NC MEDICAID MARKET
North Carolina
watch
Procurement watch; state directs vendors to official IPS
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Last verified: unavailable · unknown because no state-specific item
No current verified signal
Precapture is monitoring this market. No state-specific public intelligence item is currently published.
Plans in this market
Parent, plan, and program come from the plan graph. Enrollment and share use the latest CMS reported count. Operations counts are CMS MCPAR. A dollar amount is not on this page.
Plans in this market 85
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| not reported | Alliance Behavioral Healthcare | not reported | 58,355 (2024) | 26.5% calculated | 1 sanctions, 205 appeals resolved |
| AmeriHealth Caritas | AmeriHealth Caritas | not reported | 387,174 (2024) | 17.6% calculated | 13 sanctions, 3,256 appeals resolved |
| AmeriHealth Caritas | Amerihealth Caritas | not reported | 290,989 (2021) | 18.8% calculated | not reported |
| Blue Cross and Blue Shield of North Carolina | Healthy Blue of North Carolina | not reported | 592,325 (2024) | 27.0% calculated | not reported |
| not reported | Cardinal Innovations Healthcare Solutions | not reported | 131,460 (2021) | 26.3% calculated | not reported |
show all 85
| Parent | Plan | Programs | Latest CMS enrollment | Share | MCPAR operations |
|---|---|---|---|---|---|
| not reported | CarePartners PACE | not reported | 215 (2024) | 10.0% calculated | not reported |
| not reported | Carolina SeniorCare | not reported | 129 (2024) | 6.0% calculated | not reported |
| not reported | Carolina Seniorcare | not reported | 181 (2021) | 8.7% calculated | not reported |
| Centene | Carolina Complete Health | not reported | 274,181 (2024) | 12.5% calculated | 9 sanctions, 1,996 appeals resolved |
| Centene | WellCare | not reported | 481,884 (2024) | 21.9% calculated | 10 sanctions, 5,034 appeals resolved |
| Centene | Wellcare | not reported | 361,365 (2022) | 21.3% calculated | not reported |
| Centene | Wellcare | not reported | 409,195 (2023) | 21.7% calculated | not reported |
| not reported | Care Partners | not reported | 193 (2019) | 8.4% calculated | not reported |
| not reported | CarePartners PACE | not reported | 206 (2020) | 9.3% calculated | not reported |
| not reported | Community Carepartners, Inc. | not reported | 166 (2018) | 7.9% calculated | not reported |
| not reported | North Carolina Community Care | not reported | 1,690,986 (2020) | 100.0% calculated | not reported |
| not reported | North Carolina Community Care Carolina Access | not reported | 1,493,347 (2018) | 100.0% calculated | not reported |
| not reported | VOANS Senior CommUnity Care of North Carolina | not reported | 212 (2019) | 9.2% calculated | not reported |
| not reported | VOANS Senior Community Care | not reported | 189 (2018) | 8.9% calculated | not reported |
| not reported | Voans Senior Community Care Of North Carolina | not reported | 192 (2020) | 8.7% calculated | not reported |
| not reported | Community CarePartners, Inc. | not reported | 123 (2017) | 6.3% calculated | not reported |
| not reported | EBCI Tribal Option | not reported | 4,887 (2024) | 100.0% calculated | 1 sanctions |
| not reported | Eastpointe Human Services | not reported | 50,860 (2023) | 9.5% calculated | 38 appeals resolved |
| not reported | Elderhaus | not reported | 125 (2019) | 5.4% calculated | not reported |
| not reported | Elderhaus Inc | not reported | 111 (2017) | 5.7% calculated | not reported |
| not reported | Elderhaus, Inc | not reported | 123 (2021) | 5.9% calculated | not reported |
| not reported | Elderhaus, Inc. | not reported | 118 (2024) | 5.5% calculated | not reported |
| not reported | LIFE St. Joseph of the Pines | not reported | 286 (2019) | 12.4% calculated | not reported |
| not reported | LIFE St. Joseph of the Pines Inc | not reported | 239 (2017) | 12.3% calculated | not reported |
| not reported | LIFE St. Joseph of the Pines, Inc. | not reported | 207 (2023) | 9.7% calculated | not reported |
| not reported | LIFE St. Joseph of the Pines, Inc. | not reported | 191 (2024) | 8.9% calculated | not reported |
| not reported | Life St. Joseph of the Pines, Inc. | not reported | 221 (2022) | 10.9% calculated | not reported |
| not reported | Life of St. Joseph of the Pines, Inc. | not reported | 250 (2021) | 12.0% calculated | not reported |
| not reported | North Carolina Community Care | not reported | 177,890 (2024) | 100.0% calculated | not reported |
| not reported | North Carolina Community Care Carolina Access | not reported | 1,510,955 (2017) | 100.0% calculated | not reported |
| not reported | PACE At Home Inc | not reported | 139 (2017) | 7.2% calculated | not reported |
| not reported | PACE of the Southern Piedmont | not reported | 145 (2017) | 7.5% calculated | not reported |
| not reported | PACE of the Triad | not reported | 189 (2017) | 9.7% calculated | not reported |
| not reported | Partners Behavioral Health Management | not reported | 44,442 (2024) | 20.2% calculated | 86 appeals resolved |
| not reported | Piedmont Health SeniorCare | not reported | 337 (2019) | 14.6% calculated | not reported |
| not reported | Piedmont Health Services Inc | not reported | 304 (2017) | 15.6% calculated | not reported |
| not reported | Piedmont Health Services, Inc. | not reported | 294 (2024) | 13.6% calculated | not reported |
| not reported | Sandhills Center For MH DD SA | not reported | 196,116 (2020) | 12.2% calculated | not reported |
| not reported | Sandhills Center for MH DD SA | not reported | 73,246 (2023) | 13.7% calculated | not reported |
| not reported | Sandhills Center for MH/DD/SA | not reported | 190,341 (2017) | 11.9% calculated | 1 sanctions, 29 appeals resolved |
| not reported | Senior Total Life Care | not reported | 245 (2019) | 10.6% calculated | not reported |
| not reported | Senior Total Life Care, Inc. | not reported | 304 (2024) | 14.1% calculated | not reported |
| not reported | Stay Well Senior Care | not reported | 104 (2018) | 4.9% calculated | not reported |
| not reported | Staywell | not reported | 87 (2020) | 3.9% calculated | not reported |
| not reported | StayWell Senior Care | not reported | 103 (2017) | 5.3% calculated | not reported |
| not reported | Staywell | not reported | 87 (2024) | 4.0% calculated | not reported |
| not reported | Trillium Health Resources | not reported | 77,746 (2024) | 35.3% calculated | 36 appeals resolved |
| UnitedHealth | UnitedHealthcare | not reported | 461,957 (2024) | 21.0% calculated | 9 sanctions, 2,894 appeals resolved |
| not reported | VOANS Senior Community Care of North Carolina | not reported | 170 (2024) | 7.9% calculated | not reported |
| not reported | Voans Senior Community Care of North Carolina | not reported | 172 (2022) | 8.5% calculated | not reported |
| not reported | VAYA Health | not reported | 151,742 (2020) | 9.5% calculated | not reported |
| not reported | Vaya Health | not reported | 39,867 (2024) | 18.1% calculated | 1 sanctions, 302 appeals resolved |
| not reported | Alliance Behavioral Healthcare | not reported | 231,640 (2016) | 14.6% calculated | not reported |
| not reported | Cardinal Innovations Healthcare Sol | not reported | 455,700 (2016) | 28.8% calculated | not reported |
| not reported | Carolina Seniorcare | not reported | 191 (2016) | 11.7% calculated | not reported |
| not reported | Community Carepartners, Inc. | not reported | 72 (2016) | 4.4% calculated | not reported |
| not reported | Eastpointe Human Services | not reported | 194,537 (2016) | 12.3% calculated | not reported |
| not reported | Elderhaus Inc | not reported | 108 (2016) | 6.6% calculated | not reported |
| not reported | Life St Joseph Of The Pines Inc | not reported | 221 (2016) | 13.5% calculated | not reported |
| not reported | North Carolina Community Care Carolina Access | not reported | 1,496,105 (2016) | 100.0% calculated | not reported |
| not reported | PACE @Home | not reported | 165 (2019) | 7.1% calculated | not reported |
| not reported | PACE At Home Inc | not reported | 145 (2020) | 6.6% calculated | not reported |
