Behavioral Health and Intellectual and Developmental Disabilities (I/DD) Tailored Plans are specialized managed care products targeting the needs of individuals with significant behavioral health disorders, I/DD and traumatic brain injuries (TBI). These plans are scheduled to begin in July 2022 as part of NC Medicaid’s transition to Medicaid Managed Care and will cover a more robust package of Behavioral Health, I/DD and TBI services compared to Standard Plans.
Prior to launch of the Behavioral Health I/DD Tailored Plans, beneficiaries meeting eligibility for the Behavioral Health I/DD Tailored Plans will continue to be covered through the current Medicaid fee-for-service/local management entity – managed care organization (LME-MCO) system, also referred to as NC Medicaid Direct. Some will have the choice to opt into a Standard Plan.
DHHS has held ongoing discussions with stakeholders to refine the Behavioral Health I/DD Tailored Plan eligibility criteria used in claims/encounter data reviews. Through these discussions and with consultation from DHHS clinical leadership, additional encounter/claims data markers were identified as being indicative of I/DD or functional impairment and have been added to the criteria used for identifying beneficiaries as eligible for Behavioral Health I/DD Tailored Plans.
For more information about eligibility changes, please see the Behavioral Health I/DD Tailored Plan Memo on Eligibility and Enrollment Updates and Appendix B - Behavioral Health I/DD Tailored Plan Criteria under "Final Policy Guidance" on the Medicaid Transformation Policy Papers webpage.
Contact
NC Medicaid Contact Center: 888-245-0179