February 21, 2024  – North Carolina is set to introduce new managed care plans specifically designed for residents who rely on regional mental health offices for their mental health treatment or disability care. Dubbed as “tailored plans,” this initiative is scheduled for a July 1, 2024 launch. This move marks a significant shift in how care is coordinated and funded for some of the state’s most vulnerable populations.

These tailored plans will be administered by entities known as Local Management Entities/Managed Care Organizations (LME/MCOs), which are regional mental health offices tasked with managing healthcare services for individuals with mental illnesses, developmental disabilities, substance use disorders, or traumatic brain injuries. It’s a departure from the traditional fee-for-service (FFS) model and aims to streamline and enhance the care these beneficiaries receive.

The journey to this moment has not been without its challenges. There were multiple delays and hesitancy from medical systems to enter into necessary network contracts. After negotiations and some back and forth, the system is set to move forward this summer with tailored plans poised to offer a more integrated approach to healthcare for beneficiaries.

This new chapter in Medicaid managed care in North Carolina follows a significant consolidation phase, which saw the number of LMEs reduce from six to four. Notably, Trillium Health Resources expanded its coverage to encompass 46 counties this year, indicating a broadening reach of these specialized services.

The North Carolina Department of Health and Human Services (NCDHHS) has projected that these tailored plans will serve approximately 160,000 beneficiaries. In preparation for the rollout, beneficiaries are set to receive information packets by late May, detailing their assigned primary care providers among other vital information. Kelly Crosbie, director of the mental health, developmental disabilities, and substance use services division, emphasized during a recent webinar the importance of these packets in ensuring beneficiaries are well-informed about their care options and how to select a primary care provider if needed.

This initiative builds on the state’s broader move towards managed care, which began in July 2021 for the physical healthcare of most Medicaid beneficiaries. As North Carolina gears up for this significant transition, the tailored plans represent a step forward in providing more coordinated, comprehensive care for individuals with complex health needs, ultimately aiming to improve health outcomes and quality of life for these populations.