NCDHHS Update on Tailored Plan Beneficiaries


During the Open Enrollment period, the Department closely monitored data indicating the active selections of Tailored Plan-eligible beneficiaries into Standard Plans. None of these beneficiaries were auto-enrolled in a Standard Plan. Toward the end of Open Enrollment, there was an increased uptick in the number of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan.

  • Through June 1, approximately 7,000 Tailored Plan-eligible beneficiaries made an active selection to enroll in Standard Plans, which may make them ineligible for services they are currently receiving, have recently received, or may benefit from receiving.

Based on the number and profile of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan, the Department determined that these beneficiaries would benefit from receiving additional information to ensure they are fully aware of the impact of the decision to leave NC Medicaid Direct and their LME-MCO and enroll in a Standard Plan — including the potential loss of services.

Therefore, the Department will stop Standard Plan enrollments of these beneficiaries and all Tailored Plan-eligible beneficiaries who selected a Standard Plan will remain in NC Medicaid Direct and their LME-MCO through NC Medicaid Managed Care Go-Live on July 1, 2021.

The Department will provide additional information to ensure that these beneficiaries are fully aware of services that may be lost if they move to a Standard Plan. This will include a notice to be sent later this month informing them of the change back to NC Medicaid Direct as well as a detailed list of services that are not available in a Standard Plan.

Beneficiary choice remains paramount and Tailored Plan-eligible beneficiaries will still have the option to enroll in a Standard Plan. The Department plans to implement, by early August, a specific enrollment process for Tailored Plan-eligible individuals that will include enhanced choice counseling to help verify that beneficiaries have all the information they need to understand the impact of their decisions.

We will continue to provide updates on this process and appreciate your ongoing partnership in serving the state’s Medicaid beneficiaries and their families.