Medicaid Transformation - Information for Members

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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. Also, you can find more information by visiting Medicaid Plan.

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