care provider (PCP) through your online member account or by contacting Member Services. Your PCP plays a central role in coordinating your care within the network.