Carolina Complete Health

What Carolina Complete Health does

Carolina Complete Health is a North Carolina Medicaid Managed Care plan and the only provider-led health plan operating in the state. The company is structured as a joint venture among the North Carolina Medical Society, Centene Corporation, and the North Carolina Community Health Center Association, with Centene serving as the primary parent. It delivers comprehensive Medicaid coverage to eligible low-income adults, families, expectant mothers, infants, children, and long-term services and supports members across North Carolina.

The plan operates through capitation (per-member-per-month) arrangements with the North Carolina Department of Health and Human Services and earns related revenue from related-party products distributed within the same geography, including WellCare-branded Medicare Advantage and the Ambetter-branded Health Insurance Marketplace plan. Membership is acquired through provider referrals, community outreach, member information sessions, and direct enrollment via the state Medicaid program, with members served through a value-added benefits package that includes the My Health Pays rewards program, grocery allowances, gym memberships, non-emergency medical transportation through Modivcare, and specialized programs such as Start Smart for Baby and Room-to-Breathe.

The technology stack is built on standard managed-care infrastructure rather than proprietary AI: a member portal with mobile access to claims, ID cards, and benefits, the Teladoc Health mental health application for stress and behavioral support, Express Scripts for pharmacy benefit management (effective January 2024), EntryKeyID-based single sign-on, and a provider directory search tool. NCQA Health Plan Accreditation provides quality assurance validation. A planned April 1, 2026 merger with WellCare of North Carolina will expand operations from three to all six NC Medicaid regions and is expected to bring combined enrollment above 775,000 members, making the plan the largest Medicaid managed care organization in the state.

Name

Carolina Complete Health

Legal name

Carolina Complete Health

Website

https://carolinacompletehealth.com

Company type

Private

Operating status

Operating

Headcount range

51–100 employees

Short description

Carolina Complete Health is a provider-led North Carolina Medicaid Managed Care plan and joint venture between the NC Medical Society and Centene Corporation, serving low-income adults, families, expectant mothers, and children across North Carolina's Medicaid regions.

Ownership category

akta.pro rank

Headquarters

HQ city

Charlotte, North Carolina

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. Medicaid Managed Care Premiums: The company generates revenue by receiving capitation payments from the North Carolina Medicaid program in exchange for providing comprehensive healthcare coverage to enrolled Medicaid members. The plan is paid per member per month based on enrollment.
2. Medicare Advantage Premiums: Revenue from Medicare plans offered under the WellCare brand, providing coverage to Medicare-eligible individuals.
3. Health Insurance Marketplace Premiums: Revenue from Ambetter Marketplace plans offered through the Health Insurance Marketplace, serving individuals and families purchasing coverage.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels6 records

Core offering

Carolina Complete Health is a provider-led Medicaid Managed Care plan in North Carolina that delivers comprehensive healthcare coverage to Medicaid-eligible individuals including low-income adults, families, expectant mothers, infants, and children. The plan also offers Medicare Advantage coverage through the WellCare brand and Health Insurance Marketplace plans through Ambetter, supported by a member portal, mobile application, telemedicine access via Teladoc Health, and value-added services such as rewards programs and non-emergency medical transportation.

Differentiator

Problem solved

Functional benefit

Brands

• Start Smart for Baby: Prenatal and postnatal care program for expectant mothers
• My Health Pays
• My Healthy Balance
• My Health Pays Visa Rewards Card
• Room-to-Breathe Asthma Program

Products and services

• Carolina Complete Health Medicaid Managed Care Plan Provider-led Medicaid Managed Care plan providing comprehensive healthcare coverage to North Carolina Medicaid-eligible individuals including low-income adults, families, expectant mothers, infants, and children. Coverage includes doctor visits, hospitalization, prescription drugs, behavioral health, telemedicine, preventive screenings, pharmacy benefits through Express Scripts, and non-emergency medical transportation through Modivcare.
• WellCare Medicare Advantage Plans Medicare Advantage plans offered under the WellCare brand serving Medicare-eligible individuals in North Carolina, providing comprehensive medical and prescription drug coverage.
• Ambetter Health Insurance Marketplace Plan Health Insurance Marketplace product offered through the Ambetter brand for individuals and families purchasing coverage via the ACA exchange in North Carolina.
• Start Smart for Baby Program Prenatal and postnatal care program for expectant mothers providing OB/GYN services, care management for high-risk pregnancies, breastfeeding support, childbirth education, and rewards for completing prenatal and postpartum appointments.
• Teladoc Health Mental Health Mobile App Online mental health tool and mobile application for stress, anxiety, and chronic pain management offering personalized learning content, emotional strength building resources, and progress tracking for Carolina Complete Health members.
• My Health Pays Visa Rewards Program Rewards program offering prepaid Visa reward cards to members for completing healthy activities such as wellness visits, vaccinations, and preventive screenings.
• My Healthy Balance Food Rewards Program Food rewards Visa card program supporting members in accessing healthy food as part of nutritional health and wellness benefits.
• Room-to-Breathe Asthma Program Asthma support program for children and adults providing care management and resources to manage asthma symptoms and reduce complications.
• Carolina Complete Health Member Portal and Mobile App Online member account portal and mobile application enabling members to view claims, obtain ID cards, update personal information, find providers, and access health care service management tools.
• Combined Carolina Complete Health / WellCare NC Medicaid Plan (post-merger) Combined Medicaid Managed Care plan resulting from the merger of Carolina Complete Health and WellCare of North Carolina, providing statewide Medicaid coverage across all six NC Medicaid regions to more than 775,000 members.

