What is a Tailored Plan?
A Tailored Plan is a North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management and behavioral health services. It is for members who may have significant mental health needs, severe substance use disorders, intellectual/developmental disabilities (I/DDs) or traumatic brain injuries (TBIs). Tailored Plans offer added services for members who qualify.
Tailored Plan auto-enrollment began August 15, 2022. If you are auto-enrolled in a Tailored Plan or have the option to choose a Tailored Plan, you will receive a notice in the mail. Tailored Plans will start December 1, 2022.
Who qualifies for a Tailored Plan?
- People who get Innovations Waiver services
- People who get Traumatic Brain Injury (TBI) Waiver services
- People who may have a mental health disorder,substance use disorder, intellectual /developmental disability (I/DD) or traumatic brain injury (TBI).
Tailored Plan services
Tailored Plans offer the same services as Standard Plans.
Tailored Plan services not offered by Standard Plans
Tailored Plans offer certain services that Standard Plans don’t have. These include services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI), such as:
- Assertive community treatment
- Child and adolescent day treatment services
- Community support team (CST)
- Intensive in-home services
- Multi-systemic therapy services
- Psychiatric residential treatment facilities (PRTFs)
- Psychosocial rehabilitation
- Residential treatment facility services
- Substance abuse comprehensive outpatient treatment program (SACOT)
- Substance abuse intensive outpatient program (SAIOP)
- Substance abuse medically monitored residential treatment
- Substance abuse non-medical community residential treatment
These services may be offered by NC Medicaid Direct if you qualify.
Services only offered by Tailored Plans
- Innovations Waiver services
- Intermediate Care Facility for individuals with Intellectual Disabilities (ICF-IID) services
- State-funded (non-Medicaid) services
- TBI Waiver services
- Transitions to Community Living (TCL) program services
For a full list of services that all health plans offer, go to Benefits and services.