Use this article to figure out 1) where to start, 2) who to connect with, 3) what to expect next.
Use this article to figure out 1) where to start, 2) who to connect with, 3) what to expect next.
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 October 2023.
Do you have a copy of the annual Medicaid identification card from the NC Department of Health & Human Services Division of Health Benefits?
- Yes: find the “LME MCO” named: Alliance Health, Eastpointe, Partners Health Management, Sandhills, Trillium Health Resources, or Vaya Health.
- No: contact your county’s Department of Social Services (DSS) to inquire about your current Medicaid information. Click here for their contact information.
Unless your county changes, the “LME MCO” effectively would become your “Tailored Plan.”
If your current Medicaid expires before October 1, 2023, your DSS case worker may request additional documentation from you to ensure re-enrollment in Medicaid/Special Assistance to be eligible for the Tailored Plan.
What county do you or your sibling live in?
- Cumberland, Durham, Johnston, Mecklenburg, Orange, or Wake county
- Your Tailored Plan is: Alliance Health
- Call this number: 1-800-510-9132
- Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne, Warren, or Wilson county:
- Your Tailored Plan is: Eastpointe
- Call this number: 1-800-913-6109
- Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, or Yadkin county:
- Your Tailored Plan is: Partners Health Management
- Call this number: 1-888-235-4673
- Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, Rockingham county:
- Your Tailored Plan is: Sandhills
- Call this number: 1-800-256-2452
- Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, or Washington county:
- Your Tailored Plan is: Trillium Health Resources
- Call this number: 1-877-685-2415
- Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, or Yancey county:
- Your Tailored Plan is: Vaya Health
- Call this number: 1-800-962-9003
Ask your "LME MCO" to:
- Document your preferred primary care physician (PCP) in your Tailored Care file starting October 1, 2023
- Provide you with a list of care management agency (CMA) options
In the world of care, we hope for the best but prepare for the worst! Each Tailored Plan has a different pace in building their PCP and CMA provider network, so they may not have your preferences enrolled for you yet. If your PCP is not already in their database, ask them for specific instructions that you can provide to your PCP’s office to ensure they become in-network. And ask your Tailored Plan for the date you can call back to get a list of CMA options. You may decide to maintain care management with the LME MCO if that is your only/best option, but it can be empowering to know your options.