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 December 2022, 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 […]

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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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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 […]

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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 because they need certain services: * People who receive both Medicare and Medicaid * People who are medically needy * People in the NC Health Insurance Premium Payment (HIPP) Program * Children who receive Community Alternatives Program for Children (CAP/C) services * People who receive Community […]

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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 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 to their members beginning October 22, 2022. 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 should I do to prepare for Tailored Plan launch?

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Make sure your local Department of Social Services (DSS) has your current mailing address, phone number and email address to ensure 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 that may […]

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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 on December 1, 2022, TBI Waiver services will only be available in […]

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