A Tailored Plan is a North Carolina Medicaid and NC Health Choice health plan. It offers physical health, pharmacy, care management, and behavioral health services. It is for members who may have significant mental health needs, severe substance uses disorders, intellectual/developmental disabilities, or traumatic brain injuries. 

Tailored Plans offer added services for members who qualify. Tailored Plan auto-enrollment began August 15, 2022. If you are auto enrolled in a Tailored Plan or have the option to choose a Tailored Plan, Tailored Plans will start April 1, 2023

Tailored Plans offer certain services that Standard Plans don't have such as:

-Assertive Community Treatment 

-Child and Adolescent Day Treatment Services 

-Community Support Team 

-Intensive In-Home Services 

-Psychiatric Residential Treatment Facilities 

-Residential Treatment Facility Services 

-Substance Abuse Comprehensive Outpatient Treatment Program 

-Substance Abuse Intensive Outpatient Program

-Substance Abuse Medically Monitored Residential Treatment 

-Substance Abuse Non-Medical Community Residential Treatment

Who Qualifies?

-People who get Innovations Waiver Services 

-People who get Traumatic Brain Injury (TBI) Waiver services 

-People who may have a Mental Health Disorder, Substance Use Disorder, Intellectual/Development Disability (I/DD) or Traumatic Brain Injury (TBI) 

-Substance abuse medically monitored residential treatment

Services covered outside of health plan networks can be received from an out of network provider, if the provider takes Medicaid. These services include:

-Dental Services 

-Services provided by Local Education Agencies that are included in your child's:

     *Individualized Education Program 

     *Individualized Family Service Plan 

     *Section 504 Accommodation Plan 

     *Individual Health Plan 

     *Behavior Intervention Plan