NC Medicaid
We have compiled resources to help you navigate the publish mental health system in North Carolina. Please contact us if you encounter problems or have concerns not address by these resources.
Medicaid Transformation
NC Medicaid has undergone a transformation to managed care over the years. Standard Plans went live on July 1, 2021, while Behavioral Health I/DD Tailored Plans went live on July 1, 2024.
In 2024, NC Medicaid selected Blue Cross Blue Shield NC to operate the Children and Family Specialty Plan (CFSP), a single, statewide plan for Medicaid enrolled children and their families in the child welfare system.
Standard Plans
The Standard Plans cover "mild to moderate" mental illnesses in the Medicaid population, and psychiatrists will be included in the networks to help take care of these patients. These plans are required to accept "any willing provider" who meets quality standards and accepts the Plan reimbursement rate.
NC DHHS is requiring that all of the Plans use the NC DHHS credentialing and enrollment system, a single statewide formulary to streamline the process.
Resources:
NC DHHS
For more information on Medicaid Transformation developments, visit the NC DHHS website.
AmeriHealth Caritas
Provider Support Number: 888-738-0004
Behavioral Health Medical Director: Nerissa Price, MD
Carolina Complete Health
Provider Support Number: 833-552-3876
Behavioral Health Medical Director: Nena Lekwauwa, MD
Healthy Blue
Provider Support: 844-594-5072
Behavioral Health Medical Director: Steve Bentsen, MD
United Healthcare
Provider Support: 800-638-3302
Behavioral Health Medical Director: Stephanie Exum, MD
WellCare
Provider Support: 866-799-5318
Behavioral Health Medical Director: Therese Garrett, MD
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Tailored Plans
North Carolina launched Tailored Plans on July 1, 2024, these will be integrated health plans for individuals with behavioral health, I/DD needs, or those on innovations or TBI waivers or waitlists. Approximately 200,000 beneficiaries will be enrolled in Tailored Plans.
Tailored Plans will remain regional, and they will be able to close their provider panels as needed. They will cover all the behavioral health services covered by the Standard Plans but will also exclusively cover some enhanced behavioral health services (such as Intensive In-Home, ACT, and Residential SUD treatment).
Psychiatrists are encouraged to contract with each Tailored Plan in their service area. Once contracted has been completed, it takes approximately two to three weeks to be added into the Tailored Plan system and show up as an in-network provider.
Provider Contracting
Alliance
Chief Medical Director: Robert MacArthur, MD
Partners Health Management
Chief Medical Officer: Bess Stanton, MD
Trillium Health Resources
Chief Medical Officer: Michael Smith, MD
Vaya Health
Chief Medical Officer: Richard Zenn, MD
Resources:
Fact Sheet: What Providers Need to Know: Part 1
NCDHHS Training Resources
Recorded NC Medicaid Training Courses
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Children and Families Specialty Plans
The Children and Families Specialty Plan is a single, statewide NC Medicaid Managed Care plan that will wrap Medicaid-enrolled children and their families in the child welfare system with seamless, integrated, and coordinated health care. The CFSP is designed to support this population by providing health care and mental health care coverage that follows the person — regardless of their geographic location or situation — and works across all these multiple systems.
The CFSP provides comprehensive coverage for all services provided by the Standard Plan in addition to most Tailored Plan services, such as 1915(i) Home and Community-Based Services and enhanced behavioral health and residential services. It also includes a broad range of behavioral health services such as outpatient therapy, inpatient treatment, and crisis and therapeutic residential options for children. Additionally, the CFSP is responsible for addressing unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. The plan also covers pharmacy, long term services and supports (LTSS) and Intellectual/ Developmental Disability (I/DD) services.
At launch, the CFSP will operate statewide, offering robust care management to approximately 31,000 current and former foster care children and youth that will be enrolled automatically. Children of these eligible populations will also be automatically enrolled at launch and maintain enrollment while their parents are enrolled. In line with the plan’s goal to support and strengthen families, the plan will also be available to parents and family members of children and youth served by the child welfare system, including those receiving Child Protective Services (CPS) In-Home Services. NCDHHS is currently working on estimating this population size, and service to family members will be available no sooner than July 2026.
For information about the CFSP, please visit the Children and Families Specialty Plan webpage. |
