Tailored Care Management in North Carolina

What is Tailored Care Management?

Tailored Care Management (TCM) is a comprehensive care coordination service designed to support individuals with complex health needs, including those with behavioral health conditions, intellectual or developmental disabilities (I/DD), and traumatic brain injuries (TBI). This service ensures that individuals receive integrated, person-centered care by connecting them with medical, behavioral, and social support services.

Who is Eligible for Tailored Care Management?

To qualify for Tailored Care Management in North Carolina, individuals must:

  • Be a North Carolina resident

  • Be enrolled in Medicaid and meet eligibility for the Tailored Plan

  • Have a qualifying behavioral health condition, intellectual or developmental disability, or traumatic brain injury

  • Require care coordination services to manage health and social needs

How to Apply for Tailored Care Management

  1. Determine Eligibility: Confirm Medicaid eligibility and assess whether you meet the criteria for TCM.

  2. Choose a Care Management Provider: Select an approved TCM provider in your area who will guide you through the process.

  3. Comprehensive Assessment: A care manager will conduct a thorough assessment to identify medical, behavioral, and social support needs.

  4. Develop a Personalized Care Plan: Based on the assessment, a customized plan will be created to coordinate healthcare and community resources.

  5. Implementation & Ongoing Support: Once enrolled, your care manager will continuously monitor progress and make adjustments as needed.

What Services are Included?

Tailored Care Management provides a broad range of services, including:

  • Comprehensive Care Coordination – Assistance with managing medical, behavioral, and social needs.

  • Health Monitoring & Medication Management – Ensuring adherence to prescribed treatments and managing chronic conditions.

  • Behavioral Health Support – Connecting individuals with mental health and substance use services.

  • Community-Based Resources – Access to food, housing, transportation, and employment support.

  • Family & Caregiver Support – Education and resources for families assisting their loved ones.

  • Crisis Intervention – Immediate support for urgent health and behavioral concerns.

  • Advocacy & Navigation – Assistance with navigating Medicaid, disability benefits, and other healthcare systems.

What is the Cost of Tailored Care Management?

For individuals who qualify, Tailored Care Management services are covered by Medicaid. There is no direct cost to eligible participants. If an individual is not enrolled in Medicaid but requires similar services, there may be alternative funding sources or private-pay options available.

Frequently Asked Questions

1. How is Tailored Care Management different from regular case management?
TCM provides a more integrated and holistic approach, coordinating medical, behavioral, and social services under one plan, whereas traditional case management may focus on only one aspect of care.

2. Can I keep my current doctor or specialist?
Yes! Tailored Care Management works with your existing healthcare providers to ensure seamless coordination of care.

3. What if I don’t qualify for Medicaid?
If you don’t qualify for Medicaid, there may be other programs or private-pay options to access similar services. Your care management provider can help explore alternatives.

4. Can I switch my care manager if needed?
Yes, if you feel your needs are not being met, you can request a different care manager to ensure you receive the best possible support.

5. What happens if my needs change over time?
Your care manager will conduct periodic reassessments and adjust your care plan to reflect any changes in your medical, behavioral, or social needs.

6. Is there a waiting list for Tailored Care Management services?
Availability may vary based on location and demand. Your provider can inform you about current wait times and alternative options.

7. How do I find a Tailored Care Management provider near me?
You can search the North Carolina Medicaid directory, contact local healthcare agencies, or reach out to our wellness agency for assistance in finding a provider.

Need Help Getting Started?

HealthKeeperz is here to guide you through the Tailored Care Management process. Contact us today to learn more about how we can support you or your loved one in accessing the care you need.

[Contact Us] –

Get in touch with our experts for personalized assistance.