LME-MCOs currently only manage behavioral health services. Once Tailored Plans launch, they will manage all Medicaid services for their members, including physical health services. In most cases, your physical health providers must be in the Tailored Plan’s network. If they are not, you will likely have to change to a different physical health provider.
An LME-MCO coordinates services for mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) for NC Medicaid Direct beneficiaries and EBCI Tribal Option members. There are six LME-MCOs in North Carolina: Alliance Health, Eastpointe, Partners Health Management, Sandhills Center, Trillium Health Resources, and Vaya Health.
Tailored Plan eligibility can be based on either diagnosis or what services the person is receiving. Generally, an eligible member has a significant mental health disorder, substance use disorder, intellectual/developmental disability, or traumatic brain injury.
Tailored Plans are North Carolina Medicaid health plans. They provide physical health, pharmacy, care management and behavioral health services for beneficiaries who may have significant mental health needs, severe substance use disorders, intellectual/developmental disabilities (I/DD) or traumatic brain injury (TBI). Tailored Plans offer enhanced behavioral health services that are not available in Standard Plans, including […]
Some people can change their health plan at any time. You can change your health plan at any time for these reasons: * You need services to address a mental health disorder, substance use disorder, intellectual/developmental (I/DD) or traumatic brain injury (TBI) * You are a federally recognized tribal member or qualify for services through […]
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 […]
The NC Medicaid Ombudsman is contracted by the State of North Carolina but operates as an independent organization serving as a resource to Medicaid beneficiaries.
The NC Medicaid Ombudsman cannot provide legal advice or represent you in your appeal. However, if you have already talked with your health plan and were not able to resolve your issue, we can contact your health plan to try to resolve your issue informally. For example, we can give your health plan new information, […]
We will start by asking your name, how to reach you, what county you live in and what health plan you are enrolled in (or trying to enroll in). We will ask you if you have attempted to resolve your issue directly with the entity at issue. We will then ask you for other information […]
The Ombudsman can help with these issues and more if you have been unable to resolve them by working with your health plan or the Enrollment Broker: Enrolling in a health plan, if: You think you should not have to enroll in a health plan You have trouble enrolling in a health plan You can’t […]