Words to know

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Behavioral health provider: Professionals who diagnose mental health disorders, substance use disorders and intellectual /developmental disabilities (I/DDs) and provide treatment.

Care coordination: A service where a care coordinator or care manager refers you for services and supports you might need.

Care management: A service where a care manager helps you meet your health goals. Care managers coordinate your physical health, behavioral health and social needs. They can help you find resources like transportation, healthy food and safe housing.

Health plan: A group of doctors, hospitals and other health care providers. They work together to give you the health care you need. This includes physical health, behavioral health and medicine. To learn more, go to Get answers.

NC Medicaid Direct: North Carolina’s health care program for Medicaid beneficiaries who are not in health plans. It includes care management by Community Care of North Carolina (CCNC), the primary care case management entity (PCCMe) for physical health services. Six Local Management Entity-Managed Care Organizations (LME-MCOs) coordinate services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI).

Primary care provider (PCP): A doctor, nurse practitioner or physician assistant. They care for your health, coordinate your needs and refer you to specialists when you need them. To learn more, go to Get answers.

Provider network: A group of providers that work with the health plan. It includes doctors, therapists, specialists, hospitals and other health care facilities. They give you the health care services you need.

Standard Plan: A North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management and basic behavioral health services for members. Standard Plans offer added services for members who qualify.

Tailored Care Management: An intensive form of care management for people with behavioral health, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) needs.

Tailored Care Management provider: A doctor, nurse practitioner or physician assistant that provides Tailored Care Management services.

Tailored Plan: 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.

The Eastern Band of Cherokee Indians (EBCI) Tribal Option: A primary care case management entity (PCCMe) created by the Cherokee Indian Hospital Authority (CIHA). It manages the primary care needs of federally recognized tribal members and others who qualify for services through Indian Health Service (IHS) and live in Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain or Transylvania counties.

The EBCI Tribal Option includes care coordination by Vaya Health for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI). The EBCI Tribal Option offers added services for members who qualify. As a member of the EBCI Tribal Option, you can get services from any NC Medicaid or NC Health Choice provider.