Behavioral Health and Intellectual / Developmental Disabilities Services

Behavioral Health and Intellectual / Developmental Disabilities Services provide members with medically necessary diagnostic, therapeutic, rehabilitative, palliative or case management needs.

Transition of 1915(b)(3) Services to 1915(i) Authority

White Paper: Transition of 1915(b)(3) Services to 1915(i) Authority

LME/MCOs

Local Management Entities / Managed Care Organizations (LME/MCOs) are public managed care organizations that provide a comprehensive behavioral health services plan under the NC 1915(b)(c) Waiver for people in need of mental health, developmental disability or substance use services. LME/MCOs are regionally based. A directory of LME/MCOs is available on the LME/MCO Directory webpage. 

Medicaid beneficiaries may contact the LME/MCO in their region for information about and referrals to mental health, developmental disability and substance use services. 

Current LME/MCO contracts with NC Medicaid

Tailored Plans

The NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans launched July 1, 2024. A Tailored Plan is an integrated health plan for individuals with mental health, substance use disorders, I/DD and traumatic brain injury (TBI). Learn more about Tailored Plans.

1915(b)(c) Waivers

Behavioral Health I/DD services for Medicaid enrollees with mental illness, developmental or other intellectual disability and substance use diagnoses are provided under the North Carolina 1915(b)(c) Medicaid Waiver program. The 1915(b)(c) Medicaid Waiver allows North Carolina to enroll individuals into a state and federally approved managed care program for Behavioral Health I/DD services. More information is available at the NC Innovations Waiver webpage.

Fee Schedules

LME/MCOs set the fee schedules for their own provider networks. LME/MCO fee schedules can be obtained by contacting the LME/MCO. A directory of LME/MCOs is available on the LME/MCO Directory webpage.  

Fee schedules for providers of services not covered under the LME/MCO (providers of services for children age 0-3, NC Health Choice enrollees and legal aliens) can be found on the Medicaid Fee Schedule webpages. 

For more information on the waivers, visit these pages:

• NC Innovations Waiver
• Traumatic Brain Injury (TBI) Waiver

1915(i) Services 

1915(i) services are home and community-based services (HCBS) which provide opportunities for Medicaid enrollees to receive services in their own home or community rather than institutions. Learn more about 1915(i) services. 

Behavioral Health Clinical Coverage Policies

More information about Behavioral Health Clinical Policies can be found on the Program Specific Clinical Coverage Policies webpage.

NC Innovations

Information about the NC Innovations Waiver can be found on the NC Innovations Waiver webpage.

Departmental Waiver Advisory Committee (DWAC)

A Departmental Waiver Advisory Committee (DWAC) was established in 2012 as an advisory body to the NCDHHS on statewide implementation of the 1915(b)(c) Medicaid waivers and ongoing waiver operations. The DWAC has provider, recipient, county commissioner, LME/MCO and state staff representation. Waiver related issues are discussed and stakeholder input and guidance are sought through these meetings. 

DWAC meetings are held monthly in the Brown Building Hearing Room, conference room #104, on the Dorothea Dix campus from 1:30 p.m.–3:30 p.m. Meetings are open to the public.

Meeting minutes and agendas are published on the Councils and Committees webpage, near  the bottom of the page.

Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Information regarding Early and Periodic Screening, Diagnosis and Treatment (EPSDT) can be found on the EPSDT webpage or by contacting your LME/MCO.

Grievances and Appeals

Information regarding grievances and appeals can be obtained by contacting the LME/MCO responsible for your area. Additional information on grievances and appeals can be found on the Medicaid "Your Rights" webpage.