Practice Support Update Blog

NC Medicaid Managed Care: Contracting with Tailored Plans

Jun 14, 2022 10:00:00 AM / by Practice Support Team

It is important to contract with health plans in advance of NC Medicaid Tailored Plan launch on Dec. 1, 2022


North Carolina will launch the Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plan (Tailored Plan) on Dec. 1, 2022. A Tailored Plan is an integrated health plan for individuals with significant behavioral health needs and I/DDs. Only LME/MCOs were eligible to bid on the contract to become and operate Behavioral Health I/DD Tailored Plans, and it is a legislative requirement that Tailored Plans must contract with a licensed prepaid health plan (PHP) that covers services required under a Standard Plan contract.

The Tailored Plans will also serve other special populations, including Innovations and Traumatic Brain Injury (TBI) waiver enrollees, and waitlist members, and be responsible for managing the state’s non-Medicaid (state funded) behavioral health, developmental disabilities and TBI services for uninsured and underinsured North Carolinians. Qualifying beneficiaries will be assigned to one of six Tailored Plans based on their administrative county. Beneficiaries will be allowed to choose a primary care provider (PCP) and a Tailored Care Management provider. Tailored Care Management provider types include Care Management Agencies (CMAs), who deliver behavioral health, substance use, and/ or intellectual and developmental disability services and care management, or Advanced Medical Homes (AMH+) who deliver both primary care services and tailored care management services.

Playbook 2022 NC Medicaid

Provider and Tailored Plan Contract Deadlines for Inclusion in Beneficiary Choice Period and Auto Assignment

Tailored Plan Contracting Deadlines Questions and Answers

Tags: Medicaid Managed Care, Primary Care, behavioral health, Contracting

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