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North Carolina health officials delay start of new program for behavioral health patients

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The launch of a key Medicaid transformation initiative in North Carolina — tailored plans for behavioral health recipients — has again been delayed, this time by an additional four months until April 1.

The rollout was set to occur on Dec. 1, which already represented a delay from the initial launch date of July 1.

Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual or developmental disability, or traumatic brain injury may be eligible to enroll in a tailored plan.

The state Department of Health and Human Services said in July 2021 that tailored plans could serve about 200,000 North Carolinians, or about 8.7% of the 2.3 million Medicaid recipients in the state.

DHHS did not provide an updated potential enrollment count Thursday.

More information regarding the beneficiary choice period and other key dates leading up to the April 1 launch will be shared by DHHS in the coming weeks.

The tailored plans, when in effect, will provide the same services as standard plans in Medicaid Managed Care.

DHHS said the delayed start give the state’s six behavioral health managed care organizations more time to contract with additional providers to support member choice and to validate that data systems are working appropriately.

DHHS said the leaderships of the state’s six MCOs support the delay decision. The initial contracts are scheduled to last four years.

The MCOs are: Vaya Health (representing 31 counties); Trillium Health Resources (28 counties); Partners Health Management (14 counties); Sandhills (11 counties); Eastpointe (10 counties); and Alliance Health (six counties).

Among Partners’ counties are Davie, Forsyth, Surry and Yadkin as members. Forsyth is by far the largest member by population.

Among Vaya’s counties are Alamance, Alleghany, Ashe, Stokes, Watauga and Wilkes. Among Sandhills’ counties are Davidson, Guilford, Randolph and Rockingham.

There will be some new services going into effect Dec. 1 that involves the tailored care management program.

Through that program, eligible beneficiaries will have a single designated care manager, supported by a multidisciplinary team, to provide integrated care management that addresses whole-person health needs.

If the federal Centers for Medicare and Medicaid Services grants approval, DHHS will implement the 1915(i) option on Dec. 1.

That program provides services to help beneficiaries remain in their homes and community-based settings through services, such as respite, individual and transitional supports, community living and supports, community transition and supported employment.

By comparison, there are between 1.4 million and 1.8 million North Carolinians participating in the Medicaid transition program overseen by four statewide prepaid health plans for their whole-body coverage, including long-term care and pharmacy services.

That transition program debuted in July 2021.

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