NC Medicaid Enrollment Broker

The NC Medicaid Enrollment Broker is the intermediary between you and the managed care plan system — and for families of young adults with developmental disabilities, it's often the only entity that can fix a plan assignment mistake that locks your child out of critical services.

Most families never interact with the enrollment broker until something goes wrong. Understanding what it does and when to contact it prevents weeks of circular phone calls between agencies that each insist the problem belongs to someone else.

What the Enrollment Broker Does

North Carolina contracts with a private enrollment broker to manage all Medicaid managed care plan assignments. The broker handles:

• Initial plan assignment when a new beneficiary enrolls in Medicaid
• Plan transfers between Standard Plans and Tailored Plans
• Plan selection within the Standard Plan category (choosing between available health plan options in the beneficiary's region)
• Resolving assignment errors when a beneficiary ends up in the wrong plan type

The enrollment broker is not a state agency. It's a contracted entity that operates the mechanical process of matching beneficiaries to health plans. It doesn't determine Medicaid eligibility (that's the county DSS) and it doesn't authorize services (that's the health plan or LME/MCO).

When You Need the Enrollment Broker

The most common scenario for families in the adult disability transition: the young adult gains Medicaid through SSI approval (the automatic Section 1634 pathway), but the system assigns them to a Standard Plan instead of a Tailored Plan.

Standard Plans don't cover the Innovations Waiver, 1915(i) community supports, ICF-IID placement, or state-funded I/DD services. If the young adult has an intellectual or developmental disability and needs these services, they must be enrolled in a Tailored Plan managed by their regional LME/MCO.

The transfer process works like this:

1. The young adult's provider (or the family, with provider documentation) identifies that a Tailored Plan is needed
2. The provider submits the "Request to Move to a Tailored Plan" form to the enrollment broker
3. The form includes a Service Authorization Request to ensure clinical continuity during the handoff
4. The enrollment broker processes the transfer and assigns the beneficiary to the appropriate LME/MCO based on their county of residence

Without this transfer, the young adult has Medicaid coverage for basic healthcare but cannot access any of the specialized I/DD services that the managed care system is designed to deliver.

The County-to-LME/MCO Assignment

After the planned merger of Partners Health Management and Vaya Health takes effect on October 1, 2026, the enrollment broker will assign Tailored Plan beneficiaries to one of three regional LME/MCOs based on where they live:

• Alliance Health — Mecklenburg, Wake, Durham, Cumberland, Orange, Johnston, Harnett, and surrounding counties
• Trillium Health Resources — central, northern, and coastal counties including Guilford, Moore, and New Hanover
• Vaya Partners — western, mountain, and Piedmont regions (47 counties after the October 1, 2026 merger)

If the young adult moves to a different county, contact the enrollment broker to update the plan assignment. Moving between LME/MCO regions requires a transfer that also involves moving the individual's Registry of Unmet Needs placement date to the new LME/MCO — a step that must happen promptly to preserve their waitlist position.

How to Contact the Enrollment Broker

The NC Medicaid Enrollment Broker can be reached through the NC Medicaid managed care website (ncmedicaidplans.gov) or by calling the enrollment broker hotline. When you call, have the beneficiary's Medicaid ID number ready and be prepared to explain why a Tailored Plan is needed — the broker processes the administrative transfer, but the clinical justification must come from a provider.

If the enrollment broker says a transfer isn't possible or routes you elsewhere, escalate through the LME/MCO's member services or contact the NC Medicaid Ombudsman. Plan assignment errors are administrative — they should not require a new clinical evaluation or a new Medicaid application.

The North Carolina Adult Disability Benefits Guide includes a Medicaid plan decision flowchart and the enrollment broker contact process for families navigating the Standard-to-Tailored Plan transfer.

See more North Carolina guides →