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Home  •  Waiver & Medicaid Services  •  Innovations  •  Tailored Plans

Innovations Waiver

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Tailored Plans

On July 1, 2024, individuals receiving either Innovations waiver services, 1915(i) services (except in certain circumstances), or intensive behavioral health services will be transitioned to a tailored plan managed by their LME/MCO. Families and service providers with questions about the transition should reach out to the enrollment broker. In the tailored plans, all healthcare (i.e., physical health, mental health, prescription coverage, and care management) will come from the LME/MCO. Prior to visits to the child’s health care providers, a parent/legal guardian should ensure that the provider is listed as in-network. Check a provider’s in-network/out-of-network status here. If a provider isn’t listed as in-network, an out-of-network request can be filed with the care manager and a complaint can be filed with the LME/MCO. The NC Medicaid Ombudsman can provide assistance with this issue.

The following links provide additional information:

What to do if your NC Medicaid will move to a Tailored Plan

Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch | NC Medicaid

NC Medicaid Managed Care Reference Guide: Contacts for Beneficiaries