NC Medicaid Direct
NC Medicaid Direct is North Carolina’s health care program for Medicaid beneficiaries who are not enrolled in a managed care plan.
Vaya members who are part of NC Medicaid Direct have the following benefits:
- Physical health services, like regular checkups, maternity care, hospital care, vision care, and nursing home services, through NC Medicaid Direct
- Pharmacy services through NC Medicaid Direct
- Mental health, substance use disorder, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services, managed by Vaya
- Care management provided by Community Care of North Carolina (CCNC) or through Vaya
Am I Eligible for NC Medicaid Direct?
You may qualify for NC Medicaid Direct services through Vaya if you:
- Have NC Medicaid or are eligible for NC Medicaid
- Live in one of the 32 counties that Vaya serves
- Are not enrolled in NC Medicaid Managed Care (a Behavioral Health and I/DD Tailored Plan, Standard Plan, or the Eastern Band of Cherokee Indians Tribal Option)
To enroll, first apply for NC Medicaid. If you already have NC Medicaid, skip this step.
Apply for Medicaid in one of these ways:
- Apply online at healthcare.gov or at ePass
- Call or visit your local Department of Social Services (DSS) office
- Fill out a paper application and send by mail, fax, or drop it off at your local DSS
To choose a health plan, call the NC Enrollment Broker at 1-833-870-5500 (TTY: 711), 7 a.m. to 6 p.m., Monday – Saturday.
In you have questions about Medicaid eligibility, contact your local DSS office.
How to Get Care
Your care starts by finding your primary care provider (PCP). This could be a doctor, nurse practitioner, or physician assistant who:
- Cares for your health
- Coordinates your needs
- Helps you get referrals for specialized services if you need them
Your PCP’s name and contact information are on your Medicaid ID card. If you have any questions about choosing or changing your PCP, call your local DSS office. A list of DSS locations can be found here: ncdhhs.gov/localdss.
For help getting care, you can also call our Member and Recipient Service Line at 1-800-962-9003, 7 a.m. to 6 p.m., Monday – Saturday.
If you need help with a mental health or substance use crisis, call our Behavioral Health Crisis Line at 1-800-849-6127. This line is available 24 hours a day, seven days a week.
Services Covered by Vaya
Vaya manages mental health, substance use disorder, I/DD, and TBI services for NC Medicaid Direct members. We work closely with the rest of the NC Medicaid program.
For more information about covered services, check the NC Medicaid Direct Member Handbook.
Mental health services support your emotional, psychological, and social well-being. Services and supports are designed for different ages and may be in different places – in your home, community, or a facility.
Our goal is to support you on your journey, no matter the path you choose. From ongoing care to crisis services, your care team works with you to make a plan that supports you and your goals.
Substance use disorder services help you recover from the use of alcohol and other drugs. Services and supports are designed for different ages and may be in different places – in your home, community, or a treatment center.
Our goal is to support you on your journey, no matter the path you choose. From ongoing care to crisis services, your care team works with you to make a plan that supports you and your goals.
Vaya covers special services for individuals with I/DD. All available services are listed in the Vaya NC Medicaid Direct Member Handbook.
Some NC Medicaid Direct members are eligible for the NC Innovations Waiver. This Medicaid waiver helps individuals with I/DD get services and supports in their home and participate in their community. Learn more about NC Innovations Waiver.
Learn more about Intellectual/Development Disabilities (I/DD)
Vaya covers special services for individuals with TBI.
Extra Support
Tailored Care Management is a free service that provides support for people with mental health needs, substance use disorders, I/DD, or TBI. As an NC Medicaid Direct member, you may be eligible for Tailored Care Management.
With Tailored Care Management, a care manager works closely with you, your care team, and family or people important to you to create health goals and find needed services. Care managers help with things such as making appointments, understanding medications, and connecting you to community resources.
Members who opt out of Tailored Care Management may receive less intensive care coordination services instead. Vaya will help you coordinate services, but it will be more limited than Tailored Care Management.
