To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (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.
Tailored Plans 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).
The Department and LME/MCOs 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.
In late February 2023, when the Department made the decision to delay to Oct. 1, 2023, leadership identified three key areas that needed more work to ensure a smooth transition.
- The LME/MCO provider network and technical capability readiness needed to improve;
- The Department had the appropriate legal tools to ensure the well-being and safety of beneficiaries if an LME/MCO is failing to provide services; and
- That the LME/MCOs were focused on providing services for the populations they are best positioned to manage successfully.
While gaps remain in provider networks, progress has been made by the LME/MCOs on technical capabilities. The Department has been working collaboratively with the legislature to achieve the necessary tools to administer the Tailored Plans on par with other managed care plans, but they still are a work in progress.
Further, uncertainty with the state budget, which will fund transformation costs and rebase for the Medicaid program, creates additional needs for launching Tailored Plans. Because it remains uncertain as when those issues will be fully resolved, the Department is announcing the delay in Tailored Plans now but is not able to announce a certain go-forward date at this time.
Beneficiaries who will be covered by the Tailored Plans will continue to receive behavioral health, I/DD, TBI and physical health care as they do today. North Carolina’s unique Tailored Care Management model, which launched Dec. 1, 2022, will continue to support beneficiaries by providing a care team to coordinate care across providers. Additionally, on July 1, 2023, the LME/MCOs began to provide 1915(i) services to offer an array of home and community based (HCBS) services to Medicaid beneficiaries with serious mental diagnosis, severe substance use disorders, intellectual/developmental disabilities and traumatic brain injury.
We understand that uncertainty is challenging for beneficiaries, especially those with complex medical needs. We will continue to work closely with LME/MCOs to launch Tailored Plans on the fastest possible timeline that can guarantee a smooth transition.