What the Tribal Option does
NC Medicaid describes the EBCI Tribal Option as a primary care case management entity created by the Cherokee Indian Hospital Authority. The hospital authority calls it an Indian Managed Care Entity that contracts with NCDHHS. NC Medicaid moved most Medicaid beneficiaries who are federally recognized tribal members, or who qualify for IHS services, into it on July 1, 2021. According to NC Medicaid's fact sheet (January 2026), it:
- Manages whole-person health needs, including medical, behavioral health, pharmacy and dental care and social needs
- Coordinates care for serious mental illness, substance use disorders, intellectual and developmental disabilities and traumatic brain injury with the regional behavioral health organization
- Runs a primary care network of tribal and non-tribal practices; members can get services from any NC Medicaid provider
- Doesn't let providers collect copayments from its members
Who qualifies
NC Medicaid sets the rules. Eligible groups include federally recognized tribal members, people who qualify for IHS services, direct lineal descendants, non-Indian children under 19 in an Indian household, and non-Indian pregnant women carrying an Indian child. The option is available in 11 western counties (Buncombe, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain and Transylvania) and is offered primarily in Cherokee, Graham, Haywood, Jackson and Swain. The hospital authority says it serves about 4,000 tribal-eligible Medicaid beneficiaries.
If you have Medicare too
Most people with Medicare and full NC Medicaid are in NC Medicaid Direct. NC Medicaid's chart of managed care statuses, though, lists tribal and IHS-eligible people with full Medicaid and Medicare as able to choose either the EBCI Tribal Option or NC Medicaid Direct. People whose Medicaid only helps pay Medicare costs (the MQB programs) are listed under NC Medicaid Direct only. That chart dates from 2022, so confirm your current status with NC Medicaid.
Either way, the Tribal Option is about Medicaid. Medicare covers your Medicare services first, then Medicaid pays what it covers. Your Medicare choices (Original Medicare, a Medicare Advantage plan, a Part D plan, or a dual eligible special needs plan) are separate decisions. If you're thinking about a plan, CMS suggests checking with your Indian health provider first so you know it works with your care.
How to join or check your status
- Confirm IHS eligibility. Call Cherokee Indian Hospital Patient Registration at 828-497-9163.
- Confirm Medicaid eligibility and choose. Contact the NC Medicaid Enrollment Broker at 833-870-5500 or the EBCI/NCDHHS Medicaid and FNS Eligibility Office at 828-497-4317.
- Keep Medicare details handy. Give your Medicare card to every provider so claims go to Medicare first.
More in NC Medicaid and Medicare and our guide to American Indians and Medicare in North Carolina. To talk through Medicare plan choices with a licensed insurance agent, you can request a call from a licensed insurance agent.
Related questions
Can EBCI members use Cherokee Indian Hospital with Medicare?
Registration, referrals and billing.
How does Medicare work with IHS?
Who pays first.
Does Lumbee recognition change Medicare or IHS care?
What the 2025 law says.
Sources
- NC Medicaid — Eastern Band of Cherokee Indians Tribal Option overview (January 2026)
- NC Medicaid — Managed Care Populations and Enrollment Notices fact sheet (managed care statuses)
- NC Medicaid — NC Medicaid Managed Care Populations
- Cherokee Indian Hospital Authority — The EBCI Tribal Option
- Medicare.gov — Who pays first? (Medicaid)
More questions in this guide
- Can Eastern Band of Cherokee members use Cherokee Indian Hospital with Medicare?
- Does Lumbee federal recognition change Medicare or IHS care?
- How does Medicare work with Indian Health Service in North Carolina?
Part of the guide: American Indians and Medicare in North Carolina · All questions
Frequently asked questions
Can people with Medicare and Medicaid join the EBCI Tribal Option?
NC Medicaid's managed care status chart lists tribal and IHS-eligible people with full Medicaid and Medicare as able to choose the EBCI Tribal Option or NC Medicaid Direct. People whose Medicaid only helps with Medicare costs are in NC Medicaid Direct. Check your own status with NC Medicaid.
Does the Tribal Option replace Medicare?
No. It manages Medicaid benefits. Medicare stays your main coverage for Medicare-covered services, and Medicare.gov says Medicaid never pays first for services Medicare covers.
How do I join?
First confirm IHS eligibility with Cherokee Indian Hospital Patient Registration at 828-497-9163. Then contact the NC Medicaid Enrollment Broker at 833-870-5500 or the EBCI/NCDHHS Medicaid and FNS Eligibility Office at 828-497-4317.
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