To ensure beneficiaries can seamlessly receive care on day one, NCDHHS is delaying the implementation of NC Medicaid Managed Care Behavioral Health and Intellectual / Developmental Disabilities Tailored Plans until Oct. 1, 2023.
Tailored Plans, previously scheduled to launch April 1, will provide the same services as Standard Plans and will also provide additional specialized services for individuals with complex behavioral health conditions, Intellectual/Developmental Disabilities (I/DDs), and traumatic brain injury (TBI).
Our highest priority is making sure that the transition to Tailored Plans is as seamless as possible for the beneficiaries they will serve. The individuals who will be served by Tailored Plans often have complex behavioral and physical health needs and, as a result, their care is often more complex too. This increases the importance of a smooth transition with minimal disruption.
The most important aspects of a “smooth transition” are straightforward: On Day 1, people can get the care they need, people can get their prescriptions filled and their providers can get paid. Although the Local Management Entity/Managed Care Organizations (LME/MCOs) made progress toward this goal, and NCDHHS worked hard to ensure readiness, more time is needed to ensure Tailored Plans are where they should be statewide. As a result, the latest data projects that if we launched April 1, 20,000 to 30,000 of the people who will be in Tailored Plans would likely not have their current primary care provider in network.
The delayed start of Tailored Plans allows LME/MCOs to contract with more providers to support member choice and to validate that data systems are working appropriately.
Beneficiaries set to receive care through the Tailored Plans will continue to receive services as they do today:
• Behavioral health services, and I/DD and TBI supports through their LME/MCO
• Physical health and pharmacy services through NC Medicaid Direct.
Tailored Care Management, which launched Dec. 1, 2022, will continue to be implemented.
Additional information will be added to the NC Medicaid Behavioral Health I/DD Tailored Plan and Provider Playbook webpages as it becomes available.