NCDHHS Division of Health Benefits (NC Medicaid)

Name

NCDHHS Division of Health Benefits (NC Medicaid)

Legal name

NC Medicaid, Division of Health Benefits

Website

https://medicaid.ncdhhs.gov

Company type

Public

Operating status

Operating

Headcount range

51–100 employees

Ownership category

akta.pro rank

Product category

Government Healthcare / Medicaid Managed Care

NAICS

Health Care and Social Assistance (62), Services for the Elderly and Persons with Disabilities (624120), Social Assistance (624), Family Planning Centers (62141)

SIC

Services-Health Services (8000)

akta.pro primary industry

Maternity & Pregnancy (Perinatal) Medicaid Managed Care Programs (HLAEAEAH)

akta.pro secondary industry

Non-Communicable Disease Prevention & Chronic Disease Programs (BPAIAJAI)

Keywords

• Medicaid managed care
• State health benefits
• Medicaid enrollment
• Health coverage programs
• Behavioral health services

Headquarters

HQ city

Raleigh

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, Infrastructure, Marketing or Sales, Others

Revenue model

1. Government Healthcare Coverage Program: NC Medicaid is a joint federal-state healthcare coverage program funded by federal and state appropriations. It provides comprehensive health coverage at little or no cost to eligible North Carolina residents. The program does not generate commercial revenue but is appropriated through federal Medicaid matching funds (federal medical assistance percentage) and state budget allocations. No copay for most services; the highest copay is $4 for some services. No monthly premiums are charged.

Pricing tiers

Go-to-market motion2 records

Distribution channels6 records

Marketing channels8 records

Core offering

NC Medicaid administers North Carolina's Medicaid health coverage program, providing comprehensive medical, dental, vision, hearing, behavioral health, and prescription drug services to eligible low-income residents. Coverage is delivered through multiple managed care health plans (Standard Plans, Tailored Plans, Children and Families Specialty Plan, EBCI Tribal Option) and fee-for-service arrangements. The program supports enrollment through local DSS offices, the ePASS online portal, NCTracks provider enrollment, and the NC Navigator Consortium across all 100 North Carolina counties.

Product overview

NCDHHS Division of Health Benefits (NC Medicaid) operates a comprehensive Medicaid managed care program serving North Carolina residents. The program architecture includes multiple health plan types: Standard Plans for general populations, Tailored Plans for beneficiaries with complex behavioral health and intellectual/developmental disability needs, the Children and Families Specialty Plan for child welfare populations, the EBCI Tribal Option for Native American beneficiaries, and NC Medicaid Direct for those not in managed care. Supporting programs include the NC Innovations Waiver (1915(c) HCBS for I/DD), TBI Waiver, 1915(i) Services, Family Planning Medicaid, Postpartum Coverage, Long Term Services and Supports, and Non-Emergency Medical Transportation. Key technology platforms include ePASS for beneficiary applications and NCTracks for provider enrollment. The program transitioned to managed care delivery and expanded Medicaid eligibility in December 2023.

Differentiator

Problem solved

Functional benefit

Brands

• Standard Plans: NC Medicaid Managed Care health plans offering physical health, pharmacy, care management and basic behavioral health services for most beneficiaries including families, children, pregnant women, and people who are blind or disabled.
• Tailored Plans
• EBCI Tribal Option
• Children and Families Specialty Plan
• NC Medicaid Direct

