Eligibility for Tailored Care Management

If you are eligible, Tailored Care Management is included with your NC Medicaid benefits. It is free and will not affect your other services.

Available with Tailored Plans or NC Medicaid Direct

Tailored Care Management is available through Tailored Plans and NC Medicaid Direct.

This means your health plan ID card lists one of these companies:

  • Alliance Health
  • Partners Health Management
  • Trillium Health Resources
  • Vaya Health

These health plans are for people with more complex health needs like:

  • Mental illness (such as schizophrenia, bipolar disorder, depression)
  • Addiction to alcohol or drugs (such as opioids or cocaine)
  • Intellectual or developmental disabilities (such as Down syndrome, autism, fetal alcohol syndrome)
  • Traumatic brain injury (such as from car accidents, falls, sport injuries)

NC Innovations Waiver and TBI Waiver recipients: You are eligible for Tailored Care Management. Talk to your Tailored Plan about whether Tailored Care Management is right for you. If you are on the waitlist for the NC Innovations Waiver or TBI Waiver, having Tailored Care Management will not affect your place in line.

Dual-eligible members: “Dual-eligible” means you have Medicare and Medicaid. You may be eligible for Tailored Care Management if your health plan is with Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health.

Tab/Accordion Items

People with these Medicaid health plans are not eligible for Tailored Care Management:

  • Standard Plans
    • AmeriHealth Caritas
    • Carolina Complete Health
    • Healthy Blue
    • UnitedHealthcare Community Plan
    • WellCare
  • Eastern Band of Cherokee Indians (EBCI) Tribal Option

Certain services are like Tailored Care Management. If you already get a similar service, you may not be able to get Tailored Care Management at the same time. To find out if you are receiving similar services, call the number on your health plan ID card.

How to know if you are eligible

You may have received a letter or phone call from your Tailored Care Manager to introduce themselves.

Even if you did not get a letter or phone call, you can call the number on your health plan ID card to ask if you are eligible for Tailored Care Management.

Tailored Care Management

Need help?

These NC Medicaid health plans offer Tailored Care Management. Call the one listed on your health plan ID card or in your health plan welcome letter:

Don’t see your plan? Tailored Care Management is only available with Tailored Plans or NC Medicaid Direct; it is not available with Standard Plans or Eastern Band of Cherokee Indians (EBCI) Tribal Option. See contact information for all Medicaid health plans.

Not sure who to call? Call the number on your health plan ID card. Or call the NC Medicaid Enrollment Broker at 1-833-870-5500. Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday. They can tell you which plan you have.

If you have a complaint or concern, or you need help understanding your rights and responsibilities: Call the NC Medicaid Ombudsman at 1-877-201-3750. Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday. They are an outside group that can advocate on your behalf.

Don’t have NC Medicaid? Apply for NC Medicaid.