LME/MCO Consolidation

LME/MCOs coordinate services for mental health and substance use disorders, I/DD, and TBI. People who get services from an LME/MCO are enrolled in NC Medicaid Direct or may be uninsured/underinsured. More information on NC Medicaid Direct services can be found at NC Medicaid Direct.

LME/MCOs also provide a variety of State-Funded services. General information about those services can be found on the Division of Mental Health, Developmental Disablitiles and Substance Use Services (DMH/DD/SUS) website.

LME/MCOs and providers support Tailored Care Management (TCM) for eligible Medicaid members. TCM launched December 1, 2022, to give extra support to help beneficiaries assess their needs and meet their health goals.

To learn more about the Tailored Care Management model, its benefits and certified TCM providers go to the NCDHHS TCM webpage.

Members and recipients do not need to take any action with the LME/MCO changes and will continue to receive the same type of services as they do today.

For members with Medicaid, LME/MCO assignment will continue to be based on the member’s administrative county (the county that manages the member’s Medicaid case). Members should refer to the county that manages their case if it is different from the county they live in. County contacts can be found in the local DSS directory.

For recipients who do not have Medicaid and are currently receiving services through an LME/MCO, they should continue to receive services based on the county where they live.
The NC Medicaid Enrollment Broker will send a letter to members getting a new LME/MCO in January 2024.

The member’s new LME/MCO will send a welcome packet and Tailored Care Management (TCM) assignment letters (if needed). Welcome packets include member handbooks and other important information about the LME/MCO.

Medicaid ID cards for members with a new LME/MCO will be mailed in early February 2024. Members can use their current Medicaid ID card until they get their new one. Medicaid ID cards will be mailed by NC Medicaid. Members can contact their local DSS administrative office for questions about cards.

Call your newly assigned LME/MCO if you did not get your welcome packet or have questions about your benefits and services. Call Alliance Member and Recipient Services at 800-510-9132 if you have questions before or after February 1, 2024.

Yes. This change will not affect your current primary care provider (PCP) assignment.

Yes. From February 1, 2024 through May 30, 2024, members receiving Tailored Care Management provided by community-based TCM providers will be able to keep their current providers. Community-based TCM providers will need to contract with the member’s new LME/MCO by April 30, 2024 to keep providing services and not have members reassigned to a new TCM provider.

Members receiving TCM provided by Sandhills Center care managers may be assigned a new TCM provider. If members prefer to get TCM from a certain provider they should call their new LME/MCO and make the assignment request.

Sandhills is providing the following information to Alliance:

• List of CFAC beneficiaries impacted by the transition and their contact information
• List of CFAC current initiatives underway in transitioning areas
• Plan for transitioning county CFAC and Governing Board representation

DMH/DD/SUS will use the information to work with all LME/MCOs and their CFACs to create and carry out a transition plan that ensures a represented voice for all members, regardless of LME/MCO serving them. After February 1, 2024, Alliance will have ongoing engagement with the Harnett County CFAC.

No. LME/MCO consolidation is meant to support the Tailored Plan launch. NCDHHS and the LME/MCOs continue to work together to prepare for Tailored Plan launch on July 1, 2024.