LME-MCOs and North Carolina's Behavioral Health and I/DD Tailored Plans

In this article▾

1. What is an LME-MCO?
2. How many LME-MCOs does North Carolina have in 2026?
3. What are Behavioral Health and I/DD Tailored Plans?
4. LME-MCOs vs. Tailored Plans vs. NC Medicaid Direct
5. Which LME-MCO serves your county?
6. What the LME-MCO structure means for behavioral health providers
7. Tailored Care Management: What practices need to understand
8. Specialized programs and services administered through LME-MCOs
9. What changed with the October 2026 Vaya Partners merger?
10. Common operational problems for behavioral health practices
11. How to stay current with LME-MCO and Tailored Plan changes
12. LME-MCO compliance checklist for North Carolina providers
13. Frequently asked questions about LME-MCOs in North Carolina
14. Final takeaway

North Carolina's Local Management Entities/Managed Care Organizations (LME-MCOs) manage Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans and coordinate certain services for people enrolled in NC Medicaid Direct. For behavioral health practices, they are important contacts for provider contracting, service authorization, care coordination, and reimbursement.

The structure has changed since Tailored Plans launched on July 1, 2024. Most recently, Vaya Health and Partners Health Management merged effective October 1, 2026, forming Vaya Partners. North Carolina now lists three regional LME-MCO/Tailored Plan organizations:

1. Alliance Health
2. Trillium Health Resources
3. Vaya Partners

That current count matters. Older articles, provider documents, and county directories may still list four organizations because they predate the Vaya-Partners merger.

For practice administrators, the operational challenge is understanding which organization serves a member's county, whether the member is enrolled in a Tailored Plan or NC Medicaid Direct, and which rules apply to the service being delivered. A provider cannot assume that every Medicaid behavioral health service follows the same authorization, network, or claims process.

This guide explains how the system works, what changed in 2026, and how North Carolina behavioral health providers should manage contracting, authorizations, claims, and ongoing plan relationships.

What is an LME-MCO?

LME-MCO stands for Local Management Entity/Managed Care Organization.

In North Carolina, LME-MCOs are regional public managed care organizations responsible for managing behavioral health, substance use disorder, I/DD, and traumatic brain injury services for people with complex needs.

Their responsibilities extend beyond operating a traditional health plan. Depending on a person's Medicaid enrollment and the services involved, an LME-MCO may:

• Manage a Behavioral Health and I/DD Tailored Plan.
• Coordinate certain behavioral health and I/DD services for NC Medicaid Direct beneficiaries.
• Coordinate certain services for Eastern Band of Cherokee Indians (EBCI) Tribal Option members.
• Manage access to specialized behavioral health and I/DD services.
• Administer the NC Innovations Waiver and other applicable waiver services.
• Coordinate care and connect members with appropriate providers.
• Manage service authorization and claims for services under its responsibility.

The state describes LME-MCOs as regionally based organizations operating under North Carolina's 1915(b)/(c) Medicaid waiver structure.

The distinction between an LME-MCO and a Tailored Plan is important:

• LME-MCO describes the regional organization responsible for managing the system.
• Tailored Plan describes the Medicaid managed care health plan that the organization operates.

The terms are often used together because the same organization performs both roles. However, they are not interchangeable in every operational context.

For example, an organization may coordinate certain services for a person enrolled in NC Medicaid Direct without that person being enrolled in the Tailored Plan.

See the NC Medicaid overview of Behavioral Health and I/DD services.

How many LME-MCOs does North Carolina have in 2026?

As of November 5, 2026, North Carolina has three regional LME-MCO/Tailored Plan organizations listed by the state.

The current organizations are:

The official NCDHHS LME/MCO Directory lists the current organizations and their county coverage.

Why older sources list four organizations

North Carolina previously operated with four LME-MCOs following an earlier consolidation:

• Alliance Health
• Partners Health Management
• Trillium Health Resources
• Vaya Health

The earlier consolidation followed the dissolution of Sandhills Center and the merger of Eastpointe and Trillium. The state completed that transition in preparation for the July 2024 Tailored Plan launch.

A second consolidation occurred in 2026.