| not reported | PACE Of The Southern Piedmont | not reported | 173 (2020) | 7.8% calculated | not reported |
| not reported | PACE Of The Triad | not reported | 233 (2020) | 10.6% calculated | not reported |
| not reported | PACE at Home Inc. | not reported | 127 (2021) | 6.1% calculated | not reported |
| not reported | PACE at Home, Inc. | not reported | 157 (2024) | 7.3% calculated | not reported |
| not reported | PACE of the Southern Piedmont | not reported | 243 (2024) | 11.3% calculated | not reported |
| not reported | PACE of the Triad | not reported | 249 (2024) | 11.5% calculated | not reported |
| not reported | Pace At Home Inc | not reported | 118 (2016) | 7.2% calculated | not reported |
| not reported | Pace Of The Southern Piedmont | not reported | 120 (2016) | 7.3% calculated | not reported |
| not reported | Pace Of The Triad | not reported | 182 (2016) | 11.1% calculated | not reported |
| not reported | Partners Behavioral Health Manag | not reported | 153,055 (2016) | 9.7% calculated | not reported |
| not reported | Piedmont Health Services Inc | not reported | 220 (2016) | 13.4% calculated | not reported |
| not reported | Sandhills Center For Mh Dd Sa | not reported | 186,016 (2016) | 11.8% calculated | not reported |
| not reported | Senior Total Life Care, Inc. | not reported | 142 (2016) | 8.7% calculated | not reported |
| not reported | Stay Well Senior Care | not reported | 103 (2016) | 6.3% calculated | not reported |
| not reported | Trillium Health Resources | not reported | 192,504 (2016) | 12.2% calculated | not reported |
| not reported | Trillium Health Resources | not reported | 210,022 (2018) | 13.3% calculated | not reported |
| not reported | Vaya Health | not reported | 167,849 (2016) | 10.6% calculated | not reported |
| not reported | Voans Senior Community Care Of Nort | not reported | 159 (2016) | 9.7% calculated | not reported |
CMS reported enrollment
CMS reporting years in this file run from 2016 through 2024. Retrieved 2026-11-01. The latest reporting year is 2024, which is behind the retrieval date. Enrollment figures are the CMS cell for that reporting year. Share is calculated from CMS reported total enrollment for that state, program, and year. Precapture does not combine rows. A year missing from a trend was not reported. A plan and region with more than one CMS row in a year has no trend and no year-over-year change. The dataset says a reported 0 may not truly represent 0 when a state suppressed a small count. CMS reported.
1915(b)/(c) Medicaid Waiver for MH/DD/SA Services (Behavioral Health Organization (BHO) only (PIHP and/or PAHP))
1915(b)/(c) Medicaid Waiver for MH/DD/SA Services (Behavioral Health Organization (BHO) only (PIHP and/or PAHP)) 39
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Counties: Cumberland, Durham, Johnston, Wake | not reported | not reported | not reported | not reported | 2016: 231,640; 2017: 234,546; 2018: 235,021 |
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake Counties | not reported | not reported | not reported | not reported | 2022: 121,719 |
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Johnston, Wake | not reported | not reported | not reported | not reported | 2020: 246,961 |
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Johnston, and Wake Counties | not reported | not reported | not reported | not reported | 2019: 233,843 |
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Johnston, and Wake counties | not reported | not reported | not reported | not reported | 2021: 71,190 |
show all 39
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Cardinal Innovations Healthcare Sol | not reported | unmatched | Counties: Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren | not reported | not reported | not reported | not reported | 2016: 455,700 |
| Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren Counties | not reported | not reported | not reported | not reported | 2019: 444,996 |
| Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren counties | not reported | not reported | not reported | not reported | 2021: 131,460 |
| Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren | not reported | not reported | not reported | not reported | 2020: 459,700 |
| Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Cardinal Innovations Healthcare Solutions | Counties: Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren | not reported | not reported | not reported | not reported | 2017: 463,593; 2018: 459,024 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Bladen, Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, Wilson | not reported | not reported | not reported | not reported | 2020: 158,197 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Bladen, Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, and Wilson Counties | not reported | not reported | not reported | not reported | 2019: 154,945 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Bladen, Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, and Wilson counties | not reported | not reported | not reported | not reported | 2021: 50,080 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Counties: Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Nash, Robeson, Sampson, Scotland, Wayne, Wilson | not reported | not reported | not reported | not reported | 2016: 194,537; 2017: 177,945; 2018: 172,658 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne, and Wilson Counties | not reported | not reported | not reported | not reported | 2022: 52,175 |
| Partners Behavioral Health Manag | not reported | unmatched | Counties: Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry, Yadkin | not reported | not reported | not reported | not reported | 2016: 153,055 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry, Yadkin | not reported | not reported | not reported | not reported | 2020: 166,127 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry, and Yadkin Counties | not reported | not reported | not reported | not reported | 2019: 159,095 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry, and Yadkin counties | not reported | not reported | not reported | not reported | 2021: 54,729 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Counties: Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry, Yadkin | not reported | not reported | not reported | not reported | 2017: 153,982; 2018: 150,328 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, and Yadkin Counties | not reported | not reported | not reported | not reported | 2022: 97,427 |
| Sandhills Center For MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond | not reported | not reported | not reported | not reported | 2020: 196,116 |
| Sandhills Center For Mh Dd Sa | not reported | unmatched | Counties: Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond | not reported | not reported | not reported | not reported | 2016: 186,016 |
| Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, and Richmond Counties | not reported | not reported | not reported | not reported | 2019: 186,816 |
| Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, and Richmond counties | not reported | not reported | not reported | not reported | 2021: 55,539 |
| Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Counties: Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond | not reported | not reported | not reported | not reported | 2018: 189,502 |
| Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, and Rockingham Counties | not reported | not reported | not reported | not reported | 2022: 74,510 |
| Sandhills Center for MH/DD/SA | Sandhills Center for MH/DD/SA | Sandhills Center for MH DD SA | Counties: Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond | not reported | not reported | not reported | not reported | 2017: 190,341 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, and Washington Counties | not reported | not reported | not reported | not reported | 2022: 90,325 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington | not reported | not reported | not reported | not reported | 2020: 222,845 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, and Washington Counties | not reported | not reported | not reported | not reported | 2019: 216,254 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, and Washington counties | not reported | not reported | not reported | not reported | 2021: 76,855 |
