Tailored Plans

What are Tailored Plans?

Beneficiaries who qualify for a Tailored Plan are auto-enrolled into a Tailored Plan based on their region. The Department of Health and Human Services (DHHS) is delaying implementation of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Tailored Plan launch was scheduled for Oct. 1, 2023, but will now go forward at a date still to be determined.

Beneficiaries who will be covered by the Tailored Plans will continue to receive behavioral health, I/DD, TBI and physical health care as they do today. North Carolina’s unique Tailored Care Management model, which launched Dec. 1, 2022, will continue to support beneficiaries by providing a care team to coordinate care across providers.

Additionally, on July 1, 2023, the LME/MCOs began to provide 1915(i) services to offer an array of home and community based (HCBS) services to Medicaid beneficiaries with serious mental health diagnoses, severe substance use disorders, intellectual/developmental disabilities and traumatic brain injuries.

WellCare currently contracts with three Tailored Plans: Alliance, Vaya, and Eastpointe.

  • Alliance Counties: Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake
  • Vaya Counties: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey
  • Eastpointe Counties: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne, and Wilson

Members

Eligible members with complex behavioral health needs or intellectual/developmental disabilities are enrolled in one of the three regional Tailored Plans noted above that correspond with the member’s county of residence.

Members of these plans will get a care manager who coordinates a member’s care team.

Questions? Members can get in touch with Tailored Plans below and learn more about their care management:

Providers

Eastpointe is currently leasing WellCare’s physical health network. Vaya and Alliance have their own provider networks.

Questions? Providers are encouraged to reach out to Tailored Plans for the most up-to-date information.