On September 10, 2026, NC Medicaid announced that Vaya Health and Partners Health Management would merge effective October 1, 2026. The unified organization would operate under the name Vaya Partners.

The state said that benefits and providers would remain the same for affected members, and that the merger was primarily a name change intended to unify the two organizations.

The current state directory reflects the new three-organization structure.

For administrators, this means older documents that list Partners and Vaya separately should be checked before being used to route claims, authorizations, or provider inquiries.

Official references:

• NC Medicaid: Information Regarding the Vaya Health and Partners Health Management Merger
• NCDHHS: Current LME/MCO Directory

What are Behavioral Health and I/DD Tailored Plans?

Tailored Plans are North Carolina Medicaid managed care health plans designed for people with more complex behavioral health and related needs.

They cover physical health services alongside specialized behavioral health, substance use disorder, I/DD, and traumatic brain injury services.

A person may be eligible for a Tailored Plan if they have Medicaid and meet relevant criteria involving:

• Serious mental illness (SMI).
• Severe substance use disorder (SUD).
• Intellectual or developmental disability (I/DD).
• Traumatic brain injury (TBI).

Tailored Plans also serve people participating in certain programs, including the NC Innovations Waiver, the TBI Waiver, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID). State-funded services are also associated with the Tailored Plan system.

Tailored Plans can cover:

• Primary and specialty care.
• Prescription medications.
• Behavioral health treatment.
• Substance use disorder services.
• Long-term rehabilitation and treatment.
• Home and community-based services.
• I/DD-related supports.
• Care management.
• Certain waiver services.

The key difference from a Standard Plan is the population and service needs the plan is designed to support. Tailored Plans bring a broader range of complex behavioral health and I/DD services into one managed care arrangement.

When did Tailored Plans launch?

North Carolina launched Behavioral Health and I/DD Tailored Plans on July 1, 2024.

The launch followed multiple delays and a consolidation process intended to reduce the number of regional LME-MCO organizations.

The launch did not eliminate LME-MCOs. Instead, the regional organizations became the operators of the Tailored Plans while continuing to perform other responsibilities for certain NC Medicaid Direct beneficiaries and other populations.

The state confirmed the July 1, 2024 launch in its NC Medicaid Annual Report for State Fiscal Year 2025.

LME-MCOs vs. Tailored Plans vs. NC Medicaid Direct

These terms frequently appear together in provider communications, but they describe different parts of North Carolina's Medicaid structure.

Why the distinction matters

A member's Medicaid enrollment determines where a provider should start when verifying coverage and identifying the responsible payer.

For example:

• A member enrolled in a Tailored Plan generally receives covered services through that plan's network and processes.
• A member in NC Medicaid Direct may receive certain behavioral health and I/DD services coordinated by the regional LME-MCO.
• A member enrolled in a Standard Plan may have a different coverage and authorization pathway.

The LME-MCO's involvement does not automatically mean that every service should be billed to the Tailored Plan. Providers must identify the member's actual enrollment and the service's applicable payment arrangement.

This is why eligibility verification should happen before the first appointment and again when coverage may have changed.

For a broader explanation of managed care structures, see Medicaid Managed Care.

Which LME-MCO serves your county?

The organization responsible for a member is determined by the county that administers their NC Medicaid.

A practice serving multiple counties may therefore work with more than one LME-MCO/Tailored Plan.

The current regional structure is as follows.

Alliance Health

alliancehealthplan.org

Alliance Health serves:

• Cumberland
• Durham
• Harnett
• Johnston
• Mecklenburg
• Orange
• Wake

Provider Support Service Line: 855-759-9700

Member and Recipient Services: 800-510-9132

Trillium Health Resources

trilliumhealthresources.org

Trillium serves counties across eastern and southeastern North Carolina, as well as Guilford, Randolph, and other counties.

