NC Medicaid Direct
Vaya Health manages certain services for Medicaid beneficiaries who are not enrolled in NC Medicaid Managed Care. Our NC Medicaid Direct Prepaid Inpatient Health Plan (PIHP) includes behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) services.
The North Carolina Department of Health and Human Services (NCDHHS) manages physical health services, pharmacy benefits, Long-term Services and Supports (LTSS), and non-emergency medical transportation for Vaya’s NC Medicaid Direct members.
The following populations qualify for full benefits through NC Medicaid Direct:
- Children who get Community Alternatives Program for Children (CAP/C) services
- People who get Community Alternatives Program for Disabled Adults (CAP/DA) services
- Federally recognized tribal members or others who qualify for services through the Indian Health Service (IHS)
- People in the Program for All-Inclusive Care for the Elderly (PACE)
- People who are medically needy
- People who get Medicaid and Medicare (dual eligibles)
- Children/youth in foster care
- Children/youth who get adoption assistance
- Former foster care youth
- People who have a behavioral health disorder, I/DD, or TBI*
- People who get Innovations Waiver services*
- People who get TBI Waiver services*
* Most members in these populations will transition to a Behavioral Health and I/DD Tailored Plan in 2024.
The following populations qualify for limited benefits through NC Medicaid Direct:
- People who only get Family Planning Medicaid
- People who get coverage only of Medicare premiums or private insurance premiums through the Health Insurance Premium Payment program (HIPP)
For more information, read Vaya’s Quick Reference Guide and Provider Operations Manual, call the Provider Support Service Line at 1-866-990-9712 (7 a.m.-6 p.m., Monday-Saturday, including holidays), email provider.info@vayahealth.com, or visit the NC Medicaid Direct Services page of the NCDHHS website.