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 (SP) and Behavioral Health (BH) and Intellectual/Developmental Disabilities (I/DD) Tailored Plans (TP). 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 will be specifically designed to serve the complex needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, and traumatic brain injury, as well as foster children — populations Trillium and all other LME/MCOs have long served. We also expect the Tailored Plans will serve uninsured individuals currently receiving state-funded services, regardless of their diagnosis.
Both Standard Plans and BH IDD Tailored Plans will integrate physical health, behavioral health, and pharmacy services to best serve individual needs. To learn more, please visit the new NC Medicaid Managed Care website here or view the Frequently Asked Questions below. Trillium will continue to serve members with complex needs (significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, traumatic brain injury, and foster children) once the Standard Plans go live. Tailored Plans will not launch until later.
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 encouraged to “raise their hand” and request transition to the Tailored Plan if they have been placed on the Standard 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.
NC Medicaid has paused enrollment until they announce a new launch date.
The following are some of the behavioral health services that will be available through the Standard Plan:
- Inpatient behavioral health services
- Mobile crisis management services
- Outpatient behavioral health emergency room services
- Outpatient behavioral health services provided by direct-enrolled providers
- Facility-based crisis services for children and adolescents
- Non-hospital medical detoxification services, partial hospitalization
- Diagnostic assessment services
- Professional treatment services in a facility-based crisis program
- Medically supervised or alcohol and drug abuse treatment center detoxification crisis stabilization
- Outpatient opioid treatment services
- Research-based intensive behavioral health treatment
- Ambulatory detoxification services
- Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)
The exact list of services offered in the Tailored Plan will not be available until the RFP is released in February 2020.ers.