Its current coverage includes:

• Anson
• Beaufort
• Bertie
• Bladen
• Brunswick
• Camden
• Carteret
• Chowan
• Columbus
• Craven
• Currituck
• Dare
• Duplin
• Edgecombe
• Gates
• Greene
• Guilford
• Halifax
• Hertford
• Hoke
• Hyde
• Jones
• Lee
• Lenoir
• Martin
• Montgomery
• Moore
• Nash
• New Hanover
• Northampton
• Onslow
• Pamlico
• Pasquotank
• Pender
• Perquimans
• Pitt
• Randolph
• Richmond
• Robeson
• Sampson
• Scotland
• Tyrrell
• Warren
• Washington
• Wayne
• Wilson

Provider Support Service Line: 855-250-1539

Member and Recipient Services: 877-685-2415

Vaya Partners

vayapartners.org

Vaya Partners was formed through the October 1, 2026 merger of Vaya Health and Partners Health Management.

It serves the combined regional footprint, including:

• Alamance
• Alexander
• Alleghany
• Ashe
• Avery
• Buncombe
• Burke
• Cabarrus
• Caldwell
• Caswell
• Catawba
• Chatham
• Cherokee
• Clay
• Cleveland
• Davidson
• Davie
• Forsyth
• Franklin
• Gaston
• Graham
• Granville
• Haywood
• Henderson
• Iredell
• Jackson
• Lincoln
• Macon
• Madison
• McDowell
• Mitchell
• Person
• Polk
• Rockingham
• Rowan
• Rutherford
• Stanly
• Stokes
• Surry
• Swain
• Transylvania
• Union
• Vance
• Watauga
• Wilkes
• Yadkin
• Yancey

Provider Support Service Line: 877-398-4145

Member and Recipient Services: 888-235-4673

Important: Always use the current state directory to confirm the LME-MCO for a particular county. County assignments and contact details should not be copied from older regional maps without verification.

What the LME-MCO structure means for behavioral health providers

For practices, the LME-MCO system affects more than member eligibility. It influences how organizations establish network relationships, request authorization, coordinate care, and submit claims.

The exact process depends on the member's enrollment, service category, and the applicable plan or program requirements.

1. Provider contracting and network participation

A practice that wants to serve Tailored Plan members should understand the network requirements of the relevant plan.

Being enrolled with NC Medicaid does not automatically mean that a provider is contracted with every Tailored Plan. This is the credentialing versus contracting versus enrollment distinction in a state-specific form, and it is the single most common reason a clinician who looks approved cannot be billed for.

Likewise, having a contract with one LME-MCO does not automatically establish network participation with the others.

Providers should confirm:

• Whether the organization is accepting new providers.
• Which provider types and specialties are eligible for contracting.
• Whether individual rendering clinicians must be separately enrolled or credentialed.
• Which locations are included in the agreement.
• Which services are covered under the contract.
• Whether the agreement covers Tailored Plan members, NC Medicaid Direct services, or both.
• Which billing and authorization rules apply.

A multi-location practice should not assume that one contract or one location approval covers every service location and clinician.

NC Medicaid publishes provider contracting information for health plans. The LME-MCOs also publish provider resources and contracting information on their respective websites.

2. Authorization and medical necessity

Many specialized behavioral health and I/DD services require authorization or other utilization-management review.

The provider must identify the applicable coverage policy and authorization process before delivering a service that requires approval.

The operational workflow should include:

1. Verify the member's Medicaid enrollment.
2. Identify the responsible Tailored Plan or LME-MCO.
3. Confirm whether the service requires prior authorization.
4. Review the applicable clinical coverage policy and service definition.
5. Submit the required clinical documentation.
6. Record the authorization number, approved units, dates, and service limits.
7. Monitor utilization and request additional authorization when needed.

Do not assume that an authorization issued by one plan or LME-MCO applies to another.

The clinical record should support the service requested. That includes documenting the member's needs, functional limitations where relevant, treatment goals, and why the requested level of service is appropriate. Prior authorization in behavioral health covers the documentation reviewers actually look for.

For related background, see Level of Care Criteria.

3. Claims submission and reimbursement

Claims processes differ across Tailored Plans and may also differ by service category.

Providers should use the plan-specific instructions for:

• Electronic claims submission.
• Clearinghouse routing.
• Provider portal access.
• Paper claims, where accepted.
• Claim corrections and resubmissions.
• Timely filing.
• Coordination of benefits.
• Claim status inquiries.
• Payment disputes and appeals. A denial reason code is the starting point; see how to read an EOB and ERA.

Do not assume that the same claims portal or submission address works for all three organizations.