Products and services

• Standard Plans NC Medicaid Managed Care health plans offering physical health, pharmacy (prescriptions), care management, and basic behavioral health services for most Medicaid beneficiaries including families, children, pregnant women, and people who are blind or disabled.
• Tailored Plans Integrated NC Medicaid Managed Care health plan for individuals with serious mental illness, severe substance use disorders, intellectual/developmental disabilities (I/DD) or traumatic brain injuries (TBI). Offers physical health, pharmacy, care management, and enhanced behavioral health services.
• Children and Families Specialty Plan Statewide health plan designed for NC Medicaid-enrolled children, youth, and families served by the child welfare system including children in foster care, those receiving adoption assistance, and young adults formerly in foster care.
• Eastern Band of Cherokee Indians (EBCI) Tribal Option Indian Managed Care Entity providing NC Medicaid managed care for federally recognized Tribal members and individuals eligible for Indian Health Services in 11 western North Carolina counties (Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain, Transylvania).
• NC Medicaid Direct North Carolina's health care program for beneficiaries not enrolled in NC Medicaid Managed Care, including care management by Community Care of North Carolina and services coordinated by LME/MCOs for mental health, substance use, I/DD, or TBI.
• Family Planning Medicaid Free health coverage program providing contraceptive services, STI screening and treatment, and preventive health services for eligible individuals with incomes at or below 195% of the federal poverty level.
• NC Innovations Waiver Federally approved 1915(c) Medicaid Home and Community-Based Services waiver for individuals with intellectual or developmental disabilities (I/DD) to receive long-term care services in their home or community rather than institutional settings. CMS approved the waiver renewal effective July 1, 2024 through June 30, 2029.
• Traumatic Brain Injury (TBI) Waiver 1915(c) waiver providing community-based rehabilitative services and support for individuals with traumatic brain injuries to help with recovery and promote choice, independence, and community involvement. CMS approved amendments effective July 1, 2024 through April 30, 2026.
• 1915(i) Services Home and community-based services providing opportunities for Medicaid enrollees to receive services in their own home or community rather than institutions.
• Non-Emergency Medical Transportation (NEMT) Transportation services helping Medicaid beneficiaries get to their medical appointments for those with Standard Plans, Tailored Plans, EBCI Tribal Option, or NC Medicaid Direct.
• Long Term Services and Supports (LTSS) Services helping North Carolina residents who need the most support, including care at home, in the community, or in places like nursing homes.
• Postpartum Coverage NC Medicaid postpartum health care coverage available for eligible beneficiaries for 12 months after childbirth.
• ePASS North Carolina's secure, self-service online portal for applying for Medicaid and other government benefits without visiting a local DSS office. Available in English and Spanish.
• NCTracks Provider Portal Secure online portal for NC Medicaid providers to complete and submit enrollment applications, manage provider records, and report accreditation.

Quantifiable outcome

• NC Medicaid expansion extended coverage to adults ages 19-64 earning up to 138% of the federal poverty level effective December 1, 2023.
• +4 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

13 partnerships are on record, tiered minor, core and secondary.

• WellCare of North Carolina and Carolina Complete Health (Health Plan Merger)minorChannel Partner/ Reseller/ Distributor · 1 April 2026WellCare of North Carolina will merge with Carolina Complete Health effective April 1, 2026. The combined entity will operate under the Carolina Complete Health brand as a unified NC Medicaid Managed Care Standard Plan available statewide.
• Alliance HealthcoreStrategic or Co-development PartnerAlliance Health serves as one of four Local Management Entity/Managed Care Organizations (LME/MCOs) in North Carolina. It manages behavioral health, intellectual/developmental disability (I/DD), and substance use disorder services for Medicaid beneficiaries in its designated catchment area. Alliance Health also operates as one of four Tailored Plans providing integrated health coverage for beneficiaries with complex behavioral health and I/DD needs. Alliance Health covers TBI Waiver services in six counties (Cumberland, Durham, Harnett, Johnston, Orange, and Wake counties).
• Cardinal Innovations Healthcare SolutionscoreStrategic or Co-development PartnerCardinal Innovations Healthcare Solutions serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services in its regional catchment area. Part of the NC Medicaid managed care network.
• EastpointecoreStrategic or Co-development PartnerEastpointe serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services in its designated region.
• Partners Health ManagementcoreStrategic or Co-development PartnerPartners Health Management serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services. Also operates as a Tailored Plan for beneficiaries with serious mental illness, SUD, I/DD, or TBI.
• Sandhills CentercoreStrategic or Co-development PartnerSandhills Center serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services in its regional catchment area.
• Trillium Health ResourcescoreStrategic or Co-development PartnerTrillium Health Resources serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services. Also operates as one of four Tailored Plans offering integrated health coverage for beneficiaries with complex behavioral health and I/DD needs.
• Vaya HealthcoreStrategic or Co-development PartnerVaya Health serves as a Local Management Entity/Managed Care Organization (LME/MCO) providing comprehensive behavioral health services under the NC 1915(b)(c) Medicaid Waiver for mental health, developmental disability, and substance use services. Also operates as one of four Tailored Plans providing integrated health coverage for beneficiaries with serious mental illness, SUD, I/DD, or TBI in its catchment area.
• Eastern Band of Cherokee Indians (EBCI) Tribal OptioncoreStrategic or Co-development PartnerThe EBCI Tribal Option is an Indian Managed Care Entity that provides NC Medicaid Managed Care for federally recognized tribal members and other individuals eligible for Indian Health Services (IHS) in 11 western North Carolina counties (Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain, Transylvania).
• NC Medicaid Enrollment BrokercoreChannel Partner/ Reseller/ DistributorThe NC Medicaid Enrollment Broker is a contracted partner that helps beneficiaries learn about their health care options and primary care providers, compare health plans, and enroll in a managed care plan. Available at 1-833-870-5500 and through ncmedicaidplans.gov.
• NC Division of Public Health (Women, Infant and Community Wellness Section)coreStrategic or Co-development PartnerThe Family Planning Medicaid program is a partnership between NC Medicaid and the North Carolina Division of Public Health. The Division of Public Health's Women, Infant and Community Wellness Section manages training, outreach, and general information support for the Family Planning Medicaid program.
• NCTracks (Medicaid Provider Enrollment System)coreTechnology or IntegrationNCTracks is the state-designated provider enrollment and claims management platform for NC Medicaid. It handles provider credentialing, re-credentialing, Manage Change Requests (MCR), national accreditation tracking, and claims processing across all NC Medicaid programs and managed care health plans.
• Healthcare.govsecondaryTechnology or IntegrationNorth Carolina residents can apply for NC Medicaid through the federal Healthcare.gov marketplace platform, which handles eligibility screening and referral to state Medicaid programs. Individuals with existing Healthcare.gov applications are automatically evaluated for Medicaid eligibility.

Scale indicators4 records

Recent moves9 records

Expansion highlights6 records

Broad incumbents

• California Department of Health Care Services (Medi-Cal): California's Medicaid agency, administering Medi-Cal — the largest Medicaid program in the US. Comparable to NC Medicaid as a state-administered Medicaid program with managed care delivery, multiple plan types, and recent expansions. Operates at substantially larger scale than NC Medicaid.
• Arizona Health Care Cost Containment System (AHCCCS): Arizona's Medicaid agency, notable for long-standing managed care delivery model since 1982. Comparable to NC Medicaid as a state Medicaid administrator with managed care plans and integrated care for behavioral health and I/DD populations.
• New York State Department of Health (Medicaid): New York's Medicaid program administered through the Department of Health, with managed care (MMC plans), multiple waiver programs including 1115 MRT waiver, and specialized programs for I/DD and behavioral health populations. Comparable in program complexity and breadth.
• Washington State Health Care Authority (Apple Health): Washington's Medicaid agency administering Apple Health with managed care plans and an integrated managed care purchasing strategy. Comparable as a state Medicaid administrator with similar program structure including managed care, FFS, and specialized programs.
• Ohio Department of Medicaid: Ohio's Medicaid agency operating a managed care program (MyCare Ohio for dual eligibles, Ohio Medicaid Managed Care). Comparable to NC Medicaid in structure and beneficiary population, with similar managed care contracts and waiver programs.
• Texas Health and Human Services Commission (Texas Medicaid): Texas's Medicaid agency operating one of the largest Medicaid programs by enrollment. Comparable to NC Medicaid as a state Medicaid administrator with managed care delivery (STAR, STAR+PLUS), though Texas has not expanded Medicaid making the scope different.
• Oregon Health Authority (Oregon Health Plan): Oregon's Medicaid agency administering the Oregon Health Plan with coordinated care organizations (CCOs). Comparable to NC Medicaid as a state Medicaid agency with innovative delivery models and a focus on social determinants of health.
• Florida Agency for Health Care Administration (Florida Medicaid): Florida's state Medicaid agency operating the Statewide Medicaid Managed Care (SMMC) program with multiple plan types and specialty plans. Comparable as a state Medicaid administrator with managed care delivery.
• MassHealth (Massachusetts): Massachusetts's Medicaid program, notable for early expansion and innovative programs like the One Care demonstration for dual eligibles. Comparable to NC Medicaid as a state Medicaid agency with managed care delivery and a focus on serving complex populations.

Others

• Centers for Medicare & Medicaid Services (CMS): Federal agency within HHS that administers Medicare, Medicaid, and CHIP and sets the regulatory framework that NC Medicaid operates within. CMS approves NC Medicaid's waivers, managed care contracts, and state plan amendments, making it the primary regulatory counterparty rather than a competitor.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/nc-dhhs

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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M&A

Investments

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Frequently asked questions about NCDHHS Division of Health Benefits (NC Medicaid)