This brief draws on interviews and focus groups with a small group of key informants and beneficiaries to describe early experiences with the transition to Medicaid managed care in North Carolina. While most Medicaid beneficiaries experienced little to no disruptions in care, those with complex family situations and high medical needs, as well as those with limited English proficiency, reported challenges with navigating the new system and accessing needed services. Citing administrative burdens, many providers reportedly did not contract with all available managed-care plans, which is likely affecting access to care for some beneficiaries. Key informants knew little about the implementation of new features under the managed-care program, such as care coordination and social needs screenings. Despite many ways for beneficiaries to get information, including a newly established Ombudsman program, key informants and focus group participants largely deemed the state Medicaid agency’s communications strategy ineffective. These findings suggest that more support is needed for both Medicaid beneficiaries and providers who serve them during major program changes. In particular, outreach, education, and assistance to Medicaid beneficiaries, including in languages other than English, should remain a high priority.