NC Medicaid has published a plan-by-plan Tailored Plan Claims and Prior Authorizations FAQ. The document contains information from the individual plans about claims channels and prior authorization processes.

Because that FAQ was last revised in June 2024, providers should treat it as a reference rather than assume every portal, vendor, or submission detail remains current after the 2026 Vaya Partners merger. Confirm current instructions with the responsible plan.

4. Provider enrollment and taxonomy

A provider's NC Medicaid enrollment information must support the services being billed.

Incorrect or inactive taxonomy information can cause claim problems. Providers should verify that the taxonomy associated with the organization and rendering provider matches the applicable enrollment and claim requirements. A mismatch here typically surfaces as CO-16, which means the claim is missing or has invalid information rather than that the service was refused.

For organizations with multiple clinicians, locations, and specialties, maintain a clear record of:

• NCTracks enrollment status.
• NPI and taxonomy information.
• Rendering-provider associations.
• Billing-provider details.
• Service locations.
• Plan-specific credentialing and contract status.

A provider should not assume that a clinician's individual enrollment, the organization's enrollment, and a plan's network approval are the same thing.

5. Care coordination and referrals

LME-MCOs also play a role in coordinating care for members with complex needs.

Tailored Care Management is one important component. It is designed to help members coordinate physical health, behavioral health, I/DD, and other needs.

For providers, care coordination can involve:

• Communicating with the member's Tailored Care Manager.
• Coordinating referrals and transitions between services.
• Sharing relevant information with appropriate authorization.
• Supporting treatment-plan implementation.
• Identifying gaps in services.
• Escalating barriers to accessing covered care.

Providers should identify the member's care-management arrangement and document coordination activities when relevant to the service and applicable requirements.

NC Medicaid's Tailored Care Management provider resources include the current provider manual and program updates.

Tailored Care Management: What practices need to understand

Tailored Care Management (TCM) is a care-management model for eligible NC Medicaid beneficiaries with complex needs.

It is intended to provide coordinated, person-centered support across physical health, behavioral health, I/DD, and other services.

The model involves several types of organizations and providers:

• Tailored Plans/LME-MCOs.
• Advanced Medical Home Plus (AMH+) practices.
• Care Management Agencies (CMAs).
• Clinicians and other providers involved in the member's care.

Tailored Care Managers help members navigate appointments, coordinate services, and address medical and nonmedical factors affecting health.

What this means for behavioral health practices

A practice may interact with a Tailored Care Manager even when it is not itself an AMH+ practice or CMA.

For example, a behavioral health clinician may need to coordinate with the member's care manager about:

• Changes in symptoms or functional needs.
• Medication-related concerns.
• Referrals to other services.
• Hospital discharge and follow-up.
• Barriers to treatment access.
• Changes in the member's living or support situation.

The practice should have a process for identifying the appropriate care-management contact and sharing information through the applicable consent and privacy requirements.

Tailored Care Management does not replace the clinician's responsibility to assess, document, and deliver appropriate care. Where a level-of-care decision is involved, the ASAM Criteria framework is the common reference point for SUD services.

Specialized programs and services administered through LME-MCOs

LME-MCOs are particularly important for services that support people with complex behavioral health and I/DD needs.

NC Innovations Waiver

The NC Innovations Waiver provides home and community-based services for eligible people with I/DD.

It is intended to support individuals in community settings rather than relying solely on institutional care.

Tailored Plans are the only Medicaid health plans that offer the NC Innovations Waiver. Members must be enrolled in a Tailored Plan to access waiver services.

For providers, this means that eligibility, service planning, authorization, and waiver-specific requirements need to be understood before delivering services.

The NC Innovations Waiver information page provides information about eligibility and access.

Traumatic Brain Injury Waiver

The TBI Waiver provides services for eligible individuals with traumatic brain injuries who meet program requirements.

Tailored Plans also administer access to this waiver.

Providers serving people with TBI should verify the member's waiver status and understand the relevant plan requirements before initiating services.

1915(i) services

North Carolina also uses the 1915(i) Medicaid authority to provide certain home and community-based services.

These services can support people with behavioral health and I/DD needs, including individuals who may be waiting for access to a waiver.

