If you have NC Medicaid, your health plan may move to a Tailored Plan if you get services related to:
- Serious mental illness (SMI)
- Severe substance use disorders (SUD)
- Intellectual/developmental disabilities (I/DD)
- Traumatic brain injuries (TBI)
Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans (or “Tailored Plans”) are a new kind of NC Medicaid Managed Care health plan. Tailored Plans cover your doctor visits, prescription drugs, and services for mental health, substance use, intellectual/developmental disabilities, and traumatic brain injury in one plan. They start July 1, 2024.
One of these companies will provide your Tailored Plan:
If your NC Medicaid will move to a Tailored Plan, a letter will be mailed to you.
This letter will list your Tailored Plan. You can find the Tailored Plan for the county that administers your NC Medicaid using this directory. Or, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com).
You will need to pick a primary care provider by May 15, 2024
A primary care provider (PCP) is the doctor you see when you feel sick, need a check-up, or need management of chronic conditions like diabetes.
Pick your PCP by calling your Tailored Plan:
If you can, call your Tailored Plan to pick your PCP before May 15, 2024. If you don’t, a PCP will be assigned to you. But, you can call to change this until January 31, 2025.
Tailored Plan Care Manager
Tailored Care Managers (or “Care Managers”) are available to everyone on a Tailored Plan. They can help schedule your medical appointments, arrange transportation, help locate childcare, and more.
Update your address if needed
Your address needs to be correct so you can get important information.
If you moved recently, or will move soon, call your local Department of Social Services (DSS) to update your address.
If you have an ePASS account, you can update your address online.
Do I have to move to a Tailored Plan?
The letter you receive will describe your options.
Timeline for the move to Tailored Plans
If your NC Medicaid is moving to a Tailored Plan, here are important dates:
Mid-April 2024
Letters will be mailed to those moving to a Tailored Plan. Some people may get a letter saying they have the choice to move to a Tailored Plan. The letter gives instructions on how to pick a primary care provider. You should check to see if your providers are in your Tailored Plan’s network.
May 15, 2024
This is the last day to pick a primary care provider (PCP). If you do not pick a PCP, one will be assigned to you. You can still change your PCP later.
May 16, 2024
You can start scheduling non-emergency medical transportation (NEMT) for appointments on or after July 1, 2024. Call your Tailored Plan to schedule rides.
Late May 2024
A welcome packet and new member health plan ID card will be mailed from your Tailored Plan. Your primary care provider (PCP)’s information will be included.
July 1, 2024
Tailored Plans begin! Start seeing providers (doctors and specialists) in your Tailored Plan’s network.
Need help?
Questions about Tailored Plans: Call your Tailored Plan.
Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570
Trillium Health Resources, 1-877-685-2415, TTY: 711
Vaya Health, 1-800-962-9003, TTY: 711
Didn’t get a letter? If you think you should be in a Tailored Plan, call the NC Medicaid Enrollment Broker at 1-833-870-5500 (TTY: 711 or RelayNC.com). You may also need to update your address.
Link to Webpage with More information: https://medicaid.ncdhhs.gov/tailored-plans/moving-to-a-tailored-plan
