Monday, March 18, 2019

DHHS Issues Final Guidance on Eligibility, Enrollment for Behavioral Health and Intellectual Development Disability Tailored Plans in Medicaid Managed Care

Mar 18, 2019

The North Carolina Department of Health and Human Services today released guidance detailing the eligibility requirements and enrollment processes for Behavioral Health and Intellectual/Developmental Disability Tailored Plans as a part of the Department’s transition to integrated managed care. The Final Guidance document is available on the Medicaid Transformation website. 

In November 2019, most NC Medicaid beneficiaries will begin to transition to managed care, enrolling in Standard Plans designed to meet the needs of most people in the Medicaid program. In July 2021, individuals with higher intensity behavioral health or intellectual and developmental disability needs (such as serious mental illness, severe substance use disorder, or a traumatic brain injury) will enroll in Tailored Plans designed to meet the needs of these more complex populations. 

“We are breaking down the barriers separating our physical and behavioral health care systems to focus on whole person health,” said DHHS Secretary Mandy K. Cohen, M.D. “Tailored Plans will help us deliver on that goal for people with higher intensity behavioral health needs, providing a specialized managed care plan with additional resources and expertise.” 

This final guidance outlines the eligibility criteria for Tailored Plans and describes how people will enroll in these plans, how transitions between Standard Plans and Tailored Plans will work, and what benefits will be covered in Tailored Plans. Much of this content is an update to information included in the November 2017 Concept Paper that outlined the Department’s vision for the establishment of the Behavioral Health and Intellectual Development Disability Tailored Plans. 

This guidance document is the first in a series that will be released over the next year as part of the Department’s commitment to transparency throughout the Tailored Plan design and implementation process. 

Beneficiaries who are eligible for a Tailored Plan will not enroll in managed care until Tailored Plans launch in July 2021. They will remain in their current delivery system, receiving behavioral health services through LME/MCOs and other Medicaid services through the current fee-for-service structure, unless they choose to enroll in a Standard Plan.

Visit the DHHS Medicaid Transformation website to learn more about the Medicaid and NC Health Choice transformation to managed care:

While the department always welcomes feedback on our publications and policies, we are releasing this final guidance to be transparent about our intended policy when BH and I/DD Tailored Plans launch in 2021. The department also welcomes questions about the content of this document at any time. 


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