NC Medicaid Direct Services

Welcome to Vaya Health! Beneficiaries of NC Medicaid Direct can use the information below to get started with our services and reach out to our Member and Recipient Services line at 1-800-962-9003 with any questions. 

NC Medicaid Direct Handbook 

This handbook explains what services may be available to NC Medicaid Direct beneficiaries through Vaya, how to access those services, and their rights and responsibilities. 

How to Access Services 

Vaya Health manages NC Medicaid Direct services for beneficiaries who need care for mental health, substance use disorders, or intellectual/developmental disabilities (I/DD). To find a provider for non-emergency services, beneficiaries can use our Provider Directory or call Member and Recipient Services toll-free at 1-800-962-9003, Monday-Saturday, 7 a.m. to 6 p.m. 

Provider Directory 

Need help finding a healthcare provider? We have created an easy-to-use search tool that makes it simple to locate a provider who participates in the Vaya Health network. 

Services and Programs

The NC Medicaid Ombudsman is an independent organization that helps NC Medicaid beneficiaries understand the Medicaid programs and ensures that they get access to the care that they need. They help connect people to resources like legal aid, social services, housing resources, food assistance and other programs, and provide free, confidential support and education about the rights and responsibilities people have under NC Medicaid. 

Click here to learn more about the NC Medicaid Ombudsman.

The health of your body impacts your mind and daily life. There are many things you can do regularly to enhance your whole-person health and make both small and large differences in your life. Vaya Health offers a variety of tools you can use to take steps toward better health. For help with these tools, call our Member and Recipient Services Line at 1-800-962-9003.  

Learn more about how to improve your wellness.

Vaya Health wants to help beneficiaries and their families get and stay healthy. If they want to quit smoking or are a new mom who wants to learn more about how to best feed your baby, Vaya can connect them with the right program for support. 

Call Member and Recipient Services at 1-800-962-9003 to learn more about: 

System of Care Grant 

System of Care (SOC) is a way of working with children and families based on the idea that families know their own strengths and needs best. SOC is not a service or a program – it is a way of working together with children and families to get results that are important to them. Vaya was recently awarded a SOC Expansion and Sustainability Grant from the U.S. Substance Abuse and Mental Health Administration (SAMHSA) to expand services and access to care for children and youth with mental, behavioral, or emotional disorders, and to offer hands-on support to their families. This grant will allow us to help families: 

  • Identify needs that are not being met 
  • Connect with health care providers and community organizations  
  • Understand resources available to help them reach their goals  

Learn more about SOC and how to get involved. 

Family Partners 

“Family Partners” is a group of parents or caregivers of children who have received mental health, substance use, or intellectual/developmental disability services. They share their personal experiences and offer understanding, encouragement, and support. Family partners promote System of Care values by providing education and coaching. This helps families develop a strong voice and advocate for their needs.  

Learn more about Family Partners and how to get involved. 

Housing Initiatives 

Vaya recognizes that economic stability, housing security, and place of residence have a major impact on people’s health, well-being, and quality of life. The Housing Supports Team works with community partners to provide knowledge, resources, and training about housing and residential options. 

They focus on helping eligible individuals find housing through one of the following programs

  • Transitions to Community Living 
  • Permanent Supportive Housing 
  • Non-Medicaid Residential Services 
  • Housing Supports Grant 
  • Independence Project 
  • Integrated Supportive Housing Program 

Learn more about Housing Initiatives and how to apply for a program. 

Transitions to Community Living 

Transitions to Community Living is a program that gives eligible adults living with serious mental illness the opportunity to choose where they live and work. Participants are connected to mental and physical healthcare services. This helps them maintain a home in their own name, instead of living in a facility. The program also helps people identify their interests and connects them to supported employment services.  

Learn more about Transitions to Community Living and how to make a referral. 

Click here to learn more about special programs and supports offered to NC Medicaid Direct beneficiaries.  

UM Program Policy

Vaya’s Utilization Management (UM) Program helps us make good decisions about your health care and spend our limited taxpayer dollars responsibly. This policy describes the program’s goals, how we review and make decisions about requests for services, requirements for UM staff, the appeals process, and more.

Appeals Policies and Processes

Sometimes Vaya may decide to deny or limit a request your provider makes for you for services offered by our LME/MCO. This decision is called an “adverse benefit determination.” You will receive a letter from Vaya notifying you of any adverse benefit determination. 

You have the right to appeal adverse benefit determinations to Vaya within 60 days from the date on your letter.  

Learn more about this process.

If you do not agree with Vaya’s decision on your appeal, you can ask for a State Fair Hearing. In North Carolina, State Fair Hearings include an offer of a free and voluntary mediation session. This meeting is held before your State Fair Hearing date. 

Learn more about this process.

A grievance and a complaint are the same thing. Contacting us with a grievance means that you are unhappy with your LME/MCO, provider or your behavioral health services. Most problems like this can be solved right away. Whether we solve your problem right away or need to do some work, we will record your call, your problem, and our solution. We will inform you that we have received your grievance in writing. We will also send you a written notice when we have finished working on your grievance. 

Learn more about this process.

Contact Us

Behavioral Health Crisis Line: 1-800-849-6127 (toll-free) 

  • Available 24 hours a day, 7 days a week, to all residents in Vaya’s region. 
  • Call for help with a mental health or substance use crisis. 
  • In case of a medical emergency or life-threatening situation, call 911. 

Member and Recipient Services: 1-800-962-9003 (TTY 711) (toll-free) 

  • Available Monday – Saturday, 7 a.m. to 6 p.m. 
  • For help with non-emergency questions, issues, or concerns 
  • For help with filing a complaint, grievance, or appeal 
  • For help connecting to your Vaya Care Manager 
  • Non-emergency email: member.services@vayahealth.com 

Need Help?

Finding care can be confusing sometimes. At Vaya Health, we make it easier. The process starts with a phone call to our Member and Recipient Services Line at
1-800-962-9003