Tailored Plans - Information for Members
Tailored Plans are made to serve you.
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.
Some members will remain in Medicaid Direct; please follow any instructions in the letters you will get later this year.
What to expect when the Trillium Tailored Plan launches?
While Trillium currently coordinates services for behavioral health and intellectual/developmental disability needs, with the launch of the Trillium Tailored Plan, we will have broader capabilities to serve members including physical health care and pharmacy needs.
With the launch of the Trillium Tailored Plan, we will start exciting new programs and embrace whole-person care. Here are a few changes you will see:
- New terms, including Medicaid members and State-funded recipients; there will be separate handbooks for members and recipients to review appropriate information and requirements.
- Our Member and Recipient Services will be available on Saturdays as well as Monday through Friday.
- We will help schedule Non-Emergency Medical Transportation for members to get to doctors appointments
- The launch of our 24-hour Behavioral Health Crisis Line and Nurse Line.
- New benefits listed on our website for physical health care and pharmacy services.
- Transition to 1915(i) from the 1915(b) waiver, including modifications to existing services and new benefits.
- An updated provider directory that will include physical health care providers.
- New value-added and in lieu (pronounced “loo”) of services that are created by Trillium and approved by NCDHHS to uniquely meet the needs of our populations.
- NC Medicaid Ombudsman program where you get help with questions and issues. An ombudsman is an impartial (fair) third party who can help answer questions and resolve issues.
- New ways to improve your well-being through health promotion materials (such as diabetes resources), population health initiatives, and a tobacco cession program to stop smoking.
- A shift from care coordination to Tailored Care Management where a care manager works with you and a team of medical professionals and approved family members or other caregivers to consider your unique health-related needs and find the services you need in your community.
Key Dates
- 4/13: Tailored Plan (TP) Auto Enrollment
- 4/15-5/15: TP Primary Care Provider (PCP) Choice Period
- 4/17: Enrollment Broker begins mailing transition notices
NC Medicaid has started mailing out transition notices to members who may be moving to the Trillium Tailored Plan. Sample notices are available HERE. - 5/16: Members begin scheduling Non-Emergency Medical Transportation / PCP Auto Assignment Begins
- 5/23: Tailored Care Management (TCM) Auto Assignment Begins
- 5/23-6/7: Member ID Cards and Welcome Packets Mailed
- 6/1: Nurse, Behavioral Health (BH), and Pharmacy Call Lines Go Live
- 7/1: TP Managed Care Launch and Healthy Opportunity Program (HOP) TP Launch
Information to Download or Print
Tailored Plan Information
The remaining sessions are postponed
For Members
- Choosing a PCP, How to change PCP, and Auto-enrollment
- Requesting a new Medicaid card or other materials; How to receive information
- New providers and services for individuals with Medicaid coverage
- Open Question & Answer
February 16, 2023 | February 23, 2023 |
June 30, 2022 | November 21, 2022 |
Medicaid members do not need to do anything at this time.
NCDHHS will start mailing notices to members who will be placed on the Trillium Tailored Plan in April. Trillium will mail welcome packets out starting in May.
Please follow these pages, sign up to receive our emails, and let your care manager know if you would like to opt in to receive text messages.
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. Forms to request to stay with the Tailored Plan can also be found on the enrollment broker’s website.
You have transition of care protections.
Your health is important to us, and we want to make sure you keep getting care from your providers during the transition to Trillium. Until January 31, 2025, Trillium will allow you to get treatment from out-of-network Medicaid providers. This means you can:
- Get health care from your current doctor, nurse practitioner, physician assistant or other provider.
- Get services you need from Medicaid providers in-network and out-of-network.
What if I am in the middle of getting treatment?
If you are currently getting ongoing treatment or if you have an ongoing special condition, Trillium will work with you and your provider to make sure you can continue your current treatment.
You can keep getting treatment for an ongoing condition from your current providers until January 31, 2025.
You can change your primary care provider (PCP) at any time for any reason until January 31, 2025.
Trillium is still adding primary care providers to grow our provider network (group). If the doctor you used to see joins our network, we will let you know. If you have questions about which providers you can see, call us at 1-877-685-2415 (TTY 711). You can view providers in our network on our website on Find a Provider or on the Find page on the NC Medicaid Plans website.
The Enrollment Broker’s call center is now available
Phone: 1-833-870-5500 (TTY: 1-833-870-5588)
Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday