On July 1, 2024, North Carolina Medicaid launched behavioral health Tailored Plans for beneficiaries with a serious mental illness (SMI), a serious emotional disturbance (SED), a severe addiction disorder, an intellectual/developmental disability (I/DD), or a traumatic brain injury (TBI). Enrollment, at 219,000 is 4.2% higher than the 210,000 that the North Carolina Department of Health and Human Services (NCDHHS) anticipated. The Tailored Plans cover all Medicaid state plan services for medical services, prescription drugs, and behavioral health treatment as well as care management and access to home- and community-based services through the Innovations waiver for people with I/DD or the Traumatic Brain Injury waiver for people with TBI.
The Tailored Plans are offered by the state’s four local management entities/managed care organizations that manage public behavioral health services. Across the MCOs, approximate Tailored Plan enrollment is as follows:
- Alliance: 58,000
- Partners: 44,000
- Trillium: 77,000
- Vaya: 40,000
The following populations remain in Medicaid fee-for-service:
- People who are medically needy
- People participating in the Program of All-Inclusive Care for the Elderly (PACE)
- Children in foster care
- Former foster care youth
- Children receiving adoption assistance
- Children receiving Community Alternatives Program for Children (CAP/C) services
- People receiving Community Alternatives Program for Disabled Adults (CAP/DA) services
- People dually eligible for and receiving services through Medicaid and Medicare
- People receiving Family Planning Medicaid only (limited services)
- People who are also enrolled in Medicare, unless they are in the Innovations or TBI Home and Community Based Services (HCBS) waiver
Each county is served by a single Tailored Plan (Alliance, Partners, Trillium, and Vaya). Medicaid beneficiaries eligible for Tailored Plan enrollment were notified in mid-April 2024 that they were automatically enrolled and in the plan for their county and needed to choose a primary care provider organization (PCP) by May 15, 2024. Those who failed to choose a PCP were assigned one. However, through January 31, 2025, beneficiaries can change their PCP. Additionally, many people eligible for Tailored Plan enrollment also had the option to enroll in a Standard Plan, which offers a more limited set of benefits.
For more information, contact: Office of Communications, North Carolina Department of Health and Human Services, 101 Blair Drive, Adams Building, 2001 Mail Service Center, Raleigh, North Carolina 27699-2001; 919-855-4840; Email: news@dhhs.nc.gov; Website: https://medicaid.ncdhhs.gov/tailored-plans
November 2024 00US24EUA0065