Prior to Tailored Plan Launch, you can continue to receive your health services through NC Medicaid Direct and LME/MCO. If you are currently enrolled in NC Medicaid Direct, call 888-245-0179. In NC Medicaid Direct, you may be able to get services from a Local Management Entity/Managed Care Organization (LME/MCO). For a list of NC Medicaid […]
Standard plans provide integrated physical health, behavioral health, pharmacy and long-term services and support to most Medicaid beneficiaries, as well as other programs and services that address unmet health-related resource needs
You can call us at 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday except for State holidays. We do our best to answer every call, but if we are unable to answer, please leave a message with your name and phone number. We’ll call you back by the next business day. You can […]
Tailored Plans are health plans that offer integrated physical health, pharmacy, care coordination and behavioral health services for members who may have significant mental health needs, intellectual/developmental disabilities (I/DDs), traumatic brain injuries (TBIs) or severe substance use disorders. Standard Plans offer some basic behavioral health services. Tailored Plans offer enhanced behavioral health services that are […]
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 […]
Tailored Care Management is a service for Tailored Plan members. Tailored Plan members will have a single designated care manager, supported by a multidisciplinary care team, to provide whole-person care to address physical health, behavioral health, intellectual/developmental disability (I/DD), traumatic brain injury (TBI), pharmacy, long-term service and supports (LTSS) and unmet health-related resource needs.
Yes. Some beneficiaries will stay in NC Medicaid Direct: * People who receive both Medicare and Medicaid, except for those beneficiaries receiving the Innovations Waiver or TBI Waiver. * People who are medically needy, except for those beneficiaries receiving the Innovations Waiver or TBI Waiver. * People in the NC Health Insurance Premium Payment (HIPP) […]
Yes. Tailored Plans will begin mailing Welcome Packets including a Welcome Letter, Medicaid ID card and Member Handbook. Make sure your local DSS has your current mailing address, phone number and email address to ensure you get all important information from your Tailored Plan.
Potential Tailored Plan members will continue to receive health care services the same way they do today.
The Traumatic Brain Injury (TBI) Waiver is a special federal program that provides long-term services and supports for people who experienced a traumatic brain injury (TBI). Alliance Health is the only Tailored Plan that currently offers TBI Waiver services. At Tailored Plan launch, TBI Waiver services will only be available in the following counties: Cumberland, […]