North Carolina Medicaid is entering a major new chapter. Carolina Complete Health (CCH) and WellCare of North Carolina will officially merge into a single statewide health plan on April 1, 2026. The new combined plan will operate under the Carolina Complete Health name and will serve all six NC Medicaid regions.
As your Northwest AHEC Practice Support Team, we’re here to break down what this means for your practice, your teams, and—most importantly—the North Carolinians you care for.
Why This Merger Matters
This transition creates North Carolina’s largest Medicaid health plan, covering more than 775,000 members across the state. The unified plan continues as a Provider-Led Entity (PLE)—meaning North Carolina physicians retain a central governance role.
For practices, this means:
- Continued emphasis on provider voice in decision-making
- Streamlined processes under one statewide plan
- Reduced administrative duplication across CCH and WellCare products
Key Implementation Details You Need to Know
📅 Effective Date
April 1, 2026, unless NC DHHS issues updated guidance.
What This Means for Your Medicaid Patients
For current WellCare members
- Automatically transitioned to Carolina Complete Health
- No change in Medicaid benefits
- Will receive a new Member Welcome Packet and Member ID card
- Most members will keep their current primary care provider
For current Carolina Complete Health members
- Coverage expands statewide from 3 to 6 regions
- No change in Medicaid benefits
- New CCH Member ID card will be mailed as part of annual re-card
- Patients may keep their existing PCP
For Non-Members
Carolina Complete Health offers a free solution for payment by Electronic Funds Transfer (EFT) and Electronic Remittance Advice (835)/Explanation of Payment (ERA/EOP) through PaySpan®. If you are not already registered, create a new account by registering at payspanhealth.com or calling 1-877-331-7154, option 1.
For CCH providers
The public website will remain https://network.carolinacompletehealth.com/. WellCare providers should begin using this webpage upon go-live (anticipated to be 4/1/2026) for updated materials (i.e. provider and billing manuals, contacts, and provider tools).
What This Means for Your Practice
1. Contracting & Network Participation
- If your practice is contracted with either CCH or WellCare, you will remain contracted with the merged entity.
- To eliminate redundancy, the Medicaid product under WellCare agreements will be terminated as of April 1, 2026.
- Providers will continue serving:
- Medicaid & Tailored Plan members through the CCH agreement
- Medicare members through the WellCare agreement
If you received termination notices tied to the Medicaid product, these apply only to the WellCare Medicaid portion—not your overall WellCare contract.
2. Member Reassignment & Market Share
CCH has clarified:
- The new entity is not expected to exceed the market share cap
- Providers should not see large-scale member panel reassignment due to the merger
3. Billing, Claims & EFT/ERA
Frequently asked questions from providers include:
- EFT/ERA services will continue uninterrupted
- Claims for dates of service before April 1, 2026 will follow the originating agreement (CCH or WellCare)
- Claims on or after April 1, 2026 will process under the new CCH statewide plan
Updated provider manuals, billing guidance, and operations details will be posted on the official merger site as the go-live date approaches.
Operational Steps You Should Take Now
✔ Verify provider directory listings
Ensure your practice’s information is correct across:
- CCH Provider Directory
- WellCare Provider Directory
✔ Educate front‑desk and billing teams
Key items to emphasize:
- New member ID cards
- How to verify eligibility during the transition
- Which plan to bill based on date of service
✔ Review your contracts
Look specifically for:
- CCH agreement terms
- Any Medicaid-product termination notices from WellCare
- Tailored Plan participation details (if applicable)
✔ Monitor value-added service changes
Both CCH and WellCare note modifications coming to value-added services for 2026.
What Stays the Same
- Medicaid benefits for members
- Primary care provider assignments
- Commitment to provider-led governance
- NC Medical Society and NC Community Health Center Association remain partial owners of the Provider Led Entity (PLE)
Resources for Practice Managers
Here are the most relevant resources for keeping your team prepared:
Provider Merger FAQ (CCH Network Site)
https://network.carolinacompletehealth.com/merger.html
Member Merger Information (Public Site)
https://www.carolinacompletehealth.com/merger.html
Provider Services Contact:
1‑833‑552‑3876
NetworkRelations@CCH-Network.com