NC Medicaid publishes current 1915(i) services information. Providers and care managers should use the current assessment tools and program guidance rather than older saved versions.

State-funded behavioral health services

LME-MCOs also have responsibilities involving state-funded services for eligible people who may not have Medicaid coverage for the services they need.

These services are subject to their own eligibility, funding, and program requirements. Other states structure this differently again: California runs SUD services through county-based DMC-ODS arrangements, and Texas routes documentation through CMBHS.

A provider should not assume that state-funded services follow the same billing rules as Medicaid-covered services. Confirm the funding source, service definition, authorization process, and documentation requirements before providing care.

What changed with the October 2026 Vaya Partners merger?

The merger of Vaya Health and Partners Health Management is the most important recent structural change for North Carolina providers.

Effective October 1, 2026, the two organizations became Vaya Partners.

NC Medicaid stated that:

• The new organization would operate as the Behavioral Health and I/DD Tailored Plan and LME-MCO.
• Members of both former plans would be automatically enrolled in the unified plan.
• Existing benefits would remain the same.
• Members could continue seeing providers in good standing with both organizations.
• The combined organization would serve the former Vaya and Partners regional footprint.

The state described the merger as primarily a name change and stated that no action was needed by members to keep current services.

What should providers do?

Even when the state describes a merger as primarily a name change, practice administrators should verify operational details.

Recommended checks include:

• Update internal references from Vaya Health and Partners Health Management to Vaya Partners where appropriate.
• Confirm current provider-support contact details.
• Review new or updated provider communications.
• Confirm whether existing provider contracts remain active and whether amendments are required.
• Check whether portal access, claims routing, authorization workflows, or remittance details have changed.
• Confirm that staff know which organization now handles inquiries for the combined region.
• Review any plan-issued instructions about member IDs and eligibility verification.

Do not assume that every legacy portal, email address, or claims workflow was automatically replaced on October 1. Confirm the current process directly with Vaya Partners.

The merger notice says benefits and providers would remain the same for affected members. It does not mean that every administrative process can be assumed to remain unchanged indefinitely.

Common operational problems for behavioral health practices

The regional structure creates several recurring risks for practices, particularly those serving multiple counties or operating across several LME-MCO networks.

Build a plan-specific payer matrix

A practice serving members across North Carolina should maintain a central payer matrix.

At a minimum, include:

This matrix should be reviewed whenever a plan issues a provider update or a structural change occurs.

How to stay current with LME-MCO and Tailored Plan changes

North Carolina's managed care system is not static. Consolidations, policy changes, provider bulletins, and program updates can affect practice operations.

Credentialing and billing teams should monitor:

1. NCDHHS LME/MCO Directory: For current organizations, county assignments, and contact details.
2. NC Medicaid Behavioral Health and I/DD Services: For service and program updates.
3. LME/MCO Contracts and Reports: For contract documents and reports.
4. Tailored Plan provider resources: For claims, authorization, and provider guidance.
5. Tailored Care Management provider resources: For current manuals, assessment tools, and program changes.

Useful official links:

• LME/MCO Directory
• Behavioral Health and I/DD Services
• LME/MCO Contracts and Reports
• Tailored Plan Claims and Prior Authorization FAQ
• Tailored Care Management for Providers

LME-MCO compliance checklist for North Carolina providers

Use this checklist to review whether your practice has a reliable process for managing LME-MCO and Tailored Plan relationships.

Member and payer verification

• Verify NC Medicaid eligibility before services.
• Confirm whether the member is enrolled in a Tailored Plan, Standard Plan, or NC Medicaid Direct.
• Identify the responsible LME-MCO based on the member's county and enrollment.
• Recheck coverage when the member reports a change.

Provider enrollment and contracting

• Maintain active NC Medicaid enrollment.
• Confirm the correct NPI and taxonomy information.
• Track individual rendering-provider and organizational enrollment separately.
• Confirm network participation with each relevant Tailored Plan.
• Maintain current contracts and service-location information.

Authorization and clinical documentation

• Maintain a service-specific authorization matrix.
• Verify prior authorization requirements before delivering services.
• Track authorization numbers, dates, and approved units.
• Document medical necessity and the clinical rationale for services.
• Monitor utilization and submit additional requests when necessary.

