EBCI Tribal Option

What EBCI Tribal Option does

EBCI Tribal Option is an Indian Managed Care Entity (IMCE) contracted with the North Carolina Department of Health and Human Services (NCDHHS) to provide Medicaid managed care for federally recognized Tribal members and other individuals eligible for Indian Health Services. Operating under the Cherokee Indian Hospital Authority (CIHA) from Cherokee, North Carolina, it serves approximately 4,000–5,500 beneficiaries across Cherokee, Haywood, Swain, Jackson, and Graham counties as part of North Carolina's Medicaid Managed Care program that launched July 1, 2021. The organization was the first IMCE in the nation, established through a contract between NCDHHS and CIHA in October 2020.

The core operating model combines care management services (each member is assigned a dedicated Care Manager), a contracted provider network, member services, and a value-added services program covering items such as Cherokee language classes, transportation via Cherokee Transit, car seats, and education vouchers. Quality measurement is conducted via an Optum Analytics partnership for member survey analysis, with quarterly reporting to NCDHHS on diabetes A1c control, hypertension control, and childhood immunizations. No proprietary technology platform is described in the available material; operational infrastructure relies on standard care management software, member/provider call center operations (800-260-9992), and integration with CIHA's fully integrated health system.

EBCI Tribal Option operates as a prepaid health plan receiving capitated per-member-per-month (PMPM) premium payments from NC Medicaid to manage covered services. Revenue is governed entirely by the NCDHHS contract, with no public pricing tiers or member cost-sharing. The program addresses health disparities in American Indian/Alaska Native populations by combining culturally grounded care principles (e.g., "U wa shv u da nv te lv") with Medicaid managed care infrastructure, auto-enrollment of tribal members, and a tightly integrated tribal healthcare delivery system.

Name

EBCI Tribal Option

Legal name

Eastern Band of Cherokee Indians (EBCI) Tribal Option

Website

https://ebcitribaloption.com

Company type

Private

Founded year

2020

Operating status

Operating

Short description

EBCI Tribal Option is the nation's first Indian Managed Care Entity, contracted with NCDHHS to deliver Medicaid managed care to approximately 5,000 federally recognized Tribal members across five western North Carolina counties under Cherokee Indian Hospital Authority.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

akta.pro secondary industry

Tribal/Indigenous Public Health Authorities (HLAJAAAD)

Keywords

• Medicaid managed care
• Tribal healthcare services
• Care coordination
• Indian Managed Care Entity
• Culturally competent care

Headquarters

HQ city

Cherokee

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medicaid Capitated Premium Revenue: EBCI Tribal Option operates as a prepaid health plan under contract with NCDHHS. The organization receives capitated premium payments per enrolled Medicaid beneficiary to manage and coordinate healthcare services for Tribal-eligible members. This is a fixed per-member-per-month (PMPM) revenue model funded through North Carolina Medicaid managed care. Revenue is used to pay providers, fund care management, and cover administrative costs.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels6 records

Core offering

EBCI Tribal Option is an Indian Managed Care Entity (IMCE) that provides managed care coordination for federally recognized Tribal members and other IHS-eligible Medicaid beneficiaries in western North Carolina. Operating under contract with NCDHHS, it delivers care management services including Primary Care Provider assignment, dedicated Care Managers, chronic disease management, preventive health, behavioral health integration, and Value-Added Services such as Cherokee language classes, education vouchers, and transportation. The program serves approximately 4,000-5,500 beneficiaries across Cherokee, Haywood, Swain, Jackson, and Graham counties within CIHA's fully integrated health system.

Product overview

EBCI Tribal Option is a single, unified Indian Managed Care Entity (IMCE) product that provides Medicaid-managed care for Tribal members. It operates as an integrated healthcare coordination program consisting of several interconnected services: the core EBCI Tribal Option managed care product, Care Management Services (assigning dedicated Care Managers to each member), Member Services (health promotion, disease management, and member resources), Provider Network Services (evidence-based care coordination), and Value-Added Services (non-Medicaid supplemental benefits such as education assistance, transportation, and wellness programs). The program emphasizes holistic, culturally-sensitive healthcare delivery grounded in Cherokee cultural principles.

Differentiator

Problem solved

Functional benefit

Products and services

• EBCI Tribal Option (Managed Care Plan) An Indian Managed Care Entity (IMCE) contracted with NCDHHS to participate in North Carolina Medicaid, providing managed care for federally recognized Tribal members and other IHS-eligible Medicaid beneficiaries in Cherokee, Haywood, Swain, Jackson, and Graham counties in western North Carolina.
• Care Management Services Provides each enrolled member with an assigned Care Manager who coordinates healthcare services, working with doctors, providers, agencies, and community resources to ensure members receive appropriate care and support.
• Member Services Supports members and their families in achieving health goals through connections to local resources, health promotion, disease management programs (diabetes, hypertension, tobacco cessation), and member engagement materials, accessible via the member services call center at 800-260-9992.
• Provider Network Services Provides evidence-based care coordination for healthcare providers in the network, including quarterly performance measurement tracking (diabetes A1c control, hypertension control, childhood immunization rates), Provider Council engagement, Provider Network Manager support, and grievance processes.
• Value-Added Services (VAS) Additional services beyond the standard NC Medicaid benefit package offered at no additional cost to eligible members, including Cherokee language classes, car safety seats for newborns, prenatal gift cards or breast pumps (up to $75), computer education vouchers (up to $750), GED vouchers (up to $250), transportation via Cherokee Transit, nutrition/cooking/exercise classes, and sports shoes for youth.

