We are hiring!
Click here to view our open positions.


Medicaid Transformation and Tailored Plan Updates

For additional information about the Medicaid Transformation process in North Carolina, please visit our page of information and resources.Ā 

New timeline released for Tailored Plan rollout

The start of the new Tailored Plans, integrated health Medicaid Benefit Plans for people with intellectual and/or developmental disabilities (I/DD), as well as those with significant mental health and substance use disorders, was delayed until April 1, 2023, to give the LME MCOs more time to develop networks of health care providers for about 150,000 Medicaid enrollees.

*December 1, 2023: Tailored Care Management begins rollout.

*NOTE: the implementation of 1915(i) services set to begin December 1, 2022 has been delayed pending approval by federal regulators.

January 15, 2023: Tailored Plan Auto-Enrollment and mailing info to enrollees starts.

January 15, 2023: Tailored Plan choice period begins ā€“ Tailored Plan members can choose a tailored care management (TCM) organization as well as a primary care provider (PCP), if they have not already done so.

February 14, 2023: The choice period ends. If Tailored Plan members have not selected a care manager or PCP they will be auto enrolled after this date.

February 15, 2023: PCP and TCM auto-assignment begins for enrollees/members who have not chosen a primary care doctor and/or a care management provider.

February 17, 2023: Tailored Plan members can begin requesting Non-Emergency Medicaid Transportation services for appointments on or after April 1, 2023.

April 1, 2023: Tailored Plan services begin.

For more information, please visit the NC DHHS webpage on Tailored Plans.Ā 


Additional Updates

Tailored Care Management begins rolling out on December 1, 2022. Tailored Plan enrollees can change care management providers at any time with no limits on the number of changes until April 1, 2023. Ā If you want to change TCM providers, you must contact your LME MCO to make the change. Medicaid beneficiaries using Community Navigators/Community Guide can continue to use the service until April 1 during the transition to new related services like Tailored Care Management. For the most current information on TCM please see the NC DHHS website.

Implementation of 1915(i) services are waiting for approval from federal regulators at Centers for Medicaid and Medicare Services (CMS). 1915(i) services are an array of services meant to assist individuals on Medicaid who have an I/DD, as well as those with significant mental health and substance sue disorders, to live, work and recreate in their communities. Read more about these services. Many current b(3) services like respite will transition to 1915(i) services under the new Tailored Plans.

Tags: , , , , , , ,

Comments are closed.