Beginning August 1, 2022, NC Medicaid beneficiaries will be assessed for the Tailored Plan with a lookback period of 24 months. Assessment for Tailored Plan will be based on the following criteria, but not limited to:
* Enrolled in the Innovations or TBI Waivers, or on the waiting lists
* Enrolled in the Transition to Community Living (TCL) program
* Have used a Medicaid service that will only be available through the Tailored Plan
* Have used a mental health, substance use, I/DD or TBI service funded with state, local, federal or other non-Medicaid funds
* Children with complex needs
* Have a qualifying I/DD diagnosis code
* Have a qualifying mental illness or SUD diagnosis code, and used a Medicaid-covered enhanced behavioral health service during the lookback period*
* Have a diagnosis of a psychotic disorder (primary or secondary to a mood disorder), use of clozapine or a long-acting injectable antipsychotic medication, or receive electroconvulsive therapy (ECT) during the lookback period**
* Have had an admission to a state psychiatric hospital or Alcohol and Drug Abuse Treatment Center (ADATC), including but not limited to, individuals who have had one or more involuntary treatment episodes in a State-owned facility
* Have had two or more visits to the emergency department for a psychiatric problem; two or more psychiatric hospitalizations; or two or more episodes using behavioral health crisis services during the lookback period**
* * The look back period is 24 months