| Trillium Health Resources | Trillium Health | unmatched | Counties: Brunswick, Carteret, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell, Washington | not reported | not reported | not reported | not reported | 2016: 192,504; 2017: 213,955; 2018: 210,022 |
| VAYA Health | VAYA Health | Vaya Health | Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Swain, Transylvania, Watauga, Wilkes, Yancey | not reported | not reported | not reported | not reported | 2020: 151,742 |
| VAYA Health | VAYA Health | Vaya Health | Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Swain, Transylvania, Watauga, Wilkes, and Yancey Counties | not reported | not reported | not reported | not reported | 2019: 146,740 |
| VAYA Health | VAYA Health | Vaya Health | Counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes, Yancey | not reported | not reported | not reported | not reported | 2018: 162,422 |
| Vaya Health | Vaya Health | Vaya Health | Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey Counties | not reported | not reported | not reported | not reported | 2022: 100,173 |
| Vaya Health | Vaya Health | Vaya Health | Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Swain, Transylvania, Watauga, Wilkes, and Yancey counties | not reported | not reported | not reported | not reported | 2021: 60,276 |
| Vaya Health | Vaya Health | Vaya Health | Counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes, Yancey | not reported | not reported | not reported | not reported | 2016: 167,849; 2017: 166,185 |
BH I/DD Tailored Plan (Comprehensive MCO + MLTSS)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Hartnett, Johnston, Mecklenburg, Orange, and Wake | CMS reported 58,355 (2024) | 26.5% | not reported | not reported | 2024: 58,355 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Cabarrus, Catawba, Cleveland, Davie, Davidson, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, and Yadkin | CMS reported 44,442 (2024) | 20.2% | not reported | not reported | 2024: 44,442 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Anson, Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Guilford, Halifax, Hertford, Hoke, Hyde, Jones, Lee, Lenoir, Martin, Montgomery, Moore, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Randolph, Richmond, Robeson, Sampson, Scotland, Tyrrell, Warren, Washington, Wayne, and Wilson | CMS reported 77,746 (2024) | 35.3% | not reported | not reported | 2024: 77,746 |
| Vaya Health | Vaya Health | Vaya Health | 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 | CMS reported 39,867 (2024) | 18.1% | not reported | not reported | 2024: 39,867 |
Community Care of North Carolina (PCCM Entity)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| North Carolina Community Care | North Carolina Community Care | North Carolina Community Care | Statewide | CMS reported 177,890 (2024) | 100.0% | -169,300 (-48.8%) | 0.0 pts | 2023: 347,190; 2024: 177,890 |
| North Carolina Community Care | North Carolina Community Care | North Carolina Community Care | – | not reported | not reported | not reported | not reported | 2022: 543,859 |
Community Care of North Carolina (Primary Care Case Management Entity (PCCM Entity))
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| North Carolina Community Care Carolina Access | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Statewide | not reported | not reported | not reported | not reported | 2016: 1,496,105; 2017: 1,510,955; 2018: 1,493,347 |
| North Carolina Community Care | North Carolina Community Care | North Carolina Community Care | Statewide | not reported | not reported | not reported | not reported | 2019: 1,591,218; 2020: 1,690,986; 2021: 515,661 |
EBCI Tribal Option (PCCM Entity)
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| EBCI Tribal Option | EBCI Tribal Option | EBCI Tribal Option | Cherokee, Graham, Haywood, Jackson, and Swain Counties | not reported | not reported | not reported | not reported | 2022: 4,366 |
| EBCI Tribal Option | EBCI Tribal Option | EBCI Tribal Option | Primary service area: Cherokee, Graham, Haywood, Jackson, and Swain | CMS reported 4,887 (2024) | 100.0% | +423 (+9.5%) | 0.0 pts | 2023: 4,464; 2024: 4,887 |
EBCI Tribal Option (Primary Care Case Management Entity (PCCM Entity))
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| EBCI Tribal Option | EBCI Tribal Option | EBCI Tribal Option | Primary service areas: Cherokee, Graham, Haywood, Jackson and Swain counties; Beneficiaries can opt-in: Buncombe, Clay, Henderson, Macon, Madison, and Transylvania counties | not reported | not reported | not reported | not reported | 2021: 3,867 |
Medicaid Direct Prepaid Inpatient Health Plan (BHO only (PIHP and/or PAHP))
Medicaid Direct Prepaid Inpatient Health Plan (BHO only (PIHP and/or PAHP)) 10
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Hartnett, Johnston, Mecklenburg, Orange, and Wake | CMS reported 89,937 (2024) | 24.8% | not reported | not reported | 2024: 89,937 |
| Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Alliance Behavioral Healthcare | Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake | not reported | not reported | not reported | not reported | 2023: 125,326 |
| Eastpointe Human Services | Eastpointe Human Services | Eastpointe Human Services | Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne, and Wilson | not reported | not reported | not reported | not reported | 2023: 50,860 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Cabarrus, Catawba, Cleveland, Davie, Davidson, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, and Yadkin | CMS reported 69,882 (2024) | 19.3% | not reported | not reported | 2024: 69,882 |
| Partners Behavioral Health Management | Partners Behavioral Health Management | Partners Behavioral Health Management | Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, and Yadkin | not reported | not reported | not reported | not reported | 2023: 97,416 |
show all 10
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Sandhills Center for MH DD SA | Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, and Rockingham | not reported | not reported | not reported | not reported | 2023: 73,246 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Anson, Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Guilford, Halifax, Hertford, Hoke, Hyde, Jones, Lee, Lenoir, Martin, Montgomery, Moore, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Randolph, Richmond, Robeson, Sampson, Scotland, Tyrrell, Warren, Washington, Wayne, and Wilson | CMS reported 128,856 (2024) | 35.5% | not reported | not reported | 2024: 128,856 |
| Trillium Health Resources | Trillium Health Resources | Trillium Health Resources | Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, and Washington | not reported | not reported | not reported | not reported | 2023: 89,113 |
| Vaya Health | Vaya Health | Vaya Health | 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 | CMS reported 74,055 (2024) | 20.4% | not reported | not reported | 2024: 74,055 |
| Vaya Health | Vaya Health | Vaya Health | Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey | not reported | not reported | not reported | not reported | 2023: 99,425 |
Program of All Inclusive Care for the Elderly (PACE) (Program of All-inclusive Care for the Elderly (PACE))
Program of All Inclusive Care for the Elderly (PACE) (Program of All-inclusive Care for the Elderly (PACE)) 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Care Partners | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Buncombe and Henderson Counties | not reported | not reported | not reported | not reported | 2019: 193 |
| Carolina Seniorcare | Carolina Seniorcare | Carolina SeniorCare | Rowan, Davidson, Davie and Iredell Counties | not reported | not reported | not reported | not reported | 2019: 218 |
