Learn about the new way to get Medicaid services in North Carolina.
North Carolina is changing the way people get Medicaid health care services. As of July 1, 2021, most Medicaid beneficiaries have transitioned to health plans managed by insurance companies, also called Standard Plans, as part of NC Medicaid managed care.
The four statewide Standard Plans are AmeriHealth Caritas, HealthyBlue, UnitedHealthcare Community Plan and WellCare. Individuals who are federally-recognized tribal members or qualify for Indian Health Services may enroll in the Eastern Band of Cherokee Indians (EBCI) Tribal Option. These health plans manage all of a person’s physical health, behavioral health and pharmacy needs.
Some Medicaid beneficiaries do not need to enroll in a Standard Plan. Individuals who get services through the programs listed below do not need to choose from the health plans listed above. For now, they will stay enrolled in NC Medicaid Direct.
- N.C. Innovations Waiver
- Community Alternatives Program for Children (CAP/C)
- Community Alternatives Program for Disabled Adults (CAP/DA)
People with significant mental health or substance use disorder needs, intellectual/developmental disabilities (I/DD) or a traumatic brain injury (TBI) may choose to enroll in a Standard Plan or the ECBI Tribal Option, but they are not required to do so. Instead, they may be eligible to enroll in a Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plan.
What is the Vaya Health Behavioral Health and I/DD Tailored Plan?
Vaya will operate a new type of health plan starting July 1, 2022. The Vaya Health Behavioral Health and I/DD Tailored Plan will serve Medicaid beneficiaries in our region who have significant mental health, substance use disorder, I/DD or traumatic brain injury (TBI) needs. This includes all N.C. Innovations Waiver or TBI Waiver participants and people on the waitlists.
Vaya’s Behavioral Health and I/DD Tailored Plan will manage the following services and supports for Medicaid members:
- Physical health care
- Behavioral health care
- Long-term services and supports (LTSS)
- Unmet health-related resource needs
Vaya’s Behavioral Health and I/DD Tailored Plan will cover the same services and supports as the Standard Plans. However, it will include additional, more intensive behavioral health, I/DD and TBI services that are not available through a Standard Plan.
Vaya’s plan will also continue to serve people in our region who are uninsured or underinsured and who cannot afford care for mental health, substance use disorder, I/DD or TBI needs. Please note that non-Medicaid services do not cover physical health or pharmacy needs.
How can I learn more?
- For information on how changes in North Carolina’s Medicaid program may affect you, call Vaya’s 24/7, toll-free Access to Care Line at 1-800-849-6127.
- Medicaid beneficiaries may also call the NC Medicaid Enrollment Broker Call Center at 833-870-5500 (TTY: 833-870-5588), Monday – Sunday, 7 a.m.-8 p.m., or visit https://ncmedicaidombudsman.org/.
- For more information from the N.C. Department of Health and Human Services, visit the Medicaid Transformation and Behavioral Health I/DD Tailored Plan webpages.