Home Local News July 1 launch of behavioral health and intellectual/developmental disabilities tailored plans

July 1 launch of behavioral health and intellectual/developmental disabilities tailored plans

Kody Kinsley, secretary of the N.C. Department of Health and Human Services. RO file photo

RALEIGH — Tailored Plans are a new kind of NC Medicaid Managed Care health plan for approximately 210,000 beneficiaries with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability or a traumatic brain injury in North Carolina.

They will cover doctor visits, prescription drugs and services for mental health, substance use, I/DD and traumatic brain injury in one plan. Eligible North Carolinians who are covered by NC Medicaid Direct will be covered by a Tailored Plan beginning July 1. The name of their Medicaid plan will change but the services covered remain the same. A bilingual toolkit with accessible resources is now available for people impacted by the transition to Tailored Plans.

“Tailored Plans have the privilege and responsibility of serving North Carolinians with incredibly complex medical and behavioral needs — ensuring the plan operators are ready to support these members through this transition has been and continues to be our goal,” said NC Health and Human Services Secretary Kody H. Kinsley. “Tailored Plans are another innovation to deliver on North Carolina’s investments in behavioral health as foundational to whole person health.”

Tailored Plans will ensure beneficiaries’ needs are met regarding physical health, behavioral health and home and community-based services. Tailored Plans will also provide services that support well-being, such as food, transportation and housing.

“Tailored Plans are a step forward in improving the quality of life for people in North Carolina with serious mental illness, substance misuse, intellectual or developmental disabilities and traumatic brain injury,” said Kelly Crosbie, MSW, LCSW, Director of the NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services. “We are working with consumers, families, providers and the Tailored Plans to ensure the community has the resources they need to understand and manage the transition into Tailored Plans more easily. We created the Tailored Plan toolkit to make this information more accessible.”

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The Tailored Plans toolkit was developed with input from the community and includes resources for partners and advocates to help people understand what to expect during the transition to Tailored Plans. The toolkit, which is available in English and Spanish, includes:

  • New website content
  • A presentation deck explaining Tailored Plans, answers to common questions and resources to help eligible beneficiaries navigate the process
  • A printable flyer letting people know what actions they should take before July 1
  • Social media posts highlighting important information

The NC Medicaid Enrollment Broker will mail a letter in mid-April to anyone moving to a Tailored Plan. Tailored Plan beneficiaries will need to choose a primary care provider between April 15 and May 15, 2024. If you don’t choose a PCP by May 15, the Tailored Plan will assign one to you. People can change their PCP through Jan. 31, 2025. 31, 2025.

Tailored Plans will be managed by the Local Management Entities Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health. At a legislative committee hearing last week, NC Medicaid officially announced that all Tailored Plans are ready to go live on July 1.

For more information about Tailored Plans, visit: medicaid.nc.gov/tailored-plans. To access the toolkit, visit: medicaid.nc.gov/tailored-plans/toolkit.