| Elderhaus | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover and Brunswick Counties | not reported | not reported | not reported | not reported | 2019: 125 |
| LIFE St. Joseph of the Pines | Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Cumberland Country and portions of Harnett, Robeson, Moore and Hoke Counties | not reported | not reported | not reported | not reported | 2019: 286 |
| PACE @Home | PACE | unmatched | Catawba County and portions of Lincoln, Burke, Caldwell and Alexander Counties | not reported | not reported | not reported | not reported | 2019: 165 |
show all 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| PACE of the Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus, and Union Counties and portions of Stanley County | not reported | not reported | not reported | not reported | 2019: 186 |
| PACE of the Triad | PACE | unmatched | Guilford and Rockingham Counties | not reported | not reported | not reported | not reported | 2019: 235 |
| Piedmont Health SeniorCare | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee, and Orange Counties and a portion of Durham County | not reported | not reported | not reported | not reported | 2019: 337 |
| Senior Total Life Care | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston County and portions of Cleveland and Lincoln Counties | not reported | not reported | not reported | not reported | 2019: 245 |
| Staywell | Stay Well Senior Care | Stay Well Senior Care | Randolph and Montgomery Counties and a portion of Moore County | not reported | not reported | not reported | not reported | 2019: 108 |
| VOANS Senior CommUnity Care of North Carolina | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Durham and Wake Counties and a portion of Granville County | not reported | not reported | not reported | not reported | 2019: 212 |
Program of All Inclusive Care for the Elderly (Program of All-inclusive Care for the Elderly (PACE))
Program of All Inclusive Care for the Elderly (Program of All-inclusive Care for the Elderly (PACE)) 44
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CarePartners PACE | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Buncombe and Henderson County | not reported | not reported | not reported | not reported | 2020: 206 |
| Carolina SeniorCare | Carolina SeniorCare | Carolina SeniorCare | Serving the following zip codes in Davidson, Davie, Iredell and Rowan Counties: 27012, 27107, 27127, 27239, 27262, 27265, 27284, 27292, 27295, 27299, 27360, 28127, 27013, 27054, 28023, 28071, 28081, 28083, 28088, 28125, 28137, 28138, 28144, 28146, 28147, 28159, 27006, 27028, 27013, 27020, 28115, 28117, 28166, 28625, 28634, 28636, 28660, 28677, 28689 | not reported | not reported | not reported | not reported | 2017: 207 |
| Carolina Seniorcare | Carolina Seniorcare | Carolina SeniorCare | Rowan, Davidson, Davie and Iredell Counties | not reported | not reported | not reported | not reported | 2020: 194 |
| Carolina Seniorcare | Carolina Seniorcare | Carolina SeniorCare | Serving the following zip codes in Davidson, Davie, Iredell and Rowan Counties: 27012, 27107, 27127, 27239, 27262, 27265, 27284, 27292, 27295, 27299, 27360, 28127, 27013, 27054, 28023, 28071, 28081, 28083, 28088, 28125, 28137, 28138, 28144, 28146, 28147, 28159, 27006, 27028, 27013, 27020, 28115, 28117, 28166, 28625, 28634, 28636, 28660, 28677, 28689 | not reported | not reported | not reported | not reported | 2018: 206 |
| Carolina Seniorcare | not reported | unmatched | Serving the following zip codes in Davidson, Davie, Iredell and Rowan Counties: 27012, 27107, 27127, 27239, 27262, 27265, 27284, 27292, 27295, 27299, 27360, 28127, 27013, 27054, 28023, 28071, 28081, 28083, 28088, 28125, 28137, 28138, 28144, 28146, 28147, 28159, 27006, 27028, 27013, 27020, 28115, 28117, 28166, 28625, 28634, 28636, 28660, 28677, 28689 | not reported | not reported | not reported | not reported | 2016: 191 |
show all 44
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Community CarePartners, Inc. | Community CarePartners, Inc. | Community CarePartners, Inc. | Serving the following zip codes in Buncombe and Henderson Counties: 28701, 28704, 28709, 28710, 28711, 28715, 28726, 28729, 28730, 28731, 28732, 28735, 28739, 28742, 28748, 28757, 28758, 28759, 28766, 28773, 28778, 28787, 28784, 28790, 28791, 28792, 28801, 28803, 28804, 28805, 28806, 28810 | not reported | not reported | not reported | not reported | 2017: 123 |
| Community Carepartners, Inc. | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Serving the following zip codes in Buncombe and Henderson Counties: 28701, 28704, 28709, 28710, 28711, 28715, 28726, 28729, 28730, 28731, 28732, 28735, 28739, 28742, 28748, 28757, 28758, 28759, 28766, 28773, 28778, 28787, 28784, 28790, 28791, 28792, 28801, 28803, 28804, 28805, 28806, 28810 | not reported | not reported | not reported | not reported | 2018: 166 |
| Community Carepartners, Inc. | not reported | unmatched | Serving the following zip codes in Buncombe and Henderson Counties: 28701, 28704, 28709, 28710, 28711, 28715, 28726, 28729, 28730, 28731, 28732, 28735, 28739, 28742, 28748, 28757, 28758, 28759, 28766, 28773, 28778, 28787, 28784, 28790, 28791, 28792, 28801, 28803, 28804, 28805, 28806, 28810 | not reported | not reported | not reported | not reported | 2016: 72 |
| Elderhaus Inc | Elderhaus Inc | Elderhaus, Inc. | Serving all zip codes in New Hanover County, the following zip codes in Brunswick County: 28422, 28451, 28461, 28479 and the following zip codes in Pender County: 28443 | not reported | not reported | not reported | not reported | 2017: 111 |
| Elderhaus Inc | not reported | unmatched | Serving all zip codes in New Hanover County and the following zip codes in Brunswick County: 28422, 28451, 28461, 28479 | not reported | not reported | not reported | not reported | 2016: 108 |
| Elderhaus, Inc. | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover County and the following zip codes in Brunswick County: 28422, 28451, 28461, 28479 and the following zip code in Pender County: 28443 | not reported | not reported | not reported | not reported | 2018: 123 |
| Elderhaus, Inc. | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover and Brunswick Counties | not reported | not reported | not reported | not reported | 2020: 128 |
| LIFE St. Joseph of the Pines Inc | LIFE St. Joseph of the Pines Inc | Life St. Joseph of the Pines, Inc. | Serving the following zip codes in Cumberland, Harnett Hoke, Moore and Robeson Counties:28301, 28302, 28303, 28304, 28305, 28306, 28307, 28308, 28309, 28310, 28311, 28312, 28314, 28318, 28342, 28344, 28348, 28356, 28371, 28382, 28390, 28391, 28395, 28315, 28326, 28373, 28376, 28357, 28371, 28377, 28384, 28315, 28357, 28376, 28377, 28386, 28314, 28334, 28339 | not reported | not reported | not reported | not reported | 2017: 239 |
| Life St Joseph Of The Pines Inc | not reported | unmatched | Serving the following zip codes in Cumberland, Harnett Hoke, Moore and Robeson Counties: 28301, 28302, 28303, 28304, 28305, 28306, 28307, 28308, 28309, 28310, 28311, 28312, 28314, 28318, 28342, 28344, 28348, 28356, 28371, 28382, 28390, 28391, 28395, 28315, 28326, 28373, 28376, 28357, 28371, 28377, 28384, 28315, 28357, 28376, 28377, 28386, 28314, 28334, 28339 | not reported | not reported | not reported | not reported | 2016: 221 |
| Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Cumberland, and portions of Harnett, Robeson, Moore and Hoke Counties | not reported | not reported | not reported | not reported | 2020: 276 |
| Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Serving the following zip codes in Cumberland, Harnett Hoke, Moore and Robeson Counties: 28301, 28302, 28303, 28304, 28305, 28306, 28307, 28308, 28309, 28310, 28311, 28312, 28314, 28318, 28342, 28344, 28348, 28356, 28371, 28382, 28390, 28391, 28395, 28315, 28326, 28373, 28376, 28357, 28371, 28377, 28384, 28315, 28357, 28376, 28377, 28386, 28314, 28334, 28339 | not reported | not reported | not reported | not reported | 2018: 274 |
