Trillium Health outlines tailored Medicaid plan rollout, cites transportation and call-center strains

A Trillium Health representative told the Scotland County Board of Commissioners on Jan. 6, 2025, that the organization is six months into offering North Carolina’s tailored Medicaid plan and is working to resolve higher-than-expected call volumes and transportation disruptions affecting members in Scotland County.

The tailored plan, launched July 1, 2024, provides “whole person” care for people with significant behavioral-health needs, the representative said. Trillium serves behavioral-health, substance-use and developmental-disability services and covers members who are uninsured or underinsured in addition to Medicaid enrollees.

The update matters because tailored-plan benefits include enhanced services and residential treatment options not typically provided through standard Medicaid managed-care plans. Those services, the representative said, include child and adolescent day treatment, multisystemic therapy, assertive community treatment, ambulatory detox and medically monitored residential treatment; residential group homes and psychiatric residential treatment facilities for people with intellectual and developmental disabilities; and long-term services and supports such as nursing-home care and personal care.

Trillium’s presenter described tailored care management as “really kind of the cornerstone of our tailored plan service,” a year-long, monitored plan of care delivered by Trillium and contracted care-management agencies or advanced medical homes.

Locally, the presenter reported state data as of July showing “a little bit under 17,000” people receiving Medicaid in Scotland County. Trillium covers about 28% of that population; standard commercial managed-care plans cover roughly 72%. The representative said Trillium has “a little over 1,300” members in the county receiving tailored-plan whole-person care. (The data were state snapshots as of July and Trillium said it updates those figures every six months.)

The presenter described operational challenges during the rollout. Call-center volume roughly doubled from June to July — from “a little over 9,000 calls” in June to nearly double in July — as members called about primary care, transportation and tailored care management. Pharmacy claims volume was also substantial: from July through mid-October Trillium paid about $82,000,000 in pharmacy claims, and the presenter said net claims received in October numbered “a little over 377,000,” with an approximate three-month lag in claims reporting.

Transportation disruptions were another issue. Trillium and other tailored plans contracted MotiveCare for nonemergency medical transportation; the presenter said the vendor’s statewide deployment caused some members to experience changes or gaps in transportation schedules. Trillium said it is coordinating with MotiveCare to improve reliability and to match transportation types to members’ clinical needs.

To address service delays, Trillium increased call-center staffing and added routing options so callers can reach nurse lines or transportation support more directly. The presenter said the organization is maintaining prompt claims payment — “around 100% of Medicaid and state claims paid within 30 days” — and took an “all hands on deck” approach at launch to connect members to existing regular transportation trips.

The representative also reviewed specialized benefits available only through tailored plans: Innovation Waiver services (for people who would otherwise qualify for institutional care), 1915(i) home- and community-based services, and an expanding TBI (traumatic brain injury) waiver under North Carolina Department of Health and Human Services (N.C. DHHS). The presenter encouraged families of people with intellectual and developmental disabilities to join waiting lists for waivers because slots are limited.

On local partnerships, the presenter thanked the board for appointing Commissioner Williams to Trillium’s regional board and noted a contract with Primary Health Choice as another tailored care-management provider in the county. For crisis care, the presenter said people may call 988 or Trillium’s behavioral-health crisis line and will be connected to a clinician.

Trillium said it will return with updated enrollment data in its next six-month/annual report. The board did not take formal action on the presentation. The meeting also included a separate procedural motion to move agenda item 9 under item 6, which board members approved by voice vote.