Quantifiable outcome

• Better health outcomes for members at a lower cost to the state of North Carolina
• +1 more outcomes

Named customers1 record

Segments4 records

Ideal customer profiles6 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature3 records

Partnerships

Four partnerships are on record, tiered core and minor.

• North Carolina Medical Society (NCMS)coreStrategic or Co-development PartnerNorth Carolina Medical Society is the oldest professional member organization in North Carolina, founded in 1849, representing physicians and physician assistants. NCMS is a joint venture partner in Carolina Complete Health, providing physician-led governance and input into plan operations.
• Centene CorporationcoreStrategic or Co-development PartnerCentene Corporation is a Fortune 500 healthcare enterprise committed to helping people live healthier lives. The company provides fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs. Centene is the parent company and joint venture partner in Carolina Complete Health.
• North Carolina Community Health Center Association (NCCHCA)coreStrategic or Co-development PartnerNCCHCA is a private, non-profit membership association representing federally-qualified health centers and aspiring health centers across North Carolina. The association's mission is to promote and support its members' patient-governed community health care organizations and the populations they serve.
• American Cancer SocietyminorGTM or Marketing PartnerPartnership for virtual webinars on HPV shots and cervical cancer screenings. Carolina Complete Health hosts webinars with the American Cancer Society to educate members on cancer prevention and screening.

Scale indicators4 records

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• Elevance Health (Anthem): Elevance Health is a large diversified health insurer whose Anthem plans operate Medicaid (including Healthy Blue in NC), Medicare Advantage, and commercial products. Comparable to Carolina Complete Health through its Medicaid segment, but operates across many states and product lines.
• Centene Corporation: Centene Corporation is the parent company of Carolina Complete Health and operates Medicaid, Medicare, and Marketplace plans across the U.S. It is a broad incumbent in the managed care space, providing both direct competition in NC and the infrastructure/back-office support to Carolina Complete Health.

Direct peers

• CareSource: CareSource is a nonprofit-focused Medicaid managed care organization operating in several states. It shares the government-program focus, member demographics (low-income, TANF, expansion adults), and care management approach with Carolina Complete Health.
• Humana Healthy Horizons: Humana Healthy Horizons operates Medicaid managed care plans in multiple states including North Carolina. It serves the same Medicaid-eligible population with comparable benefits and competes for both members and providers.
• Molina Healthcare: Molina Healthcare is a national Medicaid-focused managed care company. While not necessarily present in NC, it shares a near-pure Medicaid/government-program business model, member demographics, and operating approach with Carolina Complete Health.
• UnitedHealthcare Community & State: UnitedHealthcare's Community & State segment operates Medicaid managed care plans across multiple states including North Carolina. It competes head-to-head with Carolina Complete Health for NC Medicaid members and provider network participation under a similar capitation model.
• Aetna Better Health of North Carolina: Aetna Better Health, part of CVS Health, operates a Medicaid managed care plan in North Carolina. It is a direct competitor for NC Medicaid members under a similar capitation, value-added services, and care management model.
• AmeriHealth Caritas North Carolina: AmeriHealth Caritas is a national Medicaid managed care organization with a North Carolina plan. It directly competes with Carolina Complete Health for NC Medicaid members under the same value-based, government-sponsored model.
• WellCare of North Carolina: WellCare of North Carolina is a Medicaid managed care plan in NC and the direct merger counterparty for Carolina Complete Health effective April 2026. Operates the same Medicaid product in the same state, making it the closest peer and former direct competitor.
• Healthy Blue (Blue Cross and Blue Shield of North Carolina): Healthy Blue is the NC Medicaid managed care plan operated by Blue Cross NC in partnership with Elevance/Anthem. It is one of the principal NC Medicaid competitors, serving the same Medicaid-eligible population with a comparable product offering.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat3 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xtwitter.com/NcComplete
• Facebookfacebook.com/CarolinaCompleteHealth
• LinkedInlinkedin.com/company/carolina-complete-health

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Carolina Complete Health