| PACE At Home Inc | PACE At Home Inc | PACE At Home Inc | Serving all zip codes in Catawba County and portions of zip codes in Alexander, Burke, Caldwell and Lincoln Counties: 28037, 28092, 28168, 28601, 28602, 28609, 28610, 28612, 28613, 28630, 28637, 28638, 28650, 28658, 28673, 28678, 28681, 28682, 28690 | not reported | not reported | not reported | not reported | 2017: 139 |
| PACE At Home Inc | PACE | unmatched | Catawba, and portions of Lincoln, Burke, Caldwell and Alexander Counties | not reported | not reported | not reported | not reported | 2020: 145 |
| PACE Of The Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus and Union, and portions of Stanley Counties | not reported | not reported | not reported | not reported | 2020: 173 |
| PACE Of The Triad | PACE | unmatched | Guilford and Rockingham Counties | not reported | not reported | not reported | not reported | 2020: 233 |
| PACE at Home, Inc. | PACE | unmatched | Catawba County and portions of zip codes in Alexander, Burke, Caldwell and Lincoln Counties: 28037, 28092, 28168, 28601, 28602, 28609, 28610, 28612, 28613, 28630, 28637, 28638, 28650, 28658, 28673, 28678, 28681, 28682, 28690 | not reported | not reported | not reported | not reported | 2018: 145 |
| PACE of the Southern Piedmont | PACE of the Southern Piedmont | PACE of the Southern Piedmont | Serving the following zip codes in Mecklenburg, Cabarrus, Stanly and Union Counties: 28025, 28027, 28031, 28036, 28071, 28075, 28078, 28079, 28081, 28083, 28097, 28103, 28104, 28105, 28107, 28109, 28110, 28112, 28124, 28129, 28134, 28137, 28138, 28215, 28163, 28173, 28174, 28202, 28203, 28204, 28205, 28206, 28207, 28208, 28209, 28210, 28211, 28212, 28213, 28214, 28216, 28217, 28223, 28226, 28227, 28244, 28226, 28227, 28244, 28246, 28254, 28262, 28269, 28270, 28273, 28274, 28277, 28278, 28280, 28281, 28282, 28284, 28285, 28287 | not reported | not reported | not reported | not reported | 2017: 145 |
| PACE of the Southern Piedmont | PACE | unmatched | Serving the following zip codes in Mecklenburg, Cabarrus, Stanly and Union Counties: 28025, 28027, 28031, 28036, 28071, 28075, 28078, 28079, 28081, 28083, 28097, 28103, 28104, 28105, 28107, 28109, 28110, 28112, 28124, 28129, 28134, 28137, 28138, 28215, 28163, 28173, 28174, 28202, 28203, 28204, 28205, 28206, 28207, 28208, 28209, 28210, 28211, 28212, 28213, 28214, 28216, 28217, 28223, 28226, 28227, 28244, 28226, 28227, 28244, 28246, 28254, 28262, 28269, 28270, 28273, 28274, 28277, 28278, 28280, 28281, 28282, 28284, 28285, 28287 | not reported | not reported | not reported | not reported | 2018: 162 |
| PACE of the Triad | PACE of the Triad | PACE of the Triad | Serving the following zip codes in Guilford and Rockingham Counties:27027, 27048, 27288, 27235, 27282, 27301, 27310, 27377, 27401, 27403, 27405, 27406, 27407, 27408, 27409, 27410, 27455, 27495, 27025, 27214, 27233, 27244, 27249, 27260, 27262, 27263, 27265, 27283, 27284, 27298, 27311, 27313, 27320, 27326, 27357, 27358 | not reported | not reported | not reported | not reported | 2017: 189 |
| PACE of the Triad | PACE | unmatched | Serving the following zip codes in Guilford and Rockingham Counties: 27027, 27048, 27288, 27235, 27282, 27301, 27310, 27377, 27401, 27403, 27405, 27406, 27407, 27408, 27409, 27410, 27455, 27495, 27025, 27214, 27233, 27244, 27249, 27260, 27262, 27263, 27265, 27283, 27284, 27298, 27311, 27313, 27320, 27326, 27357, 27358 | not reported | not reported | not reported | not reported | 2018: 205 |
| Pace At Home Inc | not reported | unmatched | Serving all zip codes in Catawba County and portions of zip codes in Alexander, Burke, Caldwell and Lincoln Counties: 28037, 28092, 28168, 28601, 28602, 28609, 28610, 28612, 28613, 28630, 28637, 28638, 28650, 28658, 28673, 28678, 28681, 28682, 28690 | not reported | not reported | not reported | not reported | 2016: 118 |
| Pace Of The Southern Piedmont | not reported | unmatched | Serving the following zip codes in Mecklenburg, Cabarrus, Stanly and Union Counties: 28025, 28027, 28031, 28036, 28071, 28075, 28078, 28079, 28081, 28083, 28097, 28103, 28104, 28105, 28107, 28109, 28110, 28112, 28124, 28129, 28134, 28137, 28138, 28215, 28163, 28173, 28174, 28202, 28203, 28204, 28205, 28206, 28207, 28208, 28209, 28210, 28211, 28212, 28213, 28214, 28216, 28217, 28223, 28226, 28227, 28244, 28226, 28227, 28244, 28246, 28254, 28262, 28269, 28270, 28273, 28274, 28277, 28278, 28280, 28281, 28282, 28284, 28285, 28287 | not reported | not reported | not reported | not reported | 2016: 120 |
| Pace Of The Triad | not reported | unmatched | Serving the following zip codes in Guilford and Rockingham Counties: 27027, 27048, 27288, 27235, 27282, 27301, 27310, 27377, 27401, 27403, 27405, 27406, 27407, 27408, 27409, 27410, 27455, 27495, 27025, 27214, 27233, 27244, 27249, 27260, 27262, 27263, 27265, 27283, 27284, 27298, 27311, 27313, 27320, 27326, 27357, 27358 | not reported | not reported | not reported | not reported | 2016: 182 |
| Piedmont Health Services Inc | Piedmont Health Services Inc | Piedmont Health Services, Inc. | Serving the following zip codes in Alamance, Caswell, Orange, Chatham, Lee Counties and the portion of 27278 located in Durham County:27231, 27243, 27278, 27302, 27510, 27514, 27516, 27517, 27541, 27572, 27705, 27583, 27707, 27712, 27207, 27208, 27252, 27298, 27312, 27330, 27344, 27349, 27355, 27502, 27519, 27523, 27559, 27562, 27713, 27330, 27332, 27505, 28326 | not reported | not reported | not reported | not reported | 2017: 304 |
| Piedmont Health Services Inc | not reported | unmatched | Serving the following zip codes in Alamance, Caswell, Orange, Chatham, Lee Counties and the portion of 27278 located in Durham County: 27231, 27243, 27278, 27302, 27510, 27514, 27516, 27517, 27541, 27572, 27705, 27583, 27707, 27712, 27207, 27208, 27252, 27298, 27312, 27330, 27344, 27349, 27355, 27502, 27519, 27523, 27559, 27562, 27713, 27330, 27332, 27505, 28326 | not reported | not reported | not reported | not reported | 2016: 220 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee and Orange, and a portion of Durham County | not reported | not reported | not reported | not reported | 2020: 322 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Serving the following zip codes in Alamance, Caswell, Orange, Chatham, Lee Counties and the portion of 27278 located in Durham County: 27231, 27243, 27278, 27302, 27510, 27514, 27516, 27517, 27541, 27572, 27705, 27583, 27707, 27712, 27207, 27208, 27252, 27298, 27312, 27330, 27344, 27349, 27355, 27502, 27519, 27523, 27559, 27562, 27713, 27330, 27332, 27505, 28326 | not reported | not reported | not reported | not reported | 2018: 327 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston, and portions of Cleveland and Lincoln Counties | not reported | not reported | not reported | not reported | 2020: 249 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Serving the following zip codes in Cleveland, Gaston and Lincoln Counties: 28006, 28012, 28016, 28021, 28032, 28033, 28034, 28052, 28053, 28054, 28055, 28056, 28077, 28080, 28086, 28092, 28098, 28101, 28120, 28164, 28021, 28073, 28086, 28150, 28152, 28006, 28021, 28033, 28080, 28164 | not reported | not reported | not reported | not reported | 2018: 211 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Serving the following zip codes in Cleveland, Gaston and Lincoln Counties:28006, 28012, 28016, 28021, 28032, 28033, 28034, 28052, 28053, 28054, 28055, 28056, 28077, 28080, 28086, 28092, 28098, 28101, 28120, 28164, 28021, 28073, 28086, 28150, 28152, 28006, 28021, 28033, 28080, 28164 | not reported | not reported | not reported | not reported | 2017: 191 |
| Senior Total Life Care, Inc. | not reported | unmatched | Serving the following zip codes in Cleveland, Gaston and Lincoln Counties: 28006, 28012, 28016, 28021, 28032, 28033, 28034, 28052, 28053, 28054, 28055, 28056, 28077, 28080, 28086, 28092, 28098, 28101, 28120, 28164, 28021, 28073, 28086, 28150, 28152, 28006, 28021, 28033, 28080, 28164 | not reported | not reported | not reported | not reported | 2016: 142 |
