To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined.

Tailored Plans will provide the same services as Standard Plans and will also provide additional specialized services for individuals with complex behavioral health conditions, Intellectual/Developmental Disabilities (I/DDs) and traumatic brain injury (TBI). Our highest priority is making sure that the transition to Tailored Plans is as seamless as possible for the beneficiaries they will serve. The individuals who will be served by Tailored Plans often have complex behavioral and physical health needs, and as a result their care is often more complex too. This increases the importance of a smooth transition with minimal disruption.

In late February 2023, when the Department made the decision to delay to October 1, leadership identified three key areas of work that needed to be completed to ensure a smooth transition. First, that the LME/MCO provider network and technical capability readiness needed to improve; second, that the Department had the appropriate legal tools to ensure the life and safety of beneficiaries if an LME/MCO is failing to provide services; and third, that the LME/MCOs were focused on providing services for the populations they are best positioned to manage successfully.

While gaps remain in provider networks, progress has been made by the LME/MCOs on technical capabilities. While the Department has been working collaboratively with the legislature to achieve the necessary tools to administer the Tailored Plans on par with other managed care plans, they still have not been achieved. Further, uncertainty with the budget, which will fund transformation costs and rebase for the Medicaid program, creates additional needs for launching Tailored Plans. Because there remains no clarity on when those issues will be fully resolved, the Department is announcing the delay in Tailored Plans now but is not able to announce a certain go-forward date.

Beneficiaries who will be covered by the Tailored Plans will continue to receive behavioral health care as they do today. North Carolina’s unique Tailored Care Management model, which launched Dec. 1, 2022, will continue developing and supporting beneficiaries by providing a care team to coordinate care across providers.  Additionally, on July 1, 2023, the LME/MCOs began to provide 1915(i) services to offer Medicaid beneficiaries with serious mental illness, severe substance use disorders, intellectual/developmental disabilities (I/DD) and traumatic brain injury (TBI) an array of home and community based (HCBS) services.

NCDHHS understand that uncertainty is challenging for beneficiaries, especially those with complex medical needs. They will continue to work closely with LME/MCOs to launch Tailored Plans on the fastest possible timeline that can guarantee a smooth transition.

For more information about Tailored Plans, visit NC Medicaid’s Tailored Plan website. For more information about 1915i services, visit NC Medicaid’s recent provider bulletin.