NCDHHS Division of Health Benefits (NC Medicaid)
- Company typePublic
- Founded-
- HeadquartersRaleigh, United States
- Headcount51–100
- GTM typeB2C
- OfferingServices
NCDHHS Division of Health Benefits (NC Medicaid) firmographics
Firmographics- 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
NCDHHS Division of Health Benefits (NC Medicaid) industry classification
Industry- 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
Where NCDHHS Division of Health Benefits (NC Medicaid) is headquartered
LocationHeadquarters
- HQ city
- Raleigh
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
NCDHHS Division of Health Benefits (NC Medicaid) business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others
Revenue model
- 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
| Model | Billing | Price |
|---|---|---|
| Subscription | Multi-year contract | No-cost Medicaid coverage for eligible North Carolina residents |
Go-to-market motion2 records
Distribution channels6 records
Marketing channels8 records
NCDHHS Division of Health Benefits (NC Medicaid) product offering
Product offeringCore 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
Companies that use NCDHHS Division of Health Benefits (NC Medicaid)
Customer profileNamed customers6 records
Segments6 records
Ideal customer profiles3 records
NCDHHS Division of Health Benefits (NC Medicaid) technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature4 records
NCDHHS Division of Health Benefits (NC Medicaid) partnerships and signals
Strategic signalPartnerships
13 partnerships are on record, tiered minor, core and secondary.
- WellCare of North Carolina and Carolina Complete Health (Health Plan Merger)minorWellCare 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 HealthcoreAlliance 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 SolutionscoreCardinal 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.
- EastpointecoreEastpointe 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 ManagementcorePartners 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 CentercoreSandhills 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 ResourcescoreTrillium 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 HealthcoreVaya 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 OptioncoreThe 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 BrokercoreThe 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)coreThe 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)coreNCTracks 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.govsecondaryNorth 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
NCDHHS Division of Health Benefits (NC Medicaid) competitors and assessment
Company assessmentBroad 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
NCDHHS Division of Health Benefits (NC Medicaid) social profiles
Digital presenceNCDHHS Division of Health Benefits (NC Medicaid) financial estimates
Financial estimateRevenue estimate
Valuation estimate
NCDHHS Division of Health Benefits (NC Medicaid) leadership team
Management profileNumber of profiles
NCDHHS Division of Health Benefits (NC Medicaid) funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
NCDHHS Division of Health Benefits (NC Medicaid) M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about NCDHHS Division of Health Benefits (NC Medicaid)
What does NCDHHS Division of Health Benefits (NC Medicaid) do?
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.
Is NCDHHS Division of Health Benefits (NC Medicaid) a public or private company?
NCDHHS Division of Health Benefits (NC Medicaid) is a public company. It is classified as state government owned and is currently operating.
When was NCDHHS Division of Health Benefits (NC Medicaid) founded?
NCDHHS Division of Health Benefits (NC Medicaid) was founded in -1. It employs 51 to 100 people.
Where is NCDHHS Division of Health Benefits (NC Medicaid) based?
NCDHHS Division of Health Benefits (NC Medicaid) is headquartered in Raleigh, United States, in the North America region.
How does NCDHHS Division of Health Benefits (NC Medicaid) make money?
One revenue line is on record: government Healthcare Coverage Program.
Who are NCDHHS Division of Health Benefits (NC Medicaid)'s main competitors?
Broad incumbents on record are California Department of Health Care Services (Medi-Cal), Arizona Health Care Cost Containment System (AHCCCS), New York State Department of Health (Medicaid), Washington State Health Care Authority (Apple Health), Ohio Department of Medicaid, Texas Health and Human Services Commission (Texas Medicaid), Oregon Health Authority (Oregon Health Plan), Florida Agency for Health Care Administration (Florida Medicaid) and MassHealth (Massachusetts). Centers for Medicare & Medicaid Services (CMS) is listed as an others.
Does NCDHHS Division of Health Benefits (NC Medicaid) have an API?
No public API is recorded for NCDHHS Division of Health Benefits (NC Medicaid).
What industry is NCDHHS Division of Health Benefits (NC Medicaid) in?
NCDHHS Division of Health Benefits (NC Medicaid)'s product category is Government Healthcare / Medicaid Managed Care. Its primary akta.pro industry code is HLAEAEAH, Maternity & Pregnancy (Perinatal) Medicaid Managed Care Programs, with a secondary code of BPAIAJAI, Non-Communicable Disease Prevention & Chronic Disease Programs. Its NAICS code is 62 and its SIC code is 8000.