Navigating Your Health Journey: A Comprehensive Guide to Carolina Complete Health

Making informed decisions about healthcare is crucial for individuals and families alike. In North Carolina, a significant option for many is Medicaid, and within that system, Carolina Complete Health (CCH) stands out as a key managed care health plan. This article will provide an in-depth look at Carolina Complete Health, exploring its mission, the comprehensive benefits it offers, eligibility requirements, and how to make the most of its services to support your health and well-being.

What is Carolina Complete Health?

Carolina Complete Health is a Medicaid Managed Care health plan specifically designed for residents of North Carolina. It operates as a unique joint venture, bringing together the expertise of the North Carolina Medical Society (NCMS), Centene Corporation, and the North Carolina Community Health Center Association (NCCHCA). This collaborative structure means that local physicians and other healthcare providers play a direct role in designing the plan and determining medical policies, aiming for a patient-focused, physician-led approach to care.

The core mission of Carolina Complete Health is to provide high-quality, state-of-the-art care to Medicaid beneficiaries, striving for better health outcomes at a more efficient cost. This innovative model was established to serve Medicaid beneficiaries in North Carolina, delivering comprehensive healthcare services and programs. Since July 1, 2021, North Carolina transitioned to a Medicaid Managed Care model, and CCH is one of the standard plans available to most Medicaid members. It integrates physical health, behavioral health, and pharmacy services under one cohesive plan, simplifying care coordination for its members.

The Comprehensive Benefits of Carolina Complete Health

Carolina Complete Health offers a wide array of benefits designed to support the "whole person" – addressing not just medical needs but also social factors that influence health, often referred to as social determinants of health. Beyond the essential NC Medicaid services, CCH provides valuable "Value-Added Services" that can significantly enhance a member's quality of life.

Essential Healthcare Services

As a Medicaid health plan, Carolina Complete Health covers all standard Medicaid benefits, ensuring members have access to necessary medical care. These include:

• Regular Doctor Visits: This covers office visits with your Primary Care Provider (PCP), including routine check-ups, necessary lab tests, and screenings. Your PCP is your main point of contact for most healthcare needs and helps coordinate your care.
• Specialist Referrals: If you need to see a specialist, your PCP can provide referrals. This ensures you get care from the right expert for your specific health concern.
• Preventive Care: CCH strongly emphasizes preventive health services to keep you healthy and catch potential issues early. This includes annual check-ups, various screenings (blood pressure, breast cancer mammography, cervical cancer, colorectal cancer, depression, diabetes, HIV), immunizations for children and adults, and well-baby and well-child visits.
• Eye and Hearing Exams: Essential for maintaining sensory health, these are covered benefits.
• Prescription Medications: Pharmacy services are a crucial part of the coverage, ensuring access to necessary prescriptions. You can refer to the Preferred Drug List for covered medications.
• Behavioral Health Services: CCH integrates behavioral health services, including mental health support and substance use disorder recovery programs, recognizing their importance to overall health. For instance, they offer the MyStrength Program with peer support tools for mental health needs.
• Long-Term Services and Supports (LTSS): For individuals with certain health conditions or disabilities who need help with daily activities like eating or bathing, LTSS is available. This can include home health and personal care services, provided in your home, community, or a nursing home. Nursing home services are covered for up to 90 days, with options for longer-term care if needed.

Unique Value-Added Services

Carolina Complete Health goes above and beyond standard NC Medicaid benefits by offering a range of additional services designed to promote holistic well-being and address common challenges members face. These "extra benefits" are a testament to CCH's commitment to comprehensive care:

• Wellness Programs:
  • WW® (formerly Weight Watchers®) Vouchers: Eligible members aged 13 and up can receive vouchers for 10 weeks of classes and 14 weeks of online tools.
  • Over-the-Counter (OTC) Items: A quarterly allowance of $30 per member for OTC items not covered by the Medicaid Preferred Drug List.
  • Healthy Rewards: Up to $75 yearly for completing healthy behaviors like check-ups.
  • Walmart Food Vouchers: A $20 monthly voucher for 6 months to buy "Great For You" list foods at Walmart for qualifying members.
  • Free YMCA Membership: For eligible members aged 18 and up at risk for diabetes or high blood pressure.
• Youth & Education Support:
  • Child After-School Sports/Activities or Youth Club Memberships: Up to $75 per year for members aged 6-18.
  • Child Education Support: Up to $75 per year for school supplies and online tutoring for Pre-K through 12th-grade members.
  • GED Package: Includes study materials and an exam voucher.
• Specialized Programs:
  • Asthma Management: The "Room to Breathe" program offers home visits, home assessments, asthma supplies, and education for members under 16 with asthma.
  • Pregnancy Support: Up to $100 per year for new mothers, covering items like car seats, diapers, diaper bags, and breast pumps, with home visits for high-risk pregnancies.
• Connectivity and Support:
  • Phone Programs: Connections Plus® cellphone with free calls and texts for eligible members, or SafeLink wireless services with a cell phone, monthly minutes, and free calls/texts to and from the health plan.
  • Online Peer Support Tools: For emotional health and well-being for members aged 18 and up.
  • Substance Use Disorder (SUD) Recovery: A social support network with peers and caregivers, GPS locator