Quantifiable outcome

• 97% of members were pleased with their overall experience with EBCI Tribal Option (Member Survey, Optum Analytics partnership)
• +5 more outcomes

Named customers1 record

Segments1 record

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Partnerships

Seven partnerships are on record, tiered core and minor.

• North Carolina Department of Health and Human Services (NCDHHS)coreStrategic or Co-development Partner · 1 October 2020EBCI Tribal Option operates under a contract with NCDHHS as a prepaid health plan participating in North Carolina Medicaid Managed Care. This is the foundational partnership enabling EBCI Tribal Option to provide managed care for Tribal-eligible Medicaid beneficiaries. The partnership was announced October 1, 2020, and the program launched July 1, 2021. NCDHHS provides regulatory oversight, auto-enrollment infrastructure, and capitated premium payments.
• Cherokee Indian Hospital Authority (CIHA)coreStrategic or Co-development PartnerCIHA is the parent organization of EBCI Tribal Option. CIHA founded EBCI Tribal Option and provides the integrated health system infrastructure, staff (including Care Managers), and operational support. CIHA Patient Registration handles IHS eligibility determinations. The organization is led by CEO Casey Cooper and is committed to eliminating health disparities through tribal sovereignty.
• Cherokee ChoicesminorStrategic or Co-development PartnerCherokee Choices is a community partner offering Cherokee language classes and other wellness programs. EBCI Tribal Option partners with Cherokee Choices for Value-Added Services, including enrollment in Cherokee language classes and supplemental learning materials.
• Cherokee TransitminorStrategic or Co-development PartnerCherokee Transit provides transportation services for Tribal Option members related to their care plan within routes and regions covered. Transportation is a Value-Added Service for job training and activities required for implementation of the member's individual care plan.
• NC MedicaidcoreStrategic or Co-development PartnerNC Medicaid (NCDHHS) provides oversight, policy guidance, and quality measurement frameworks for EBCI Tribal Option. Performance measures are reported quarterly to NCDHHS, including diabetes A1c control, hypertension control, and childhood immunization rates.
• Cherokee Indian Hospital Authority / CIHAcoreImplementation/ SI/ Consulting PartnerCIHA is the parent organization that founded and operates EBCI Tribal Option. CIHA provides the integrated health system, staff, facilities, and operational infrastructure. CIHA's patient registration determines IHS eligibility, and CIHA's programs (SAFE Nurse Program, Behavioral Health) support Tribal Option's care management approach.
• Jackson County Department of Social ServicesminorStrategic or Co-development PartnerThe EBCI/NCDHHS Medicaid and FNS Eligibility Office is state-run through Jackson County DSS to increase access to Medicaid and FNS services for tribal members on the Qualla Boundary. The office is co-located with EBCI TANF and Child Support Services offices.

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Molina Healthcare: Molina operates Medicaid and Medicare managed care plans with provider networks, care coordination, and capitated reimbursement. Its government-sponsored member focus makes it a direct business-model peer to EBCI Tribal Option.
• CareSource: CareSource is a nonprofit Medicaid managed care organization focused on low-income and underserved members, offering care management and community-based support. Its service orientation and value-added approach are close to EBCI's model.
• AmeriHealth Caritas: AmeriHealth Caritas operates Medicaid managed care programs and care-management services for government-sponsored populations. It is a direct peer in Medicaid risk-bearing care coordination, although it serves multiple states at greater scale.
• Blue Cross and Blue Shield of North Carolina / Healthy Blue: BCBSNC's Healthy Blue plan participates in North Carolina Medicaid and provides member services, provider networks, and care coordination. It is one of the closest regional comparables because it operates in EBCI's home state and Medicaid market.
• Carolina Complete Health: Carolina Complete Health is a North Carolina Medicaid managed care plan offering care management and member services with a provider-community orientation. It is a close regional peer in the same state and Medicaid category.

Broad incumbents

• Centene Corporation: Centene is a large health insurer whose government-sponsored business includes Medicaid managed care, provider networks, and care-management services. It is comparable in plan administration and target population, but operates at substantially greater scale.
• UnitedHealthcare Community & State: UnitedHealthcare Community & State provides Medicaid managed care for government-sponsored populations through health plans, provider networks, and care coordination. It overlaps with EBCI's core Medicaid risk-bearing model, but serves a much broader national market.
• Elevance Health / Amerigroup: Elevance's Amerigroup Medicaid business provides managed care to government-sponsored populations with care coordination and provider-network management. It is comparable in Medicaid plan model and beneficiary focus, while being a much larger incumbent.

Regional players

• L.A. Care Health Plan: L.A. Care is a public Medicaid managed care plan serving low-income and underserved populations in Los Angeles County through care coordination and community partnerships. It is relevant as a comparable public-sector plan with a strong whole-person care emphasis.
• CalOptima: CalOptima is a county-organized Medi-Cal managed care plan providing care coordination and community supports in Orange County. It is comparable in public-sector Medicaid plan administration and whole-person care, although it serves a different geography.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/ebcitribaloption

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

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 EBCI Tribal Option