If you move outside of your Tailored Plan’s service area, you will continue to receive services from your Tailored Plan. If the county that manages your Medicaid case (administrative county) changes, you may be moved to a different 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. Tailored Plans will start accepting trips on October 17, […]
To choose a PCP or Tailored Care Management provider with the Tailored Plan, contact your Tailored Plan directly.
* August 1, 2022: Tailored Plan Criteria * August 15, 2022: Tailored Plan Auto-Enrollment (NC Medicaid Enrollment Broker begins mailing Enrollment Packets to potential Tailored Plan members) * August 15, 2022 through October 14, 2022: Choice Period (Beneficiaries can choose a primary care provider (PCP) and Tailored Care Management provider with their Tailored Plan or […]
If you are currently enrolled in a Standard Plan and need to access behavioral health, I/DD, or substance use disorder services, you may submit a Request to Move to The Tailored Plan. Use the Request to Move to The Tailored Plan: Beneficiary form. (link coming soon) If you are a provider, you may ask for […]
You or your provider can contact the NC Medicaid Enrollment Broker at 833-870-5500 or ncmedicaidplans.gov to learn more about your health care options.
Medicaid beneficiaries will be assessed for Tailored Plan eligibility in August 2022. Some beneficiaries will be auto-enrolled in a Tailored Plan. Some will be able to opt-in to a Tailored Plan. In both cases, beneficiaries will receive a notice from the NC Medicaid Enrollment Broker letting them know about Tailored Plans. Tailored Plan members will […]
All health plans offer the same basic benefits and services. Some health plans also offer added services. Standard Plans offer integrated physical health, pharmacy, care coordination and basic behavioral health for most people receiving NC Medicaid. Tailored Plans provide the same services as Standard Plans and provide additional services not available in Standard Plans. These […]
LME-MCOs currently only manage behavioral health services. Beginning December 1, 2022, Tailored Plans 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.
No. Tailored Plan members will not have the option to change their Tailored Plan. Only one Tailored Plan serves each county in North Carolina. Tailored Plan enrollment is based on the county that manages your Medicaid case (administrative county).