Embracing whole-person care
There’s a new way to receive Medicaid health care in North Carolina.
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 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 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.
What does this mean if I get Vaya services today?
Most people receiving services through Vaya were 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. Vaya will be mailing Tailored Plan welcome packets.
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 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.
If you are not enrolled in Medicaid, 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 1-800-962-9003, 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.
Start Your Journey
Vaya Health Plans
Vaya Total Care Tailored Plan for Medicaid Members
For Medicaid 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
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
- Intellectual/developmental disabilities (I/DD) services
- TBI services
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.