Tailored Plans offer some behavioral health services that are not available in Standard Plans, including Innovations and TBI Waiver services and State-funded services. To see a list of services offered by Tailored Plans, visit https://ncmedicaidplans.gov/en/tailored-plan-services.
Tailored Plans
TCM is a new kind of care management for eligible NC Medicaid beneficiaries. The goal of the program is to provide whole person care management to help beneficiaries meet their health goals. Whole person care looks at all the beneficiary’s needs including: Physical health Behavioral health Intellectual and developmental disabilities (I/DD) Traumatic brain injuries (TBI) […]
Yes. Tailored Plans will begin mailing Welcome Packets including a Welcome Letter, Medicaid ID card and Member Handbook May 23, 2024. 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.
Tailored Plans will provide NEMT for all Medicaid-covered services, including carved-out services. This means you will need to call your Tailored Plan, not your local Department of Social Services (DSS), when you need to schedule a ride to a doctor, pharmacy or other health provider. You can begin scheduling rides for appointments on or after […]
Make sure your local Department of Social Services (DSS) has your current mailing address, phone number and email address so you receive all important information. You can find your local county DSS at dhhs.gov/localdss. * Report all changes, including your address and any changes such as income or a change in household (the number of family […]
If you move outside of the county that manages your Medicaid case (administrative county), you will be moved to the Tailored Plan that serves that area.
To choose a PCP or Tailored Care Management (TCM) provider with your Tailored Plan, contact your Tailored Plan directly. If you are getting TCM services now, you will keep your TCM provider. If you do not choose a PCP by May 15, 2024, one will be assigned to you.
NC Medicaid will transition beneficiaries who may need certain services for a severe mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) to Tailored Plans) July 1, 2024. Until then, potential Tailored Plan beneficiaries will receive health care services the same way they do today, through NC Medicaid Direct or […]
NC Medicaid beneficiaries will be assessed for Tailored Plan eligibility. Eligible beneficiaries will get a letter from the NC Medicaid Enrollment Broker in mid-April. The letter will tell you if you have been auto-enrolled in a tailored Plan or if you have the choice to opt-in. To learn more about the move to Tailored Plans, […]
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. Your primary care provider (PCP) must be in the Tailored Plan’s network. If they are not, you will likely have to change to a different PCP.
