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NCDHHS delays Medicaid Managed Care Tailored Plans

NCDHHS delays Medicaid Managed Care Tailored Plans

Publication Date: September 29, 2022

To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until April 1, 2023.

Tailored Plans, originally scheduled to launch Dec. 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care and will also provide additional specialized services for individuals with significant behavioral health conditions, intellectual/developmental disabilities (I/DD) and traumatic brain injury (TBI).  

The delayed start allows Local Management Entity-Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working properly. The decision is supported by the leadership of North Carolina's six LME-MCOs. Sandhills Center is the LME-MCO that serves Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham counties in central North Carolina.

Despite the delay, specific new services will still go live on Dec. 1. NCDHHS and the LME-MCOs will support providers of Tailored Care Management to launch their services on Dec. 1. Through Tailored Care Management, eligible beneficiaries will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the beneficiary’s whole-person health needs.

In addition, pending approval from the U.S. Centers for Medicare and Medicaid Services, NCDHHS will implement the 1915(i) option on Dec. 1. This program provides services to help beneficiaries remain in their homes and community-based settings through services such as Respite, Individual and Transitional Supports, Community Living and Supports, Community Transition and Supported Employment.  

Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health, I/DD and TBI supports through their LME-MCO, and physical health and pharmacy services through NC Medicaid Direct, just as they do today.  

More information regarding the beneficiary choice period and other key dates leading up to the April 1 launch will be shared by NCDHHS in the coming weeks.   

For more information about Tailored Plans please visit NC Medicaid’s Tailored Plan website.

NC Medicaid will host a webinar on Friday, Sept. 30, from 1:00 – 2:00 p.m. to provide additional information.