Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan

Tailored Plans are a new kind of NC Medicaid Managed Care health plan.

Version en español

Tailored Plans start July 1, 2024.

You might be eligible for a Tailored Plan if you have NC Medicaid and health needs related to:

• Serious mental illness (SMI)
• Severe substance use disorders (SUD)
• Intellectual/developmental disabilities (I/DD)
• Traumatic brain injuries (TBI)

Tailored Plans will also serve people on the NC Innovations Waiver or Traumatic Brain Injury (TBI) Waiver. (People will not lose their spots on the waitlist.)

Tailored Plans start July 1, 2024. Some people on Medicaid will be automatically enrolled in a Tailored Plan. If your NC Medicaid will move to a Tailored Plan, a letter will be mailed to you in mid-April. Learn more about the move to Tailored Plans and what you need to do.

Tailored Plans are designed to meet certain needs

Tailored Plans cover doctor visits, prescription drugs, and services for serious mental health, severe substance use, I/DD, and TBI all in one plan. See list of benefits and services.

Other services available under Tailored Plans include, but are not limited to:

• Access to a Tailored Care Manager (Tailored Care Management)
• Child and adolescent day treatment services
• Community living and supports*
• Intensive in-home services
• Multi-systemic therapy services
• Psychosocial rehabilitation
• Residential treatment facility services
• Respite*
• Substance abuse intensive outpatient program (SAIOP)
• Supported employment*
• State-Funded behavioral health, I/DD and TBI services
• Innovations Waiver services
• Traumatic Brain Injury (TBI) Waiver services

*Depends on your eligibility. For details, talk to your Tailored Plan or Tailored Care Manager.

Tailored Care Management is a service available to people on a Tailored Plan. You can get a Tailored Care Manager to help you get the medical or specialized care you need. They can help schedule your medical appointments, arrange transportation and more. Learn more about Tailored Care Management.

For more information on Tailored Plan services, contact your Tailored Plan.

How to get a Tailored Plan

1. Apply for NC Medicaid. (If you already have NC Medicaid, skip this step.)
2. Your eligibility for the Tailored Plan will be automatically reviewed. If you are eligible, you should get a letter in the mail letting you know.
3. You can ask to move to a Tailored Plan. You or your provider can submit the form “Request to Move to NC Medicaid Direct or LME/MCO.” 

Tailored Plans start July 1, 2024. Some people on Medicaid will be automatically enrolled in a Tailored Plan. If your NC Medicaid will move to a Tailored Plan, a letter will be mailed to you in mid-April. If you got a letter about Tailored Plans, learn more about what you should do. 

How to find providers in the Tailored Plan’s network

Providers are doctors or specialists.

To have your services paid for by NC Medicaid, your Medicaid providers must be in your Tailored Plan’s network (Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health).

If your providers are not in-network, their services will not be paid for by NC Medicaid. You will be responsible for the charges.

3 ways to find providers:

• Use this directory to find a provider near you
• Or, call your Tailored Plan:
  • Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
  • Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570
  • Trillium Health Resources, 1-877-685-2415, TTY: 711
  • Vaya Health, 1-800-962-9003, TTY: 711
• Or, ask your Tailored Care Manager, if you have one

Tailored Plan companies

Each county is served by a single Tailored Plan company. Your Tailored Plan company is assigned based on the county that administers your NC Medicaid. You can call them with questions about Tailored Plans, even if you are not a member. 

Tailored Plan companies:

• Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
• Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570
• Trillium Health Resources, 1-877-685-2415, TTY: 711
• Vaya Health, 1-800-962-9003, TTY: 711

Don’t know which company to call? These companies are also known as Local Management Entity/Managed Care Organizations (“LME/MCO”). Find the Tailored Plan (LME/MCO) for the county that administers your NC Medicaid using this directory. Or, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com). 

Updates

• Tailored Plans start July 1, 2024. Some people on Medicaid will be automatically enrolled in a Tailored Plan. If your NC Medicaid will move to a Tailored Plan, a letter will be mailed to you in mid-April. Learn more about the move to Tailored Plans and what you need to do.
• NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch (Feb. 1, 2024)

Need help?

Questions about eligibility: Contact the NC Medicaid Enrollment Broker at 1-833-870-5500. Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday.

Questions about Tailored Plans:  Call your Tailored Plan.

• Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
• Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570
• Trillium Health Resources, 1-877-685-2415, TTY: 711
• Vaya Health, 1-800-962-9003, TTY: 711

Your Tailored Plan is assigned based on the county that administers your NC Medicaid. Find your Tailored Plan (also known as “LME/MCO”) by using this directory. Or, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com). 

Other related services

• Tailored Care Management
• Behavioral Health and Intellectual/Developmental Disabilities Services

Information for Providers

• Provider Playbook: NC Medicaid Managed Care