Consolidation for Members and Recipients

The North Carolina General Assembly requested the North Carolina Department of Health and Human Services (NCDHHS) to reduce the number of LME/MCOs to a total of no more than five, and at least four. 

In an effort to improve delivery of care, stabilize the system, and launch Tailored Plans, NCDHHS Secretary Kody H. Kinsley has directed the regions of Sandhills Center, Eastpointe, and Trillium Health Resources be combined except for the counties of Davidson, Harnett, and Rockingham. This will reduce the number of LME/MCOs down to four (Alliance, Partners, Trillium, and Vaya). For more information, view our press release here.

The current six LME/MCOs will be reduced to four Tailored Plans. The four remaining LME/MCOs will be Alliance, Partners, Trillium, and Vaya. Eighteen counties will join Trillium’s region: Guilford, Randolph, Montgomery, Moore, Lee, Hoke, Richmond, Anson, Scotland, Robeson, Sampson, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, and Warren. We will ensure that each member can keep their current provider and current services, and will experience no disruption in care. 

Trillium will work with NCDHHS and the new counties to find out how many people on Medicaid who live in these counties, receive services for I/DD, behavioral health or traumatic brain injury, have not been placed on the Standard Plan, and will move to Trillium.

Trillium serves members through its Provider Network, the local agencies, and practitioners who are located in the communities they serve. Members and recipients can view this Network through our online Provider Directory or by calling our Member and Recipient Services at 1-877-685-2415. Each county will have staff such as Care Managers and Community Liaisons who will work locally every day. Trillium will continue to operate existing local offices in the 18 new counties. 

Just as Care Managers play a critical role in reassuring members and their families during a transition, other LME/MCO employees play important roles for providers, county Departments of Social Services, and other local stakeholders. Continued employment of the current LME/MCO workforce is an essential part of a successful transition.

NCDHHS will send letters in January to all members in these 18 counties who will be served by Trillium. Once we have received information on our new members, you will receive a new welcome packet from Trillium before Feb. 1, 2024. 

We are committed to ensuring a smooth transition to Medicaid managed care and a smooth transition for beneficiaries moving into a new LME/MCO. Beneficiaries can continue to receive care today - LME/MCOs will honor transition of care for members in ongoing course of treatment.

You will be able to remain with your existing Tailored Care Manager. As long as your provider is in good standing, or the TCM staff at your current MCO decides to stay with Trillium, you will be able to continue seeing them. Trillium plans to maintain continuity of care for members, including the services they receive. Until Feb. 1, 2024, you can continue to call your current MCO.

NCDHHS did approve the consolidation of Sandhills Center and Eastpointe, but this consolidation will occur at the same time as the consolidation with Trillium. As of Feb. 1, 2024, the following counties will join Trillium’s region: Guilford, Randolph, Montgomery, Moore, Lee, Hoke, Richmond, Anson, Scotland, Robeson, Sampson, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, and Warren. 

Our priority during this change is continuity of care for members and stability for providers. It is critical to ensure that the transition process is as seamless as possible for members who are currently served by Sandhills Center and Eastpointe.

Services are no prior authorization (NPA) for the first 120 days. In terms of annual or update, it is not typical for EOR to submit their own SAR, but we can look into this. Trillium has all providers submit treatment authorization requests (TAR, similar to SARs).