Trillium Health tells Scotland County commissioners tailored Medicaid plan is working despite transition strains

A Trillium Health representative told the Scotland County Board of Commissioners on Jan. 6, 2025, that Trillium's tailored Medicaid plan, launched July 1, 2024, is serving county residents with significant behavioral health needs and that the rollout has produced higher call volumes and claims even as providers continue to be paid promptly.

The presentation matters because tailored plans are designed to serve people with severe mental health, substance use and developmental disability needs with "enhanced services" not typically offered through standard Medicaid managed care plans. The Trillium representative described how tailored care management, residential services and specialized waivers work and outlined local enrollment and operational impacts so far.

According to the presenter, state data as of July showed "a little bit under 17,000" people receiving Medicaid in Scotland County; Trillium was covering about 28% of that population. The presenter said Trillium had "a little over 1,300" members receiving tailored plan benefits and also referenced a subset described as in "Medicaid direct" (reported in the presentation as about 35,100). The presenter attributed these figures to state enrollment reports and noted the county update will be refreshed for a planned annual report.

The representative detailed services available through the tailored plan, including tailored care management, child and adolescent day treatment, multisystemic therapy, assertive community treatment and residential options such as psychiatric residential treatment facilities and group homes for adults with intellectual and developmental disabilities. The presentation noted that some enhanced services are available through Innovation Waiver and other home- and community-based services and that those waivers have long waiting lists; the presenter encouraged families to join waiting lists for those waivers.

The presenter acknowledged operational challenges during the transition to tailored plans. Call volume to Trillium's contact center rose sharply, from about 9,000 calls in June (prelaunch) to nearly double that in July, the month of the tailored plan launch. Claims volume increased as well; the presenter said the most recent claims snapshot (through October) showed about 377,000 claims processed, with a lag in reporting. Pharmacy claims from July through mid-October were reported at roughly $82,000,000. Despite higher volumes, the presenter said Trillium is paying "around a 100% of Medicaid and state claims paid within 30 days," and later summarized that the organization continues to achieve approximately 99.9% of claims paid within 30 days.

Transportation disruptions were discussed as an area of concern. The presenter said all the tailored plans are contracting with a statewide transportation provider, MotiveCare, and that Trillium was working with MotiveCare and members to resolve scheduling and reliability issues because many members require consistent, specialized transportation. To address call-center delays, Trillium reported adding staffing and implementing call-routing options (nurse line and transportation routing) to accelerate responses for members.

The presenter described nonmedical supports offered under tailored care management and Trillium's value-added services, including neighborhood connections that link members to housing and other community resources, GED vouchers, move-in assistance and recovery apps to support substance use recovery. The presentation noted that Trillium and an additional provider, Primary Health Choice, operate as tailored care management providers in the county.

During the meeting, the board approved a revision to the published agenda to move agenda item 9 under item 6; a motion was made and seconded and the board voted in favor (no recorded roll-call votes were provided in the transcript). The Trillium update concluded with the presenter advising commissioners that crisis resources remain available and that residents can reach crisis services by calling 988 or Trillium's behavioral health crisis line.

The presenter said Trillium will return with an updated enrollment and claims report at the annual update and encouraged county residents and providers to contact Trillium for information on available behavioral health, developmental-disability and traumatic-brain-injury services.