Members whose main needs are related to physical health may get care management from CCNC instead of through Vaya.
1915(i) services help you be more independent in your home or local community. They can help you or a loved one live at home, find a job, learn skills to participate in the community, recover from substance use disorder, and more.
Services include:
- Community living and support
- Community transition
- Individual and transitional support
- Respite
- Supported employment services
For members living in a care facility, like a hospital or group home, we will work with you to find your best options. Our team can help you move back into your own home or apartment if that is a safe and healthy option. We will work with you to:
- Make a plan for your move
- Set up the services you need
- Make sure you have a safe place to live
- Support you after you move
Diversion means helping people stay in their own homes and communities, not in a facility. Our team works with eligible members to find the right support and housing. Together, we can make a plan that helps you achieve your goals.
Quitting smoking or other tobacco products is one of the most important steps you can take to improve your health. If you want to quit smoking, we can connect you with QuitlineNC.com for support.
Vaya uses the System of Care model to support youth receiving behavioral health services. North Carolina’s System of Care brings together community-based services, including those provided by Vaya and through schools and other state agencies, such as juvenile justice or child welfare.
System of Care Family Partners can support families to make sure the services that a child and their family receive are coordinated and address their specific needs and strengths. Family Partners can also be part of the care management team.
NC Medicaid can help you get to regular medical appointments for free. This is called Non-Emergency Medical Transportation (NEMT).
For NC Medicaid Direct beneficiaries, your local DSS can help you schedule a ride.
If you have a medical emergency, call 911 or go to the nearest emergency room.
For more information about eligibility, services, or approvals, always check the NC Medicaid Direct Member Handbook.
NC Medicaid Direct Programs
Recipient Rights and Responsibilities, Grievances, and Appeals
As a NC Medicaid Direct member, you have certain rights and responsibilities. It is important to know what those are.
If you have a complaint about your health plan, provider, care, or services, contact us. You can send a complaint, also called a grievance.
Sometimes Vaya may make a decision about your services that you do not agree with. You can ask us to review it. This is called an appeal.
Resources
Questions and Answers
- Children/youth in foster care
- Children/youth who get adoption assistance
- Children who get Community Alternatives Program for Children (CAP/C) services
- Federally recognized tribal members or others who qualify for services through the Indian Health Service (IHS)
- Former foster care youth
- People in the Health Insurance Premium Payment (HIPP) program
- People in the Program for All-inclusive Care for the Elderly (PACE)
- People who are medically needy
- People who get Community Alternatives Program for Disabled Adults (CAP/DA) services
- People who get Family Planning Medicaid only
- People who get Medicaid and Medicare
- People who may have a mental health disorder, substance use disorder, I/DD, or TBI
Your Medicaid ID card is mailed to you. The mailing address on the card is the same as the address on file at your local DSS office. Your Medicaid ID card has:
- Your primary care provider’s name and phone number.
- Your Medicaid ID Card
- Information on how to contact Vaya
If anything is wrong on your Medicaid ID card, or if you lose your card, call your local DSS office right away. A list of DSS locations can be found here: ncdhhs.gov/localdss.
Always carry your Medicaid ID card with you. You will need to show it each time you go for care. However, if you do not have your card, your provider may still be able to see you.
You have an opportunity to choose your own PCP. Your PCP’s name and contact information are on your Medicaid ID card. If you do not choose a PCP, NC Medicaid may choose one for you based on your past health care.
Your PCP is a doctor, nurse practitioner, or physician assistant who will:
- Care for your physical health when you are well and sick.
- Help you get referrals to specialized providers if you need them (like a cardiologist).
You can change your PCP at any time and for any reason. If you have any questions about choosing or changing your PCP, call your local DSS office.
Which North Carolina counties are in the Vaya region?
Vaya serves NC Medicaid Direct members with eligibility from the following counties: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rockingham, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey.