For individuals or family members with mental health needs, substance use disorders, intellectual/developmental disabilities (I/DD) or traumatic brain injuries, you may qualify for enhanced services beginning July 1, 2024 with North Carolina Medicaid’s Tailored Plans. 

Tailored Plans include coverage for physical health services, pharmacy services, care coordination and care management, behavioral health services, and added services, such as wellness programs. It includes services that support well-being, such as food, transportation and housing.

There are four Tailored Plans offered by North Carolina’s Local Management Entity/Managed Care Organizations: Alliance Health, Partners Health Management, Trillium Health Resources, and Vaya Health. There are four Tailored Plans: Alliance Health, Partners Health Management, Trillium Health Resources, and Vaya Health. Alliance Health is the only Tailored Plan that currently offers TBI Waiver services.

Who Qualifies for a Tailored Plan?

• People who get Innovations Waiver services
• People who get Traumatic Brain Injury (TBI) Waiver services
• People who may have a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI).

How to Get a Tailored Plan?

• Apply for NC Medicaid.
• Your eligibility for the Tailored Plan will be automatically reviewed. If you are eligible, you should get a letter in the mail letting you know.
• You can ask to move to a Tailored Plan. You or your provider can submit the form “Request to Move to NC Medicaid Direct or LME/MCO.” 

The North Carolina Department of Health and Human Services has a full list of services all health plans offer here.