Medicaid might be the biggest challenge any case manager or homeless navigator can face. There are even Medicaid Navigators to help you get clients signed up.  Your clients have to be under 65 and below  a threshold poverty level.  If they already have SNAP or EBT benefits then qualifying for Medicaid is no problem.

For a lot of people experiencing homelessness, a simple Medicaid plan is not enough. The next level of care in North Carolina is called a “Tailored Plan.”

In North Carolina, a “Tailored Plan” is a type of Medicaid managed care plan designed for individuals with serious mental illness, substance use disorders, or intellectual/developmental disabilities. Here’s a general outline of how you might qualify for a Tailored Plan in North Carolina:

1. **Medicaid Eligibility**: First, you need to be eligible for Medicaid. This generally means meeting income and resource limits and being a resident of North Carolina. Medicaid eligibility can depend on various factors, including age, disability status, and income.

2. **Specific Needs**: Tailored Plans are specifically for individuals with:

   – Serious mental illness (SPMI)
   – Substance use disorders (SUDs)
   – Intellectual or developmental disabilities (I/DD)

      You must have a diagnosed condition that fits within these categories.

3. **Enrollment Process**:

   – **Assessment**: You may need to go through a comprehensive assessment to determine your eligibility and care needs. This assessment might be done by a healthcare provider, case manager, or a regional behavioral health managed care organization (LME/MCO).

   – **Plan Selection**: If you qualify, you will receive information about available Tailored Plans and can select one based on your preferences and needs.

4. **Referral**: Sometimes, a healthcare provider or case manager might refer you to a Tailored Plan based on your diagnosed conditions and needs.

5. **Plan Transition**: If you’re already receiving Medicaid services through a Standard Plan and you meet the criteria for a Tailored Plan, there may be a process to transition you to the new plan.

**Steps to Take**:

1. **Contact Your Local LME/MCO**: Reach out to your local Local Management Entity/Managed Care Organization (LME/MCO) for more information and guidance. In Charlotte, the state has selected Alliance Health as the LME/MCO. They can provide details on the eligibility criteria and assist with the application or assessment process.

2. **Consult with a Healthcare Provider**: Speak with your healthcare provider about your eligibility for a Tailored Plan and ask them for assistance with the referral or assessment process.

3. **Visit the North Carolina Medicaid Website**: Check the North Carolina Medicaid website or contact the Medicaid office for the latest information and specific details on eligibility and application procedures. By following these steps and working with your healthcare providers and local LME/MCOs, you can navigate the process to determine if a Tailored Plan is a good fit.