Launch of Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans Delayed

RALEIGH —The Department of Health and Human Services is delaying implementation of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Tailored Plan launch was scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined. The Department and the LME/MCOs remain committed to the implementation of the Tailored Plans, ensuring minimal disruption for the roughly 160,000 eligible beneficiaries set to be in the Tailored Plans. Tailored Plans will serve people with complex behavioral health conditions, intellectual/developmental disabilities (I/DD) and traumatic brain injury (TBI). Their behavioral and physical health needs are often significant, requiring ongoing care from multiple providers.

In late February 2023, when the Department made the decision to delay to Oct. 1, leadership identified three key areas that needed more work to ensure a smooth transition. First, that the LME/MCO provider network and technical capability readiness needed to improve; second, that the Department had the appropriate legal tools to ensure the well-being and safety of beneficiaries if an LME/MCO is failing to provide services; and third, that the LME/MCOs were focused on providing services for the populations they are best positioned to manage successfully.

While gaps remain in provider networks, progress has been made by the LME/MCOs on technical capabilities. The Department has been working collaboratively with the legislature to achieve the necessary tools to administer the Tailored Plans on par with other managed care plans, but they are still a work in progress. Further, uncertainty with the state budget, which will fund transformation costs and rebase for the Medicaid program, creates additional needs for launching Tailored Plans. Because it remains uncertain as to when those issues will be fully resolved, the Department is announcing the delay in Tailored Plans now but is not able to announce a certain go-forward date at this time.

The delay will minimize confusion for beneficiaries, who were otherwise set to receive notices in mid-July informing them of their enrollment with a Tailored Plan and directing them to select a primary care provider.

Beneficiaries who will be covered by the Tailored Plans will continue to receive behavioral health, I/DD, TBI and physical health care as they do today. North Carolina’s unique Tailored Care Management model, which launched Dec. 1, 2022, will continue to support beneficiaries by providing a care team to coordinate care across providers. Additionally, on July 1, 2023, the LME/MCOs began to provide 1915(i) services to offer an array of home and community based (HCBS) services to Medicaid beneficiaries with serious mental health diagnoses, severe substance use disorders, intellectual/developmental disabilities and traumatic brain injuries.

For more information about Tailored Plans, visit NC Medicaid’s Tailored Plan website. For more information about 1915(i) services, visit NC Medicaid’s recent provider bulletin.