Transition to tailored plans: What NC Medicaid members need to know
New tailored Medicaid plans are launching on July 1. Here’s what North Carolinians need to know.
The North Carolina Department of Health and Human Services (NCDHHS) is launching its Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans on Monday, July 1. These plans are a new type of NC Medicaid Managed Care health plan aimed at integrating physical and behavioral health services. NCDHHS Secretary Kody H. Kinsley emphasized that this initiative is a significant step toward creating a more robust and accessible behavioral health system for North Carolina’s 210,000 eligible residents.
Tailored Plans are designed for individuals covered by NC Medicaid who have serious mental illness, severe substance use disorders, intellectual or developmental disabilities, or traumatic brain injuries. These plans will cover a wide range of services, including physical care, prescription drugs, mental health services, long-term services and supports, and other health-related needs.
According to NC Medicaid Deputy Secretary Jay Ludlam, the new plans will ensure comprehensive support for members from day one, covering their physical and behavioral health needs as well as prescription medications.
In April, the NC Medicaid Enrollment Broker sent out letters to notify eligible North Carolinians about the transition to Tailored Plans and how to select a primary care provider. Individuals who did not select a primary care provider by the May 15 deadline were assigned one, but they can change their provider without cause through January 31, 2025. Welcome packets and new member ID cards have been sent out by providers such as Alliance Health, Partners Health, Trillium Health, and Vaya Total Care. Those who believe they should be in a Tailored Plan but did not receive these materials can contact the NC Medicaid Enrollment Broker for assistance.
NCDHHS has published a communication toolkit to aid residents in navigating the transition. Available in both English and Spanish, the toolkit includes flyers, presentations, and social media graphics to provide clear information about the new plans. Kelly Crosbie, Director of the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services, highlighted the importance of these resources in helping North Carolinians understand the services available to them under Tailored Plans.
Additionally, the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services will host its monthly webinar, “Side by Side with DMHDDSUS,” on July 1 to provide updates on the Tailored Plan launch. Residents interested in more information or webinar registration can visit the provided registration link. For further details on Tailored Plans, individuals can visit the dedicated Medicaid webpage.
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