| Stay Well Senior Care | Stay Well Senior Care | Stay Well Senior Care | Serving the following zip codes in Montgomery, Moore and Randolph Counties: 27203, 27205, 27208, 27233, 27239, 27248, 27260, 27263, 27283, 27292, 27298, 27313, 27316, 27317, 27325, 27341, 27344, 27350, 27355, 27360, 27370, 27371, 28127, 27209, 27229, 27281, 27306, 27341, 27356, 27371, 28127, 27208, 27209, 27242, 27281, 27325, 27330, 27341, 27356, 27376, 28327, 28347, 28350, 28374, 28387, 28394 | not reported | not reported | not reported | not reported | 2018: 104 |
| Stay Well Senior Care | not reported | unmatched | Serving the following zip codes in Montgomery, Moore and Randolph Counties: 27203, 27205, 27208, 27233, 27239, 27248, 27260, 27263, 27283, 27292, 27298, 27313, 27316, 27317, 27325, 27341, 27344, 27350, 27355, 27360, 27370, 27371, 28127, 27209, 27229, 27281, 27306, 27341, 27356, 27371, 28127, 27208, 27209, 27242, 27281, 27325, 27330, 27341, 27356, 27376, 28327, 28347, 28350, 28374, 28387, 28394 | not reported | not reported | not reported | not reported | 2016: 103 |
| StayWell Senior Care | StayWell Senior Care | Staywell Senior Care | Serving the following zip codes in Montgomery, Moore and Randolph Counties:27203, 27205, 27208, 27233, 27239, 27248, 27260, 27263, 27283, 27292, 27298, 27313, 27316, 27317, 27325, 27341, 27344, 27350, 27355, 27360, 27370, 27371, 28127, 27209, 27229, 27281, 27306, 27341, 27356, 27371, 28127, 27208, 27209, 27242, 27281, 27325, 27330, 27341, 27356, 27376, 28327, 28347, 28350, 28374, 28387, 28394 | not reported | not reported | not reported | not reported | 2017: 103 |
| Staywell | Stay Well Senior Care | Stay Well Senior Care | Montgomery, Moore and Randolph | not reported | not reported | not reported | not reported | 2020: 87 |
| VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | Serving the following zip codes in Durham, Wake County : 27503, 27613, 27701, 27703, 27704, 27705, 27706, 27707, 27712, 27713, 27502, 27511, 27513, 27518, 27519, 27523, 27526, 27529, 27539, 27540, 27545, 27560, 27562, 27571, 27587, 27591, 27592, 27597, 27601, 27603, 27604, 27605, 27606, 27607, 27608, 27609, 27610, 27612, 27613, 27614, 27615, 27616, 27617 and Granville County zip codes: 27509, 27522 | not reported | not reported | not reported | not reported | 2017: 192 |
| VOANS Senior Community Care | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Serving the following zip codes in Durham, Wake County: 27503, 27613, 27701, 27703, 27704, 27705, 27706, 27707, 27712, 27713, 27502, 27511, 27513, 27518, 27519, 27523, 27526, 27529, 27539, 27540, 27545, 27560, 27562, 27571, 27587, 27591, 27592, 27597, 27601, 27603, 27604, 27605, 27606, 27607, 27608, 27609, 27610, 27612, 27613, 27614, 27615, 27616, 27617 and Granville County zip codes: 27509, 27522 | not reported | not reported | not reported | not reported | 2018: 189 |
| Voans Senior Community Care Of Nort | not reported | unmatched | Serving the following zip codes in Durham, Wake County : 27503, 27613, 27701, 27703, 27704, 27705, 27706, 27707, 27712, 27713, 27502, 27511, 27513, 27518, 27519, 27523, 27526, 27529, 27539, 27540, 27545, 27560, 27562, 27571, 27587, 27591, 27592, 27597, 27601, 27603, 27604, 27605, 27606, 27607, 27608, 27609, 27610, 27612, 27613, 27614, 27615, 27616, 27617 and Granville County zip codes: 27509, 27522 | not reported | not reported | not reported | not reported | 2016: 159 |
| Voans Senior Community Care Of North Carolina | Community Care Health Plan (WI) | Community Care Health Plan (WI) | Durham and Wake, and a portion of Granville Counties | not reported | not reported | not reported | not reported | 2020: 192 |
Program of All Inclusive for the Elderly (PACE)
Program of All Inclusive for the Elderly (PACE) 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CarePartners PACE | CarePartners PACE | CarePartners PACE | Buncombe and Henderson | CMS reported 215 (2024) | 10.0% | not reported | not reported | 2024: 215 |
| Carolina SeniorCare | Carolina SeniorCare | Carolina SeniorCare | Rowan, Davidson, Davie, and Iredell | CMS reported 129 (2024) | 6.0% | not reported | not reported | 2024: 129 |
| Elderhaus, Inc. | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover, and Brunswick | CMS reported 118 (2024) | 5.5% | not reported | not reported | 2024: 118 |
| LIFE St. Joseph of the Pines, Inc. | LIFE St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Cumberland, portions of Harnett, Robeson, Moore, and Hoke | CMS reported 191 (2024) | 8.9% | not reported | not reported | 2024: 191 |
| PACE at Home, Inc. | PACE | unmatched | Catawba, portions of Lincoln, Burke, Caldwell, and Alexander | CMS reported 157 (2024) | 7.3% | not reported | not reported | 2024: 157 |
show all 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| PACE of the Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus, Union, and portions of Stanley | CMS reported 243 (2024) | 11.3% | not reported | not reported | 2024: 243 |
| PACE of the Triad | PACE | unmatched | Guilford and Rockingham | CMS reported 249 (2024) | 11.5% | not reported | not reported | 2024: 249 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee, Orange, and a portion of Durham | CMS reported 294 (2024) | 13.6% | not reported | not reported | 2024: 294 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston, portions of Cleveland and Lincoln | CMS reported 304 (2024) | 14.1% | not reported | not reported | 2024: 304 |
| Staywell | Staywell Senior Care | Staywell Senior Care | Montgomery, Moore, and Randolph | CMS reported 87 (2024) | 4.0% | not reported | not reported | 2024: 87 |
| VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | Durham, Wake, and a portion of Granville | CMS reported 170 (2024) | 7.9% | not reported | not reported | 2024: 170 |
Program of All Inclusive for the Elderly (Program of All-inclusive Care for the Elderly (PACE))
Program of All Inclusive for the Elderly (Program of All-inclusive Care for the Elderly (PACE)) 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CarePartners PACE | CarePartners PACE | CarePartners PACE | Buncombe and Henderson counties | not reported | not reported | not reported | not reported | 2021: 211 |
| Carolina Seniorcare | Carolina Seniorcare | Carolina SeniorCare | Rowan, Davidson, Davie and Iredell counties | not reported | not reported | not reported | not reported | 2021: 181 |
| Elderhaus, Inc | Elderhaus, Inc | Elderhaus, Inc. | New Hanover and Brunswick counties | not reported | not reported | not reported | not reported | 2021: 123 |
| Life of St. Joseph of the Pines, Inc. | Life of St. Joseph of the Pines, Inc. | Life of St. Joseph of the Pines, Inc. | Cumberland county, and portions of Harnett, Robeson, Moore and Hoke counties | not reported | not reported | not reported | not reported | 2021: 250 |
| PACE at Home Inc. | PACE | unmatched | Catawba county, and portions of Lincoln, Burke, Caldwell and Alexander counties | not reported | not reported | not reported | not reported | 2021: 127 |
show all 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| PACE of the Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus and Union counties, and portions of Stanley county | not reported | not reported | not reported | not reported | 2021: 184 |
| PACE of the Triad | PACE | unmatched | Guilford and Rockingham counties | not reported | not reported | not reported | not reported | 2021: 220 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee and Orange counties, and a portion of Durham county | not reported | not reported | not reported | not reported | 2021: 303 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston county, and portions of Cleveland and Lincoln counties | not reported | not reported | not reported | not reported | 2021: 238 |
| Staywell | Staywell Senior Care | Staywell Senior Care | Montgomery, Moore and Randolph counties | not reported | not reported | not reported | not reported | 2021: 77 |
| Voans Senior Community Care of North Carolina | Voans Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | Durham and Wake counties, and a portion of Granville county | not reported | not reported | not reported | not reported | 2021: 176 |
Program of All-Inclusive Care for the Elderly (PACE)
Program of All-Inclusive Care for the Elderly (PACE) 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CarePartners PACE | CarePartners PACE | CarePartners PACE | Buncombe and Henderson Counties | not reported | not reported | not reported | not reported | 2022: 208 |
| Carolina SeniorCare | Carolina SeniorCare | Carolina SeniorCare | Rowan, Davidson, Davie, and Iredell Counties | not reported | not reported | not reported | not reported | 2022: 159 |
| Elderhaus, Inc. | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover and Brunswick Counties | not reported | not reported | not reported | not reported | 2022: 109 |
| Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Cumberland, and portions of Harnett, Robeson, Moore, and Hoke Counties | not reported | not reported | not reported | not reported | 2022: 221 |
| PACE at Home, Inc. | PACE | unmatched | Catawba, and portions of Lincoln, Burke, Caldwell, and Alexander Counties | not reported | not reported | not reported | not reported | 2022: 123 |
show all 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| PACE of the Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus, Union, and portions of Stanley Counties | not reported | not reported | not reported | not reported | 2022: 182 |
| PACE of the Triad | PACE | unmatched | Guilford and Rockingham Counties | not reported | not reported | not reported | not reported | 2022: 239 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee Orange, and a portion of Durham Counties | not reported | not reported | not reported | not reported | 2022: 306 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston, and portions of Cleveland and Lincoln Counties | not reported | not reported | not reported | not reported | 2022: 233 |
| Staywell | Staywell Senior Care | Staywell Senior Care | Montgomery, Moore, and Randolph Counties | not reported | not reported | not reported | not reported | 2022: 79 |
| Voans Senior Community Care of North Carolina | Voans Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | Durham, Wake, and a portion of Granville Counties | not reported | not reported | not reported | not reported | 2022: 172 |
Program of All-Inclusive for the Elderly (PACE)
Program of All-Inclusive for the Elderly (PACE) 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| CarePartners PACE | CarePartners PACE | CarePartners PACE | Buncombe and Henderson | not reported | not reported | not reported | not reported | 2023: 217 |
| Carolina SeniorCare | Carolina SeniorCare | Carolina SeniorCare | Rowan, Davidson, Davie, and Iredell | not reported | not reported | not reported | not reported | 2023: 152 |
| Elderhaus, Inc. | Elderhaus, Inc. | Elderhaus, Inc. | New Hanover and Brunswick | not reported | not reported | not reported | not reported | 2023: 111 |
| LIFE St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Life St. Joseph of the Pines, Inc. | Cumberland, Portions of Harnett, Robeson, Moore, and Hoke | not reported | not reported | not reported | not reported | 2023: 207 |
| PACE at Home, Inc. | PACE | unmatched | Catawba, portions of Lincoln, Burke, Caldwell, and Alexander | not reported | not reported | not reported | not reported | 2023: 154 |
show all 11
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| PACE of the Southern Piedmont | PACE | unmatched | Mecklenburg, Cabarrus, Union, and portions of Stanley | not reported | not reported | not reported | not reported | 2023: 211 |
| PACE of the Triad | PACE | unmatched | Guilford and Rockingham | not reported | not reported | not reported | not reported | 2023: 239 |
| Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Piedmont Health Services, Inc. | Alamance, Caswell, Chatham, Lee, Orange, and a portion of Durham | not reported | not reported | not reported | not reported | 2023: 293 |
| Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Senior Total Life Care, Inc. | Gaston, portions of Cleveland and Lincoln | not reported | not reported | not reported | not reported | 2023: 285 |
| Staywell | Staywell Senior Care | Staywell Senior Care | Montgomery, Moore, and Randolph | not reported | not reported | not reported | not reported | 2023: 89 |
| VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | VOANS Senior Community Care of North Carolina | Durham, Wake, and a portion of Granville | not reported | not reported | not reported | not reported | 2023: 166 |
Standard Plan (Comprehensive MCO + MLTSS)
Standard Plan (Comprehensive MCO + MLTSS) 13
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| AmeriHealth Caritas | AmeriHealth Caritas of North Carolina | AmeriHealth Caritas of North Carolina | Statewide | CMS reported 387,174 (2024) | 17.6% | +51,470 (+15.3%) | -0.2 pts | 2023: 335,704; 2024: 387,174 |
| AmeriHealth Caritas | AmeriHealth Caritas of North Carolina | AmeriHealth Caritas of North Carolina | – | not reported | not reported | not reported | not reported | 2022: 305,459 |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | AmeriHealth Caritas of North Carolina | Statewide | not reported | not reported | not reported | not reported | 2021: 290,989 |
| Carolina Complete Health | Carolina Complete Health, Inc. | Centene | Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly, Union, Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, Wilson, Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson, and Scotland Counties | not reported | not reported | not reported | not reported | 2022: 218,237 |
| Carolina Complete Health | Carolina Complete Health, Inc. | Centene | Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly, Union, Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, Wilson, Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson, and Scotland counties | not reported | not reported | not reported | not reported | 2021: 203,876 |
show all 13
| Plan | CMS parent | Parent | Region | 2024 enrollment | 2024 share | Change from prior reporting year, calculated | Share change, calculated | Trend |
|---|---|---|---|---|---|---|---|---|
| Carolina Complete Health | Carolina Complete Health, Inc. | Centene | Alexander, Anson, Cabarrus, Catawba, Cleveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly, Union, Alamance, Caswell, Chatham, Durham, Franklin, Granville, Johnston, Nash, Orange, Person, Vance, Wake, Warren, Wilson, Bladen, Brunswick, Columbus, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, New Hanover, Pender, Richmond, Robeson, Sampson, and Scotland | CMS reported 274,181 (2024) | 12.5% | +34,143 (+14.2%) | -0.3 pts | 2023: 240,038; 2024: 274,181 |
| Healthy Blue of North Carolina | Blue Cross and Blue Shield of North Carolina | Blue Cross and Blue Shield of North Carolina | Statewide | CMS reported 592,325 (2024) | 27.0% | +80,808 (+15.8%) | -0.2 pts | 2021: 386,181; 2023: 511,517; 2024: 592,325 |
| Healthy Blue of North Carolina | Blue Cross and Blue Shield of North Carolina | Blue Cross and Blue Shield of North Carolina | – | not reported | not reported | not reported | not reported | 2022: 447,068 |
| UnitedHealthcare | UnitedHealthcare of North Carolina, Inc. | UnitedHealth | Statewide | CMS reported 461,957 (2024) | 21.0% | +72,367 (+18.6%) | +0.4 pts | 2021: 342,725; 2023: 389,590; 2024: 461,957 |
| UnitedHealthcare | UnitedHealthcare of North Carolina, Inc. | UnitedHealth | – | not reported | not reported | not reported | not reported | 2022: 366,519 |
| WellCare | WellCare of North Carolina, Inc. | Centene | Statewide | CMS reported 481,884 (2024) | 21.9% | not reported | not reported | 2024: 481,884 |
| Wellcare | WellCare of North Carolina, Inc. | Centene | – | not reported | not reported | not reported | not reported | 2022: 361,365 |
| Wellcare | Wellcare of North Carolina, Inc. | Centene | Statewide | not reported | not reported | not reported | not reported | 2021: 324,114; 2023: 409,195 |
Plan operations (CMS MCPAR)
Counts, rates, dates, and status are the CMS MCPAR cells for that plan, program, and reporting year. The appeal rate is calculated from CMS reported appeals resolved in favor of the enrollee divided by CMS reported appeals resolved. It is not a CMS-published rate. A plan links when the name matches one enrollment plan in that same state and program. Unmatched is shown and is not guessed. A sanction amount is not on this page. Retrieved 2026-11-02. CMS MCPAR.
National plan operations · Federal compliance deadlines
Appeals, grievances, and enrollment share (2024)
Appeals, grievances, and enrollment share (2024) 13
| Plan | Parent | Program | Appeals resolved | In favor of enrollee | Appeal rate | Grievances resolved | Medicaid enrollment share | Managed care enrollment share |
|---|---|---|---|---|---|---|---|---|
| North Carolina Community Care | North Carolina Community Care | Community Care of North Carolina | not reported | not reported | not reported | not reported | 12.6% | 14.6% |
| Alliance | Alliance Behavioral Healthcare | PIHP | 149 | not reported | not reported | 748 | 4.5% | 5.2% |
| Eastpointe | Eastpointe Human Services | PIHP | 15 | not reported | not reported | 177 | 1.7% | 2% |
| Partners | unmatched | PIHP | 154 | not reported | not reported | 220 | 3.5% | 4% |
| Sandhills | Sandhills Center for MH DD SA | PIHP | 12 | not reported | not reported | 159 | 2.5% | 2.9% |
show all 13
| Plan | Parent | Program | Appeals resolved | In favor of enrollee | Appeal rate | Grievances resolved | Medicaid enrollment share | Managed care enrollment share |
|---|---|---|---|---|---|---|---|---|
| Trillium | Trillium Health Resources | PIHP | 25 | not reported | not reported | 261 | 4.3% | 5% |
| Vaya | Vaya Health | PIHP | 189 | not reported | not reported | 474 | 3.5% | 4.1% |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Standard Plan | 1,795 | not reported | not reported | 820 | 12% | 13.9% |
| Blue Cross and Blue Shield | unmatched | Standard Plan | 2,080 | not reported | not reported | 1,324 | 18.3% | 21.1% |
| Carolina Complete Health | Centene | Standard Plan | 1,074 | not reported | not reported | 491 | 8.5% | 9.9% |
| UnitedHealthcare | UnitedHealth | Standard Plan | 1,726 | not reported | not reported | 1,042 | 14.1% | 16.3% |
| WellCare | Centene | Standard Plan | 2,927 | not reported | not reported | 2,626 | 14.8% | 17.1% |
| EBCI Tribal Option | EBCI Tribal Option | Tribal Option | not reported | not reported | not reported | not reported | 0.2% | 0.2% |
Sanctions (2024)
Sanctions (2024) 28
| Plan | Parent | Topic | Date | Corrective action plan | Remediation status |
|---|---|---|---|---|---|
| Alliance | Alliance Behavioral Healthcare | Other, specify ((Privacy and Security)) | 2024-04-09 | Yes | Yes, remediated |
| Partners | unmatched | Other, specify ((Privacy and Security)) | 2024-05-13 | Yes | Yes, remediated |
| Sandhills | Sandhills Center for MH DD SA | Other, specify (Other (Failure to Provide Medically Necessary Services)) | 2024-04-26 | Yes | Yes, remediated |
| Vaya | Vaya Health | Other, specify ((Privacy and Security)) | 2024-03-11 | Yes | Yes, remediated |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Other, specify (Other (Privacy and Security)) | 2023-09-05 | Yes | Yes, remediated |
show all 28
| Plan | Parent | Topic | Date | Corrective action plan | Remediation status |
|---|---|---|---|---|---|
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Other, specify (Other (Call Center)) | 2023-09-20 | Yes | Yes, remediated |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Other, specify (Other (Annual Network Adequacy)) | 2023-11-28 | Yes | Yes, remediated |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Other, specify (Other (Automated Claims Processing)) | 2024-01-31 | Yes | Remediation in progress |
| Amerihealth Caritas | AmeriHealth Caritas of North Carolina | Other, specify (Privacy and Security) | 2024-02-09 | Yes | Yes, remediated |
| Blue Cross and Blue Shield | unmatched | Other, specify (Privacy and Security) | 2024-02-20 | Yes | Yes, remediated |
| Blue Cross and Blue Shield | unmatched | Other, specify (Other (Privacy and Security)) | 2023-09-08 | Yes | Yes, remediated |
| Blue Cross and Blue Shield | unmatched | Other, specify (Call Center) | 2023-09-20 | Yes | Yes, remediated |
| Blue Cross and Blue Shield | unmatched | Other, specify (Other (Annual Network Adequacy)) | 2023-11-28 | Yes | Yes, remediated |
| Blue Cross and Blue Shield | unmatched | Other, specify (Other (Automated Claims Processing)) | 2024-01-31 | Yes | Remediation in progress |
| Carolina Complete Health | Centene | Other, specify (Call Center) | 2023-09-20 | Yes | Yes, remediated |
| Carolina Complete Health | Centene | Other, specify (Other (Annual Network Adequacy)) | 2023-11-28 | Yes | Yes, remediated |
| Carolina Complete Health | Centene | Other, specify (Other (Automated Claims Processing)) | 2024-01-31 | Yes | Remediation in progress |
| Carolina Complete Health | Centene | Other, specify ((Privacy and Security)) | 2024-02-09 | Yes | Yes, remediated |
| Carolina Complete Health | Centene | Other, specify (Other (Provider Welcome Packets)) | 2024-03-04 | Yes | Yes, remediated |
| UnitedHealthcare | UnitedHealth | Other, specify (Other (Annual Network Adequacy)) | 2023-11-28 | Yes | Yes, remediated |
| UnitedHealthcare | UnitedHealth | Other, specify (Other (Automated Claims Processing)) | 2024-01-31 | Yes | Remediation in progress |
| UnitedHealthcare | UnitedHealth | Other, specify ((Privacy and Security)) | 2024-02-09 | Yes | Yes, remediated |
| UnitedHealthcare | UnitedHealth | Other, specify (Other (Provider Welcome Packets)) | 2024-03-04 | Yes | Yes, remediated |
| UnitedHealthcare | UnitedHealth | Other, specify (Other (Call Center)) | 2024-05-08 | Yes | Yes, remediated |
| WellCare | Centene | Other, specify (Other (Call Center)) | 2023-09-20 | Yes | Yes, remediated |
| WellCare | Centene | Other, specify (Other (Annual Network Adequacy)) | 2023-11-28 | Yes | Yes, remediated |
| WellCare | Centene | Other, specify (Other (Privacy and Security)) | 2024-02-09 | Yes | Yes, remediated |
| WellCare | Centene | Other, specify (Other (Call Center)) | 2024-03-05 | Yes | Yes, remediated |
Award history
- Medicaid Managed Care Standard Plans Standard Plans: awarded. On February 4, 2019, NCDHHS announced Prepaid Health Plan contract awards for Medicaid managed care Standard Plans. The fact sheet dates the RFP to August 9, 2018 and says the program launches in November 2019. Statewide awards are AmeriHealth Caritas North Carolina, Inc.; Blue Cross and Blue Shield of North Carolina; UnitedHealthcare of North Carolina, Inc.; and WellCare of North Carolina, Inc. Carolina Complete Health received the regional award for Regions 3 and 5. The fact sheet says only that plan's total score, among the provider-led entities that offered a regional contract, met the threshold. It does not print the numeric score. The retrieved pages do not print a solicitation number or a contract end date.
Retrieved 2026-11-03. Sources and scores
Early procurement signals
- forecast NCDHHS says it will release a Standard Plan RFP in early 2026: suggested. In early 2026. Overdue: forecast was early 2026; no RFP on the record yet. An NCDHHS document titled Improving Member Health through Managed Care Program Enhancements says that in early 2026 the department will release a Request for Proposal for the Standard Plans, which it also calls Prepaid Health Plans. Early 2026 is not a calendar day. The document does not show that the RFP has been issued. North Carolina. No plan is named on the record. A solicitation or early procurement signal is on the record. No next date is on the record. Overdue: forecast was early 2026; no RFP on the record yet.
Coverage: not_collected. Source receipts: 1 unchanged at 2026-11-15T10:15:48+00:00. Sources and dates
Contract amendments
No official Medicaid managed-care contract amendment has been retrieved for this state. This is not a finding that no amendment exists. Contract amendments
Medicaid policy
Indiana rows are official policy instruments. Other states show only Federal Register notices of hearings on SPA disapprovals, which are a narrow slice and not waiver or SPA coverage.
Federal Register notices of hearings on SPA disapprovals are read from the Federal Register JSON API. That covers no approved SPAs, waivers, or section 1115 demonstrations.
Coverage not_collected.
No official Medicaid managed-care policy instrument has been retrieved for this state. This is not a finding that no waiver, state plan amendment, or rule exists. Medicaid policy
Federal Register SPA disapproval hearing notices (2015 or later): 0
Plan financials
No official Medicaid plan financial filing has been retrieved for this state. This is not a finding that no filing exists, and it is not a zero. Plan financials. Coverage: not_collected.
Federal compliance deadlines
Cited federal Medicaid managed care deadlines, with the Federal Register citation, the effective date, the compliance date, and the plan obligation.