Where dual eligibles are today
NC Medicaid's "Medicaid Health Plans and Programs" page (last modified March 3, 2026) says Standard Plans serve people who are blind or disabled "and do not get Medicare." It places "people who get Medicaid and Medicare" in NC Medicaid Direct, along with CAP/DA and PACE participants and people who are medically needy.
NC Medicaid Direct is North Carolina's program for members who aren't in managed care. Physical health care management comes from Community Care of North Carolina, and LME/MCOs coordinate services for mental health, substance use, I/DD and traumatic brain injury.
What state law says
G.S. 108D-40 lists who the capitated health plans don't cover:
- (a)(1) People with Medicare and Medicaid whose Medicaid "is limited to the coverage of Medicare premiums and cost sharing," that is, MQB only. This exclusion has no end date.
- (a)(13) Full dual eligibles and long-stay nursing home residents, "for a period of time to be determined by the Department that shall not exceed five years after the date that capitated PHP contracts begin."
- (a)(4) and (a)(11) People who are medically needy and CAP/DA participants.
The 2026 status
We reviewed NC Medicaid's beneficiary pages and its announcements from mid-2025 through November 13, 2026. None sets a date to move full dual eligibles into a Standard Plan or announces an integrated Medicare-Medicaid plan program. One related change: since April 17, 2025, Medicare crossover claims for dually eligible members assigned to a Tailored Plan or prepaid inpatient health plan go to that plan, which shows some duals have behavioral health or I/DD services managed this way.
Medicare side: every North Carolina D-SNP for 2027 is coordination-only, so a D-SNP doesn't change where your Medicaid comes from.
What this means for you
- Use your NC Medicaid ID card. Show both your Medicare (or Medicare plan) card and your NC Medicaid card at every visit.
- Watch your mail. If NC Medicaid announces a change, letters will explain it. Keep your address current with your county DSS.
- Choose Medicare coverage on its own merits. You can keep Original Medicare and a Part D plan or choose a Medicare Advantage plan, including a D-SNP. You can request a call from a licensed insurance agent to compare plans from the companies they work with.
More in NC Medicaid and Medicare.
Related questions
What is a D-SNP in North Carolina?
Coordination-only plans for people with both.
Can I have NC Medicaid and Medicare at the same time?
How dual eligibility works.
What is the CAP/DA waiver?
Home care through NC Medicaid Direct.
Sources
- NC Medicaid — Medicaid Health Plans and Programs (modified 03/03/2026)
- N.C. General Statutes § 108D-40, Populations covered by PHPs
- NC Medicaid — Tailored Plan and PIHP dually eligible Medicare crossover claims (Aug. 26, 2025)
- NC Medicaid — Recent announcements
- CMS — CY2027 Landscape files
More questions in this guide
- Can I have NC Medicaid and Medicare at the same time?
- Did NC Medicaid expansion change anything for people on Medicare?
- Does NC Medicaid pay for nursing home care?
- Does NC Medicaid take your house after you die?
- Medicare vs. Medicaid in North Carolina
- What is a dual eligible special needs plan in North Carolina?
- What is Special Assistance in North Carolina?
- What is the CAP/DA waiver in North Carolina?
- What is the Medicaid look-back period in North Carolina?
Part of the guide: NC Medicaid and Medicare together · All questions
Frequently asked questions
Do I need to pick a Medicaid health plan if I have Medicare?
Generally no. People with Medicare and Medicaid get Medicaid through NC Medicaid Direct. If you receive a letter about choosing a plan, call the number on the letter or the NC Medicaid Contact Center at 1-888-245-0179 to confirm what applies to you.
Who manages my behavioral health services as a dual eligible?
In NC Medicaid Direct, local management entity/managed care organizations (LME/MCOs) coordinate mental health, substance use, I/DD and TBI services. NC Medicaid also reports that some dually eligible members are assigned to a Tailored Plan or a prepaid inpatient health plan for those services.
Will dual eligibles move into NC Medicaid Managed Care?
State law allows NCDHHS to keep full dual eligibles out of managed care for a period it sets, up to five years after capitated contracts began. NC Medicaid had not announced a date or plan as of November 13, 2026.
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