Welcome to Vaya Health! Use the information below to get started as a recipient 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 recipients through Vaya, how to access those services, and the rights and responsibilities of our recipients.
How to Access Services
Vaya Health manages state-funded services for recipients who need care for mental health, substance use disorder, or intellectual/developmental disabilities (I/DD). To find a provider for non-emergency services, call Member and Recipient Services toll-free at 1-800-962-9003, Monday-Saturday, 7 a.m. to 6 p.m.
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.
Recipient Services & Programs
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 Access to Care Line at 1-800-849-6127.
Care and Case Management
Managing your health care alone can be hard, especially if you are dealing with many health problems at the same time. If you need extra support to get and stay healthy, we can help.
Case Management for Adults and Children with Behavioral Health Needs
Some adults and children who have mental health and substance use disorder needs, but do not have Medicaid, may be eligible to get case management services. A case manager is a specially trained behavioral health care worker who works with you and your health care providers to make sure you get the right care when and where you need it. The case manager knows what resources are available in your community and will work with local providers to get you the help you need.
Care Management for Adults and Children with I/DD and TBI
Some adults and children who have I/DD and TBI conditions, but do not have Medicaid, may be eligible to have a Care Manager who works for Vaya. If you qualify, Vaya will match you to a Care Manager that has specialized training to meet your needs.
If you are eligible to receive case or care management services, you may not be able to get services if funding has been used. If this happens, you may be put on a waiting list by Vaya until additional funds are available. Call Member and Recipient Services at 1-800-962-9003 for more information.
Help to Quit Smoking or Using Tobacco
Quitting smoking or use of other tobacco products is one of the most important steps you can take to improve your health. In fact, tobacco use is the number one cause of preventable death in the United States and North Carolina. Smoking causes damage to every system and nearly every organ of the body.
QuitlineNC provides free help to any North Carolina resident who wants to stop smoking or stop using other tobacco products. The program offers coaching and support to help you get started on your tobacco-free life. For more information, call 1-800-QUIT-NOW (1-800-784-8669) or visit quitlinenc.com. You can also talk to your provider or call Recipient Services at 1-800-962-9003 for additional information and resources.
Other Programs Offered
System of Care Grant
System of Care (SOC) is a way of working with children and families based on the principle 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 are 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.
Our Housing Supports Team works with community partners to provide knowledge, resources, and training about housing and residential options. They recognize that economic stability, housing security, and place of residence are social determinants of health. The team focuses on improving quality of life for eligible individuals who qualify for the following housing programs:
- Transitions to Community Living Initiative (TCLI)
- Permanent Supportive Housing
- Non-Medicaid Residential Services
- Housing Supports Grant
- Independence Project
- Integrated Supportive Housing Program
Transitions to Community Living
Transitions to Community Living 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.
Filing Appeals & Complaints
Appeals Policies and Processes
Sometimes Vaya may decide to deny, suspend, reduce, or terminate a request your provider makes for you for state-funded services covered by our plan. You will receive a letter from Vaya notifying you of any decision to deny, suspend, reduce, or terminate a service request your provider makes. The letter will include information about the reason for the decision and any available options while the appeal is under review. State-funded services recipients have the right to appeal decisions to deny, suspend, reduce, or terminate their services. Vaya must receive the appeal in writing within 11 working days from the date of the letter.
State Appeals Panel
The state appeals panel will review your request and issue a decision on your service request. Vaya will make a final decision on your request that is informed by the state appeals panel decision. We will make a final decision within 10 days of the panel’s decision.
Complaints Policies and Processes
Contacting us with a complaint means that you are unhappy with Vaya, your provider or your 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 concern, and our solution. We will notify you in writing to confirm that we have received your complaint. We will also send you a written notice when we have finished working on your complaint.
Access To Care 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