North Carolina will launch the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan. This is an integrated health plan for individuals with behavioral health needs and intellectual/developmental disabilities (I/DDs).
Tailored Plan Implementation Delayed
Beneficiaries who will be covered by the Tailored Plans will continue to receive care as they do today.
To ensure beneficiaries can seamlessly receive care on day one, NCDHHS is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined. Beneficiaries who will be covered by the Tailored Plans will continue to receive care as they do today.
Tailored Plans will also serve other special populations including Innovations and Traumatic Brain Injury (TBI) waiver enrollees and waitlist members and will be responsible for managing the state’s non-Medicaid behavioral health, developmental disabilities and TBI services for uninsured and underinsured North Carolinians.
The following organizations will serve as regional Behavioral Health I/DD Tailored Plans:
- Alliance Health alliancehealthplan.org
- Member phone numbers: 800-510-9132, TTY: 711 or 800-735-2962
- Eastpointe eastpointe.net
- Member phone numbers: 800-913-6109, TTY: 888-819-5112
- Partners Health Management partnersbhm.org
- Member phone numbers: 888-235-4673, TTY: English: 800-735-2962, TTY: Spanish: 888-825-6570
- Sandhills Center sandhillscenter.org
- Member phone numbers: 800-256-2452, TTY: 711 or 866-518-6778
- Trillium Health Resources trilliumhealthresources.org
- Member phone numbers: 877-685-2415, TTY: 711
- Vaya Health vayahealth.com
- Member phone numbers: 800-962-9003, TTY: 711
Contact information for each of the Tailored Plan organizations can be found on the Health Plan webpage.
Tailored Care Management
As North Carolina transitions its Medicaid and NC Health Choice program to managed care, the Department is focused on building effective models for managing beneficiaries comprehensive needs through care management. The Department is investing in the Tailored Care Management model, a community-based, provider-driven model aimed at whole person care and driving toward better health outcomes.
Through Tailored Care Management, Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide integrated care management that addresses all of their needs including: physical health, behavioral health, I/DD, TBI, pharmacy, long-term services and supports (LTSS) and addresses their unmet health-related resource needs. More information on Tailored Care Management is available on the Tailored Care Management webpage.
Behavioral Health I/DD Tailored Plan Webinar - Oct. 28, 2020
This webinar provides an overview about what is happening in North Carolina, review key information about Behavioral Health I/DD Tailored Plans and highlight what's next for beneficiaries.
Town Hall Meeting - Feb. 18, 2020
Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper Webinar - Feb. 10, 2020
This webinar walks stakeholders through the following remaining aspects of the Behavioral Health I/DD Tailored Plan design, including the procurement process, administration and entity management, financial management and monitoring, provider participation/contracting, quality and other programmatic features under Behavioral Health I/DD Tailored Plans.
State-funded Services Design Under Behavioral Health I/DD Tailored Plans Webinar - Jan. 24, 2020
This webinar provides background and guiding principles on the transition to Medicaid Managed Care and the Department's vision for State-funded services. It also provides information on care management requirements, community integration, local health functions and accountability.
How Beneficiaries Move Between the Standard Plan and Behavioral Health I/DD Tailored Plan - Nov. 6, 2019
Behavioral Health I/DD Tailored Plan Eligibility and Enrollment - March 26, 2019
Note: Eligibility and enrollment policy was updated July 16, 2019. Please refer to the update documents for accurate information.
MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - March 6, 2019
- Presentation - Tailored Plan Eligibility
- Presentation - Tailored Plan Design
- Presentation - Care Management
MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - Feb. 4, 2019
Integration of Behavioral and Physical Health Care in Tailored Plan - Jan. 24, 2019
This page was last modified on 07/11/2023