Tailored Plans - Information for Members

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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 

  1. 4/13: Tailored Plan (TP) Auto Enrollment
  2. 4/15-5/15: TP Primary Care Provider (PCP) Choice Period
  3. 4/17: Enrollment Broker begins mailing transition notices
  4. 5/16: Members begin scheduling Non-Emergency Medical Transportation / PCP Auto Assignment Begins
  5. 5/23: Tailored Care Management (TCM) Auto Assignment Begins
  6. 5/23-6/7: Member ID Cards and Welcome Packets Mailed
  7. 6/1: Nurse, Behavioral Health (BH), and Pharmacy Call Lines Go Live
  8. 7/1: TP Managed Care Launch and Healthy Opportunity Program (HOP) TP Launch

Tailored Plan Information

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

Please visit NCMedicaidPlans.gov for more information
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