Claims and reimbursement

• Use the current plan-specific claims submission process.
• Verify billing and rendering provider details.
• Track timely filing and appeal deadlines.
• Reconcile remittances and investigate unpaid claims.
• Maintain current provider-support contacts.

Ongoing plan updates

• Use the current three-organization LME-MCO directory.
• Update references to Vaya Partners after the October 2026 merger.
• Monitor plan bulletins and provider communications.
• Review contract and portal changes.
• Assign an owner for maintaining the payer matrix.

Frequently asked questions about LME-MCOs in North Carolina

What does LME-MCO stand for?

LME-MCO stands for Local Management Entity/Managed Care Organization. These regional public organizations manage Behavioral Health and I/DD Tailored Plans and coordinate certain behavioral health and I/DD services for NC Medicaid Direct beneficiaries and EBCI Tribal Option members.

How many LME-MCOs are there in North Carolina?

As of November 5, 2026, North Carolina has three organizations listed in the current state directory: Alliance Health, Trillium Health Resources, and Vaya Partners. Vaya Partners was formed when Vaya Health and Partners Health Management merged on October 1, 2026.

What is the difference between an LME-MCO and a Tailored Plan?

An LME-MCO is the regional organization managing the system. A Tailored Plan is the Medicaid managed care health plan operated by that organization for eligible members with complex behavioral health, I/DD, and related needs.

When did North Carolina Tailored Plans launch?

North Carolina launched Behavioral Health and I/DD Tailored Plans on July 1, 2024.

Who qualifies for a Tailored Plan?

Eligibility can involve serious mental illness, severe substance use disorder, I/DD, traumatic brain injury, or participation in certain waiver and institutional programs. The state reviews eligibility based on Medicaid enrollment and applicable criteria.

Does every Medicaid behavioral health provider need a contract with an LME-MCO?

Not every provider or service arrangement is identical. Providers should confirm whether the service is delivered through a Tailored Plan network, NC Medicaid Direct, or another applicable arrangement. State Medicaid enrollment and plan network contracting are separate considerations.

Can a provider serve members from more than one LME-MCO region?

Yes. A practice may serve members from different counties and therefore work with multiple LME-MCO/Tailored Plan organizations. It should confirm each member's responsible plan and maintain the relevant contracts and billing processes.

Are LME-MCOs responsible for prior authorizations?

LME-MCOs/Tailored Plans manage authorization processes for services under their responsibility. The exact requirements depend on the service, the member's enrollment, and the applicable coverage policy. Providers should confirm the current plan-specific process before delivering services that require approval.

Does the Vaya Partners merger change member benefits?

NC Medicaid stated that benefits would remain the same for members affected by the October 1, 2026 merger. Members were automatically enrolled in the unified plan. Providers should still verify current plan details and administrative instructions.

Where can providers find their regional LME-MCO?

Use the official NCDHHS LME/MCO Directory. It lists the current organizations and the counties they serve.

Final takeaway

North Carolina's LME-MCO system is the regional structure behind its Behavioral Health and I/DD Tailored Plans. For providers, understanding the structure is essential to managing Medicaid eligibility, network participation, authorization, claims, and care coordination.

The most important current development is the October 1, 2026 merger of Vaya Health and Partners Health Management into Vaya Partners. North Carolina now lists three regional organizations: Alliance Health, Trillium Health Resources, and Vaya Partners.

But knowing the organization name is only the starting point. Practices also need to identify the member's actual Medicaid enrollment, confirm the responsible payer for the service, maintain the correct provider contracts, and follow current authorization and claims instructions.

A current payer matrix, clear ownership of plan communications, and routine eligibility verification can prevent avoidable billing and administrative problems.

If your team is maintaining that payer matrix by hand across three organizations, the reconciliation work is probably larger than the contracting work. Book a demo to see how Supa handles eligibility, authorization tracking and denial follow-up across plans.

This article is for educational and operational purposes and is not legal or reimbursement advice. Requirements vary by service, member enrollment, and plan. Verify current provider manuals, contracts, coverage policies, and submission instructions with NC Medicaid and the responsible LME-MCO/Tailored Plan before changing practice workflows.