Provider Outreach to Members

Some providers are encouraging patients to sign up for managed care (i.e. the Standard Plans) and listing the health plans they have contracted with to help patients with health plan selection. We welcome this engagement from our providers, but please note that not all Medicaid members are moving to managed care now. We understand receiving letters or other information from providers to sign up for a health plan is causing some confusion for our members who are not required to sign up at this time.

Members who are not required to sign up include those on the Innovations Waiver or people receiving intensive mental health or substance abuse services.

If you hear from your provider conducting outreach, we encourage you to call the NC Medicaid Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). The enrollment broker can tell you if you are required to sign up for Medicaid Managed Care at this time and can help you with making an informed choice if you are.

Medicaid Transformation - Information for Members

NC DHHS seal logo

The 1115 Waiver seeks to transition Medicaid services in North Carolina from fee-for-service to managed care. Services will be offered through two distinct products: Standard Plans and Behavioral Health (BH) and Intellectual/Developmental Disabilities (I/DD) Tailored Plans. Standard Plans will serve most Medicaid and NC Health Choice members, including all adults and children and those with mild to moderate behavioral health needs. 

BH I/DD Tailored Plans are specifically designed to serve the complex needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities, and traumatic brain injury — populations Trillium and all other LME/MCOs have long served. The Tailored Plans will also serve uninsured individuals currently receiving state-funded services, regardless of their diagnosis.

Thumbnail of the Medicaid transformation flyer page 1    Thumbnail of the Medicaid transformation flyer page 2

 

INFORMATION FOR MEMBERS AND FAMILIES

Members do not need to do anything at this time. They will be contacted by the state if the state determines they will be served by the Standard Plan. Notification letters will include instructions if they feel they should be served by the Tailored Plan.  The state has published a “County Playbook: Medicaid Managed Care” website that will post many of the letters and communications that will be developed for members. 

Members will be able to request transition to the Tailored Plan if they have been placed on the Standard Plan and choose to be served by the Tailored Plan. Members who use certain services for their developmental disability, mental illness, traumatic brain injury, or substance use disorder (for example, need access to State-funded or B3 services, are on Innovations Waiver, OR are on the Innovations waiting list) may choose to follow the directions in the letter and ask to be served through the Tailored Plan.

The Enrollment Broker’s call center is open for the Standard Plans: 

  • Phone: 1-833-870-5500 (TTY: 1-833-870-5588)
    Hours of operation: 7 a.m. to 8 p.m., Monday through Sunday

Please visit NCMedicaidPlans.gov for more information.

Page last verified on

See something that needs to be updated?

If you find any wrong or out of date information on our pages, we want to know. Please email Info@TrilliumNC.org with any corrections.


Help Stop Fraud & Abuse

You can help keep fraud, waste, abuse, unethical, or illegal activity out of our workplace. If you are uncomfortable communicating a concern in person, report it anonymously by calling the toll-free hotline number, 1.855.659.7660, or report it online at EthicsPoint and follow the instructions on the screen