State-Funded Services
If you are uninsured or underinsured and cannot afford to pay for care, you may be eligible for State-funded services. In the Vaya Health region, these services are available through the Vaya Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plan.
A person who receives State-funded services is called a Tailored Plan recipient. Recipients who live in Vaya’s region may be eligible for services for:
- A mental health condition
- Substance use disorder
- I/DD
- Traumatic brain injury (TBI)
The availability of State-funded services depends on funding Vaya receives from the state of North Carolina, federal block grants, and county governments. State-funded services do not include physical health care, pharmacy benefits, transportation, or Vaya Total Care Perks.
Am I Eligible for State-Funded Services?
You may be eligible for State-funded services through Vaya if:
- You do not have health insurance, or your health insurance or Medicaid does not cover all your needs
- You live in one of the 32 counties that Vaya serves
Mental Health Conditions and Substance Use Disorders Eligibility
There are certain eligibility requirements to get State-funded mental health or substance use disorder services:
- Your household income cannot be more than 300% of poverty level based on the U.S. Department of Health & Human Services Federal Poverty Guidelines
- You meet ONE of the following criteria:
- You are uninsured
- You have insurance, but it does not cover the State-funded service, and there is no alternative clinically appropriate service available
- You have insurance that covers the State-funded service, but the cost-sharing associated with the service is unaffordable
I/DD or TBI Eligibility
There is no minimum financial requirement to be eligible for State-funded I/DD or TBI services. However, first you must apply for Medicaid and also meet at least one of the following criteria:
- You are uninsured
- You have insurance, but your insurance does not cover the State-funded service, and there is no alternative clinically appropriate service available
How to Get Care
For help getting care, call our Member and Recipient Service Line at 1-800-962-9003, 7 a.m. to 6 p.m., Monday – Saturday.
If you need help with a mental health or substance use crisis, call our Behavioral Health Crisis Line at 1-800-849-6127. This line is available 24 hours a day, seven days a week.
Behavioral Health, I/DD, and TBI Services
Vaya covers State-funded services for adults and children with mental health, substance use disorder, I/DD, and/or TBI needs. We work with a network of health care providers who deliver services and supports to recipients.
Mental health challenges can affect anyone and any age. There are services like assessments, counseling, crisis support, peer support groups, and treatment programs available to support you.
A path to recovery looks different for everyone. Counseling, group support, and learning skills to avoid substances can help. There are outpatient services, residential programs, detox centers, and places to live while working toward recovery.
Services for people with I/DD help people to live as independently as possible. Services can provide support at home, during the day, and at work. There are residential options where people can live with different levels of support, day programs to build skills and socialize, and employment help to find and keep jobs. Additional support can also help give caregivers a break (respite).
Learn more about Intellectual/Developmental Disabilities (I/DD)
Vaya provides services and supports to individuals with TBI. Services include residential supports, day programs, vocational, transportation, therapy, respite, assistive technology, and home modifications.
Crisis Services
A behavioral health crisis might include thoughts of suicide, confusion about what’s real, severe distress from substance use, uncontrollable behavior, or inability to meet basic needs. There is help for anyone, any age in crisis in Vaya’s region, regardless of insurance. There are services that can come to you, facilities for treatment, and detox options.
All available services are listed in the Vaya Tailored Plan Recipient Handbook.
Call our Behavioral Health Crisis Line at 1-800-849-6127 if you or someone you know needs help in a crisis. Trained professionals are available to take your call 24 hours a day, seven days a week. If you are hearing impaired, call Relay NC at 711.
If you or someone you know needs immediate medical attention or is experiencing a life-threatening situation, call 911.
Extra Supports
Managing your health care alone can be hard, especially if you are dealing with many health problems at the same time. Vaya Total Care has extra support options to help.
Some adults and child recipients may be eligible for care management. A care manager is a specially trained health care worker who helps you and your providers make sure you get the right care when and where you need it. The care manager knows what resources are available in your community and will work with providers to get you the care you need.
You may require services and supports that are provided in long-term facility settings, such as a psychiatric hospital or adult care home. You may be eligible for extra support from Vaya to move to or remain in the community. Vaya will reach out to you if you live in these types of facilities to see whether you qualify for extra support and explain the choice you have a to leave these facilities and live in community settings.
Vaya will work with you if you choose to leave these types of facilities to create a plan to receive services in your home and community. Vaya staff will work with you to prepare you for the move. Once you move to the community, Vaya will connect you to care management to make sure you have the right services and supports.
Vaya will help divert people who are at risk of admission to an institution, like an adult care home, so that they can stay in the community. We will work with you to provide information on and access to community- based services.
For those who choose to remain in the community, we will work with you to create a Community Integration Plan to ensure this decision was based on informed choice and to provide services and support, including permanent supported housing as needed.
QuitlineNC provides free services to any North Carolina resident who needs help quitting tobacco. Call 1-800-QUIT-NOW (1-800-784-8669) for free support, 24 hours a day, 7 days a week. Interpretation services are available for many languages.
Vaya uses the System of Care model to support youth receiving behavioral health services. North Carolina’s System of Care model brings together a group of community-based services, including those provided by Vaya and those provided through schools and other state agencies, such as juvenile justice or child welfare.
System of Care Family Partners are available to support families to ensure the services that a child and their family are receiving are coordinated and address the specific needs and strengths of both the child and family. Family Partners can also work with families on the development of care plans.
For more information on what services are covered and not covered, read the Tailored Plan Recipient Handbook.
Recipient Rights and Responsibilities, Complaints, and Appeals
As a Tailored Plan recipient, you have certain rights. It is important you know and understand these rights.
If you are unhappy or have a complaint with any of your State-funded behavioral health, I/DD, or TBI services, or about your care manager, Vaya, or your provider, you may file a complaint.
Sometimes Vaya might make a decision you do not agree with. You can ask us to review it. This is called an appeal.
Resources
We serve eligible children and adults in the following North Carolina counties:
Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rockingham, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey.