BY Clarissa Donnelly-DeRoven
Back in August, Lucy Plyler was mailed a 19-page letter from the state health department.
The letter said that the way Victoria, her 24-year-old daughter with multiple disabilities, received Medicaid was about to change. Instead of being in NC Medicaid Direct, Victoria would be put on a “tailored plan.” That meant all her care would no longer be coordinated through the state Department of Health and Human Services, but through the regional behavioral health organization, called an LME-MCO.
Where Plyler and her daughter live in Rutherford County, their LME-MCO would be Partners Health Management.
This switch is happening for nearly 200,000 people out of a total of more than 2.8 million North Carolina Medicaid beneficiaries. These tailored plans are targeted primarily for those with complicated health problems, severe mental health needs, intellectual and developmental disabilities, and traumatic brain injuries. It’s the next phase in the state’s transition to managed care, which started back in July 2021 when about 1.6 million people saw their Medicaid change from being state-run to being coordinated by one of five private insurance companies called managed care organizations.
These tailored plans will be quite different from the other managed care plans. Unlike the rest of the Medicaid population, those on tailored plans will not have four to five managed care plans to choose from. In fact, they will have no options to choose from. They will be automatically enrolled in the tailored plan that is run by the LME-MCO that covers their county already.
“The big fear is will a very, very vulnerable population — people with profound disabilities — lose access to care that they really need?” said Doug Sea, an attorney with the Charlotte Center for Legal Advocacy. “The fact is that the General Assembly set this up in a way that directly discriminates against people on the basis of these profound disabilities.Launch delayed for Medicaid tailored plans – NC Health News (northcarolinahealthnews.org)