What to do if your NC Medicaid will move to a Tailored Plan

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Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (or “Tailored Plans”) are a new kind of NC Medicaid Managed Care health plan. Tailored Plans cover your doctor visits, prescription drugs, and services for mental health, substance use, intellectual/developmental disabilities, and traumatic brain injury in one plan. They start July 1, 2024.

If your NC Medicaid will move to a Tailored Plan, a letter will be mailed to you in mid-April 2024.

A letter like this one (envelope pictured) will be mailed in mid-April 2024 to beneficiaries who are eligible for a Tailored Plan.
A letter will be mailed in mid-April 2024 to beneficiaries who are eligible for a Tailored Plan.


If you have NC Medicaid, your health plan may move to a Tailored Plan if you get services related to:

  • Serious mental illness (SMI)
  • Severe substance use disorders (SUD)
  • Intellectual/developmental disabilities (I/DD)
  • Traumatic brain injuries (TBI)

Didn’t get a letter? If you think you should be in a Tailored Plan, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com). You may also need to update your address.

 

What you should do

If your Medicaid is moving to a Tailored Plan, do these things. Click each headline for more details.

Tab/Accordion Items

One of these companies will provide your Tailored Plan:

The letter being mailed in mid-April will list your Tailored Plan. You can find the Tailored Plan for the county that administers your NC Medicaid using this directory. Or, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com).

A primary care provider (PCP) is the doctor you see when you feel sick, need a check-up, or need management of chronic conditions like diabetes.

Pick a PCP in your Tailored Plan’s network (group). If your current PCP is not in-network, you need to a pick new one who is in your Tailored Plan’s network. You will go to this PCP starting July 1, 2024.

Pick your PCP by calling your Tailored Plan:

If you can, call your Tailored Plan to pick your PCP before May 15, 2024. If you don’t, a PCP will be assigned to you. But, you can call to change this until January 31, 2025.

Providers are doctors or specialists.

To have your services paid for by NC Medicaid, your Medicaid providers must be in your Tailored Plan’s network (Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health).

If your providers are not in-network, their services will not be paid for by NC Medicaid. You will be responsible for the charges.

Check each of your providers to find out if they are in your Tailored Plan’s network. Find new ones if needed.

3 ways to check or find providers:

Can’t find your provider? Learn more about what you can do if a provider is not in your Tailored Plan’s network.

Tailored Care Managers (or “Care Managers”) are available to everyone on a Tailored Plan. They can help schedule your medical appointments, arrange transportation, help locate childcare, and more.

Call your Tailored Plan and ask who your Tailored Care Manager is, or how to get one:

If you already have a Tailored Care Manager, they will still be your Tailored Care Manager when you move to a Tailored Plan.

Your address needs to be correct so you can get important information.

If you moved recently, or will move soon, call your local Department of Social Services (DSS) to update your address. Use this directory to find your DSS, or call the NC Medicaid Contact Center 1-888-245-0179 (TTY: 711 or RelayNC.com).

If you have an ePASS account, you can update your address online.

Get printable posters and flyers, PowerPoint presentations, and other materials in our Tailored Plan Transition Toolkit.

 

If a provider is not in your Tailored Plan’s network

Your Medicaid providers (doctors and specialists) must be in your Tailored Plan’s network to be covered. If they are not in your Tailored Plan’s network, you’ll be responsible for the charges.

You can use this directory to find providers in your Tailored Plan’s network. Or, you can call your Tailored Plan or Tailored Care Manager. Let them know which provider you need. They can also help you find new providers.

If there is not an in-network provider that can give the care you need, you may be able to get a referral for an out-of-network provider. The rules and restrictions vary, so call your Tailored Plan or Tailored Care Manager for details:

 

Do I have to move to a Tailored Plan?

The letter being mailed in mid-April will describe your options.

For most people, if you get a letter that says your NC Medicaid is moving to a Tailored Plan:

  • Moving to a Tailored Plan lets you keep your current coverage of services. Tailored Plans cover the same services you get now through NC Medicaid Direct and your LME/MCO.
  • You may refuse to enroll in a Tailored Plan, but you could lose coverage for certain services. If you are currently in NC Medicaid Direct and choose to stay instead of moving to the Tailored Plan, you could lose coverage for certain services.

Changing Tailored Plan companies: There is only one Tailored Plan company (LME/MCO) per county. You cannot change your Tailored Plan company unless you move.

Need help? The NC Medicaid Enrollment Broker can help you understand your eligibility for health plans and provide counseling for picking a health plan. Call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com).

 

What the move to a Tailored Plan means for you

If your Medicaid is moving to a Tailored Plan:

 

Timeline for the move to Tailored Plans

If your NC Medicaid is moving to a Tailored Plan, here are important dates:

Mid-April 2024

Letters will be mailed to those moving to a Tailored Plan. Some people may get a letter saying they have the choice to move to a Tailored Plan. The letter gives instructions on how to pick a primary care provider. You should check to see if your providers are in your Tailored Plan’s network.

May 15, 2024

This is the last day to pick a primary care provider (PCP). If you do not pick a PCP, one will be assigned to you. You can still change your PCP later.

May 16, 2024

You can start scheduling non-emergency medical transportation (NEMT) for appointments on or after July 1, 2024. Call your Tailored Plan to schedule rides.

Late May 2024

A welcome packet and new member health plan ID card will be mailed from your Tailored Plan. Your primary care provider (PCP)’s information will be included.

July 1, 2024

Tailored Plans begin! Start seeing providers (doctors and specialists) in your Tailored Plan’s network.

 

Need help?

Questions about Tailored Plans: Call your Tailored Plan.

You can find the Tailored Plan for the county that administers your NC Medicaid using this directory. Or, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com).

Questions about your health plan options: Call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com). Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday.

 

Other related services

Information for Providers

Provider Playbook: NC Medicaid Managed Care