Are you or your sibling living in North Carolina with:

  • the Innovations Waiver for adults with intellectual/developmental disabilities (I/DD) or
  • the TBI Waiver for adults with traumatic brain injury (TBI)?

Then, you’re likely to be a part of the upcoming Medicaid Transformation into the “Tailored Plans,” which are set to launch in April 2023. If you read our last article, you’ll notice that the launch date has been delayed for another season. However, Care Management is still set to launch in December 2022.

AKALAKA is here to help you, the best we can, to feel less lost and less alone in navigating this wilderness of disability services. This article is the second in AKALAKA’s series on the “Behavioral Health I/DD Tailored Plan” for our North Carolina members.

Use this article to figure out 1) what care management is, 2) who can provide care management, 3) what to expect next.

Note: AKALAKA is working daily to update our database with the latest information. Let us know if you have any questions or suggestions.

1) What is [tailored] care management?

It may end up being just like what you’ve experienced with “case management” or “care coordination” from your current “LME MCO” but here are a few new aspects:

  • whole-person: your tailored care management provider would be responsible for managing your other health care services in addition to Innovations or TBI Waiver services
  • provider-based: your tailored care management is more and more likely to be provided by a local service provider organization certified as a care management agency (CMA) or advanced medical home+ (AMH+) rather than your Tailored Plan over the next few years
  • conflict-free: your tailored care management provider cannot also provide you with other Innovations or TBI Waiver services

You should have a choice in all of this, according to the NC DHHS, and you may choose to remain with your Tailored Plan for care management or you can choose from the growing list of local CMAs or AMH+ providers:

2) Who can provide care management?

As a reminder, you’ll need to confirm that the CMA/AMH+ you want is enrolled in your Tailored Plan. Click here for the AKALAKA article with more information about Tailored Plans.

3) Expect mix ups

In the world of care, we hope for the best but prepare for the worst! Since “Tailored Care Managment” is set to launch on December 1, 2022, you may receive contact about your new care manager over the next few months. However, you technically would not be enrolled in the “Tailored Plan” until April 2023 so your Innovations or TBI Waiver services may continue to be handled by your “LME/MCO and physical health and pharmacy services through NC Medicaid Direct” (NCDHHS Press Release).

We know… we’ll try our best to make it make sense! Reach out to us if you need any help as AKALAKA strives to provide you with more timely, thoughtful, and delightful support and resources:

Join our interest list for our upcoming AKALAKA Innovations & TBI Waiver 101 classes where we’ll learn how to better navigate this wilderness with peers who can relate.