Welcome to Vaya Health! Use the information below to get started as a member of Vaya Health and reach out to our Member and Recipient Services line at 1- 800-962-9003 with any questions.
This handbook explains what services may be available to members through Vaya, how to access those services, and the rights and responsibilities of our members.
How to Access Services
Vaya Health manages all of your Medicaid services in one place. If you are sick, experiencing a behavioral health crisis, or need other health care services, choose one of the options on this page. (In a life- threatening emergency, always call 911 or visit the nearest emergency department.)
Need help finding a healthcare provider? We’ve created an easy-to-use search tool that makes it simple to locate a provider near you who participates in the Vaya Health network.
Member Services & 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.
Health & Wellness Programs
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. The Vaya Health Tailored Plan offers a variety of tools you can use to take steps toward better health. For help with these tools, call our Behavioral Health Crisis Line at 1-800-849-6127.
Special Programs & Supports
Vaya wants to help you and your family get and stay healthy. If you want to quit smoking or are a new mom who wants to learn more about how to best feed your baby, we can connect you with the right program for support.
Call Behavioral Health Crisis Line at 1-800-962-9003 to learn more about:
- Tobacco cessations services to help you stop smoking or using other tobacco products
- Women, Infants and Children (WIC) special supplemental nutrition program
- Newborn screening program
- Hearing screening program
- Early intervention program
Other Programs Offered
Some other great programs offered by Vaya Health are:
System of Care (SOC) 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 achieve 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 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
“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.
At Vaya, we recognize that economic stability, housing security, and place of residence have a major impact on people’s health, well-being, and quality of life. Our Housing Supports Team works with community partners to provide knowledge, resources, and training about housing and residential options.
The Housing Supports Team focuses 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
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.
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.
Vaya Health’s service array includes “in lieu of” services, also known as ILOS. ILOS are not included in the NC Medicaid State Plan but have been approved by the NC Department of Health and Human Services (NCDHHS) for use by Vaya as medically appropriate, cost-effective alternatives to State Plan services.
Appeals Policies and Processes
Sometimes Vaya may decide to deny or limit a request your provider makes for you for Medicaid benefits or services covered by our plan. This decision is called an “adverse benefit determination.” You will receive a letter from Vaya notifying you of any adverse benefit determination.
Medicaid members have the right to appeal adverse benefit determinations to Vaya within 60 days from the date on your letter.
State Fair Hearing Policies and Procedures
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.
Grievances Policies and Processes
A grievance and a complaint are the same thing. Contacting us with a grievance means that you are unhappy with Vaya, your provider, or your 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 notify you in writing to confirm that we have received your grievance. We will also send you a written notice when we have finished working on your grievance.
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: firstname.lastname@example.org