In July 2021, almost 1.6 million North Carolina Medicaid beneficiaries transitioned from a fee-for-service to a risk-based managed care system for their health care. The Urban Institute is studying this transition and its effects on equitable health outcomes for North Carolinians. Qualitative data collected in the pre-implementation period highlight positive and negative aspects of the state’s multipronged communications strategy to notify beneficiaries about the managed care transition and help with health plan enrollment. Some study participants praised the Medicaid agency’s effort to provide information and assistance, but others shared concerns the website was difficult to navigate and reported technical glitches or long wait times with the enrollment broker’s call center. Health plans, Medicaid officials, and care providers prepared for the managed care launch by focusing on activities related to developing provider networks, educating providers and beneficiaries about upcoming changes, and finalizing health plan contract requirements. Study participants were concerned the transition would negatively affect access to care if new administrative burdens prompted providers to limit participation in the Medicaid program or leave it altogether. But some felt risk-based managed care, and North Carolina’s Medicaid transformation more generally, would lead to community-level improvements focused on social determinants of health. They described managed care as applying a new set of resources, including financial incentives, to identify and address health inequities.