Tailored Plans will start October 1, 2023
NC Medicaid changed the start date for Tailored Plans to October 1, 2023. Until October 1, 2023, you will keep getting services the way you do now. 

Information and processes on this page will be changing in the weeks to come. 
Learn about Tailored Plan here


Tailored Care Management

Integrated Care for Improved Health Outcomes

What is Tailored Care Management?

Tailored Care Management is an important part of the Trillium Tailored Plan. Tailored Care Management combines support from an integrated care team of physical, mental, and developmental disability providers. This is known as "whole person care." Whole person care brings together all aspects of a person’s needs, including behavioral health, physical health, pharmacy, and unmet health-related resource needs. Tailored Care Management helps achieve better health outcomes for our members.

All Trillium Medicaid members are enrolled in Tailored Care Management except for:

  • Members in Assertive Community Treatment (ACT); 
  • Members in Intermediate Care Facilities for Individuals for Intellectual Disabilities (ICF-IIDs); and
  • Members in the High-Fidelity Wraparound program.

Trillium members can choose to stop receiving Tailored Care Management at any time. They will still be supported as needed through care coordination and care transitions (see Member Handbook for more information).

You have a choice in where you receive Tailored Care Management:

  • Care Management Agencies (CMAs): provider organizations with experience providing behavioral health, intellectual/developmental disability, and/or traumatic brain injury services to our population.
  • Advanced Medical Home Plus (AMH+): primary care practices whose providers have experience providing primary care services to our population.
  • Trillium Tailored Plan: care managers who work at Trillium.

If you have questions about Tailored Care Management, please call Trillium at 1-877-685-2415. Here are some things to think about when you choose how you receive Tailored Care Management:

  • the providers you are seeing now,
  • your specific behavioral health, intellectual or developmental disability (I/DD), and/or traumatic brain injury (TBI) needs,
  • how serious are your physical medical needs,
  • where you live. 

Trillium will match you to a Care Manager that has specialized training to meet your needs. You may change your Care Manager twice a year for any reason and at any time with a good reason (good cause). You can choose not to have a Care Manager at any time by calling Member and Recipient Services at 1-877-685-2415 or completing the form in the Member & Recipient Portal.

If choose to stop receiving Tailored Care Management

Even if members opt out of Care Management, are not active in Tailored Care Management, or cannot receive Tailored Care Management, we will continue to support those members through care coordination and care transitions. Care coordination will help with finding housing, handling legal issues related to member’s health, and other unmet health-related resource needs. Trillium will also helps with care transitions such as moving from one clinical setting to another. 

Please click the link to complete the form to stop getting Tailored Care Management. . If you need to download Adobe (a safe program needed to use this form), please click here. For best results, please save the form to your computer before you complete and submit the form. 

What is Tailored Care Management for State-Funded Recipients?

Although there will be many things that are similar to Tailored Care Management received by Medicaid members, there are some distinct differences for state-funded recipients. State-funded recipients with the highest level of need will receive Case or Care Management.

For recipients with behavioral health diagnoses, Case Management is available for children and adults with serious mental health or substance use disorder needs. Trillium has a state-funded behavioral health Care Management coordinator who supports case management services. For recipients with I/DD and TBI diagnoses, Trillium is responsible for providing care management. 

Recipients can get case management if they cannot receive Medicaid and meet all of the following: 

  • Do not have community-based services that are available to meet their needs;
  • Need support from 2 or more agencies, including medical or non-medical providers, and there are no natural or community supports that can provide this;
  • Are expected to have difficulty staying in treatment services without additional support;
  • Cannot get provider-based case management services; and
  • Meet 1 of the following:
    • Live in or may soon enter institutional settings (e.g., state developmental facilities, ICF-IIDs, state psychiatric facilities, or adult care homes);
    • Have been in the criminal justice system through arrest;
    • Have frequently used crisis services (such as emergency department, behavioral health urgent care, and facility crisis); or
    • Are at risk for out-of-home placement from legal guardians.

Trillium has a waitlist for those state-funded recipients who are waiting to receive Care or Case Management. Providers and others can suggest recipients to be added to the list; please call Trillium at 1-877-685-2415 if you feel you need to be placed on this list.

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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