When are these changes happening?

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* 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 […]

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How do I access enhanced services only offered by Tailored Plans if I am required to enroll in a Standard Plan after Tailored Plans launch December 2022?

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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 […]

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How will the transition to Tailored Plans occur?

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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 […]

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Do all health plans offer the same services?

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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 […]

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How are Tailored Plans different from what the LMEs do now?

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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.

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Can I change my Tailored Plan?

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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).

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