How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services prior to Tailored Plan launch?

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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 […]

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What are Standard Plans?

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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

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What enhanced services are only offered by Tailored Plan?

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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 […]

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What is the Tailored Plan Criteria Review?

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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 […]

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What is Tailored Care Management?

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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.

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Will any beneficiaries stay in NC Medicaid Direct?

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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) […]

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Will I receive a new Medicaid ID card?

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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.

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What is the Traumatic Brain Injury (TBI) Waiver?

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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, […]

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