Embracing whole-person care

There’s a new way to receive Medicaid health care in North Carolina.

On December 1, 2022, Vaya will manage physical health care, pharmacy, long-term services and supports (LTSS), behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services under a single, integrated health plan, called a Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plan.

This plan is designed to serve people in our region with Medicaid and NC Health Choice who have a serious mental health condition, a severe substance use disorder, an I/DD, or a TBI.

We will also continue to manage behavioral health, I/DD, and TBI services for residents of our region who are uninsured or do not have enough insurance and cannot afford care. (“Behavioral health” means both mental health and substance use disorders.)

A short video about what is changing at Vaya Health moving forward,
Young girl with a disability on a blanket in a field with her parent or caregiver.

What is NC Medicaid Managed Care? 

Managed care is a way of delivering Medicaid benefits. Under NC Medicaid Managed Care, health care services are still covered by Medicaid, but services are managed by a health plan. Vaya is a managed care organization that offers a health plan.

What is whole-person care?

Whole-person care combines care for the mind and body with other factors that affect a person’s health. Your doctor, other providers, and care manager work together to help you get the care you need to be healthy.

What are the different Medicaid health plans in North Carolina?

Most Medicaid and NC Health Choice beneficiaries will receive services through NC Medicaid Managed Care. Some beneficiaries will get their services through NC Medicaid Direct. A small group of people will be able to choose if they want to participate in NC Medicaid Managed Care or NC Medicaid Direct.

Tailored Plans are for Medicaid and NC Health Choice beneficiaries with intensive, specialized behavioral health, I/DD, or TBI needs. Tailored Plans also offer physical health care and pharmacy benefits and serve participants in North Carolina’s Innovations and TBI waivers.

Young man with an Intellectual/Developmental Disability, riding a bicycle.

What does this mean if I get Vaya services today?

Most people getting services through Vaya today will be automatically enrolled in the Tailored Plan. You do not need to take any action. Look out for updates sent in the mail from NC Medicaid in August 2022. In October, Vaya will begin sending Tailored Plan welcome packets.

Key dates

August 15

Auto-Enrollment and PCP Choice Period will begin

Late August

Enrollment Packets will be mailed by the NC Enrollment Broker to members and recipients

October 15

PCP Choice Period ends, and a PCP will be auto-assigned if one is not chosen

October/November

Tailored Plan Welcome Packets are mailed to members and recipients

Is a Tailored Plan the right option for me?

The right option for you will depend on your eligibility and your unique health needs. If you are currently enrolled in Medicaid or NC Health Choice and want to learn more about choosing the right plan for you, call the NC Medicaid Enrollment Broker Call Center at 1-833-870-5500 (TTY: 1-833-870-5588), Monday through Sunday from 7 a.m. to 8 p.m. The Enrollment Broker can answer your questions when the Tailored Plan enrollment period begins in August 2022.

If you are not enrolled in Medicaid or NC Health Choice, you can find out if you are eligible by contacting your county’s Department of Social Security (DSS) office. A list of DSS offices is available on the NCDHHS website.

Have questions?

  • If you have questions about Vaya Total Care or NC Medicaid Managed Care, please call our Member and Recipient Service Line at 1-800-926-9003, Monday through Saturday from 7 a.m. to 6 p.m. You can also call the Member and Recipient Service Line if you have questions about State-funded Services for recipients.
  • Medicaid beneficiaries may call the NC Medicaid Enrollment Broker Call Center at 1-833-870-5500 (TTY: 833-870-5588), Monday through Sunday from 7 a.m. to 8 p.m., or visit https://ncmedicaidombudsman.org/.
  • For more information from the North Carolina Department of Health and Human Services (NCDHHS), visit the Medicaid Transformation and Behavioral Health I/DD Tailored Plan webpages.
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Start Your Journey

Vaya Health Plans

Vaya Total Care Tailored Plan for Medicaid Members

For Medicaid and NC Health Choice beneficiaries with serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/ developmental disabilities (I/DD), or a traumatic brain injury (TBI):

  • Physical health care services
  • Pharmacy benefits
  • Mental health services
  • Substance use recovery services
  • Intellectual/developmental disabilities (I/DD) services
  • NC Innovations Waiver services
  • Traumatic Brain Injury (TBI) services
  • Long-term services and supports (LTSS)
  • Dedicated care manager

Available on December 1, 2022

Learn more

Vaya Total Care Tailored Plan for Recipients of State-funded Services

For qualifying North Carolina residents with no insurance, or not enough insurance:

  • Mental health services
  • Substance use recovery services
  • I/DD services
  • TBI services

Available on December 1, 2022

Learn more

NC Medicaid Direct Beneficiaries (HIDDEN)

Some Medicaid beneficiaries do not need to enroll in a managed care plan. These people will be enrolled in Medicaid Direct, which means they will get their physical health and pharmacy services through NC Medicaid, and the following services through Vaya Health.

  • Mental health services
  • Substance use recovery services
  • I/DD services
  • NC Innovations Waiver and TBI Waiver services (for tribal members who opt out of managed care)

Learn more

Related News and Announcements

Explore the following resources to learn more about Medicaid Transformation, enrollment, and the latest news. As NC Medicaid continues to evolve, we’re here to help you find support and stay informed. 

What’s next?

We’re here to help you find support and stay informed. For the latest updates, please continue to check the NCDHHS Medicaid Transformation page and our News page. 

Resources