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Updated: Jan 20, 2026
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Tailored Plans: The Next Step in a Long Evolution
Rob Robinson1, Pam Silberman2, Cynthia Binanay3
1chief executive officer, Alliance Health, Morrisville, North Carolina rrobinson@alliancehealthplan.org.
North Carolina Medical Journal
|September 1, 2019
Summary
North Carolina is transforming Medicaid to offer "tailored" health plans for individuals facing behavioral health challenges. These plans will serve vulnerable populations, including those with serious mental illness and substance use disorders.
Area of Science:
- Public Health
- Health Policy
- Behavioral Health Services
Background:
- North Carolina has a long history of addressing behavioral health needs.
- Medicaid transformation is a significant policy shift in the state.
- Vulnerable populations require specialized care coordination.
Purpose of the Study:
- To outline the upcoming Medicaid transformation in North Carolina.
- To detail the scope of "tailored" health plans.
- To highlight the role of LME/MCOs in serving specific populations.
Main Methods:
- Policy analysis of the North Carolina Medicaid transformation.
- Description of the "tailored" health plan structure.
- Identification of target populations and service providers.
Main Results:
- "Tailored" health plans will be implemented under Medicaid transformation.
- Coverage will extend to individuals with severe mental illness, substance use disorders, intellectual/developmental disabilities, and traumatic brain injury.
- Local Management Entities/Managed Care Organizations (LME/MCOs) are positioned to serve these individuals.
Conclusions:
- The Medicaid transformation signifies a structured approach to behavioral health care in North Carolina.
- Specialized health plans aim to improve outcomes for vulnerable populations.
- LME/MCOs possess unique qualifications to manage care for these individuals.
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