- Quick Reference Guide
- Detailed Explaination of Accessing Services
- What Does An LME/MCO Do for Individuals?
- What Services May Be Available?
- How Do I Apply for Services?
- What Funding May Be Available?
- Who is Eligible for Services?
- Local Offices-LME/MCOs
Services for TBI are provided through the Division of Mental Health/Developmental Disabilities/Substance Abuse Services.
- Click this link to find the local office that serves your county: http://www.ncdhhs.gov/mhddsas/lmeonblue.htm
- Tell them that you or your family member has a TBI and describe the problems you are currently facing
- It may be helpful to have documentation of your TBI (if you have it) available for the call
Detailed Explanation of Accessing TBI Services
The Division of Mental Health, Developmental Disabilities, and Substance Abuse Services has been the lead agency for TBI in the State of North Carolina since 1996. The structure of the Division and its local offices has changed significantly over the last ten years and continues to change.
Presently there are eight local offices which are commonly referred to as Local Management Entities/Managed Care Organizations (LME/MCOs). These local offices offer both Medicaid and State funded services. They manage the providers that deliver services in the community. Each local office has a different name. You can find the local office that serves your county by clicking on the following link:
How Can an LME/MCO Help?
Each LME/MCO has different providers in their network; therefore services may differ by location. Your LME/MCO can assist you in getting services if you are eligible. The first step is to call the “Access Line” for your local office. All offices have a toll free number that you can call. Tell them that you (or your family member if you are calling for someone) have a TBI. They may ask for medical documentation of the TBI. Each office has financial eligibility requirements so you will also be asked for information about your family’s finances.
In NC, TBI has been defined as a Developmental Disability. This means that the person with TBI may be eligible for services designed for someone with an IDD (Intellectual or Developmental Disability). Make sure that you tell the person any challenges or difficulties that you or your family member is experiencing because you may also be eligible for Mental Health or Substance Abuse Services.
What Services May Be Available?
When you call the local office, you should describe the problems that you are having so that the local office can help determine what you may need. Some of the types of services that may be available include: residential placement, day services (such a TBI Clubhouse if available in your area), personal assistance or therapies like physical, occupational or speech. If you are determined to be eligible you will need to have an assessment to help determine the best services for your situation.
How Do I Apply for Services?
The first step is to call your local office to receive information about eligibility and possible services as noted above.
More TBI information is available through the Division’s website: NC MH/DD/SAS TBI Services
This website also lists the phone number of a Division staff person who will be able to answer questions if you have difficulty at the local office.
What Funding May Be Available?
Medicaid: Medicaid is health insurance available to individuals who are disabled and who meet certain income restrictions. Medicaid may pay for some services. You can apply for Medicaid through your county office of the Division of Social Services (DSS).
Additional Information on the Medicaid Process: Medicaid Application
Innovations Waiver: (Community Alternative Program for children and adults with Intellectual and/or Developmental Disabilities) A NC Medicaid waiver program for individuals who need ICF/IDD (Intermediate Care Facility) level of care and can safely live in the community within available resource limits set by Medicaid. The Innovations Waiver covers a particular list of services and supports; there may be a wait for this service in your area.
State Funded Services: If you meet financial eligibility requirements as well as functional limitation requirements, you may be able to receive some limited services. Your local office will determine this and discuss it with you.
Who is Eligible for Services?
Residents of any North Carolina county, age three and older, whose condition meets the following state definition (N.C. General Statutes G.S. 111c-3 (12a). “Developmental disability” means a severe, chronic disability of a person which:
- Is attributable to a mental or physical impairment or combination of mental and physical impairments;
- Is manifested before the person attains age 22, unless the disability is caused by a traumatic head injury which can occur at any age, and
- Is likely to continue indefinitely;
- Results in substantial functional limitations in three or more of the following areas of major life activity:
Receptive & expressive language
Capacity for independent living
- Reflects the person’s need for a combination and sequence of special interdisciplinary, or generic care, treatment, or other services which are of a lifelong or extended duration and are individually planned and coordinated; or
- When applied to children from birth through four years of age, may be evidenced as a developmental delay.
Alliance Behavioral Healthcare: 1-800-510-9132
Counties served: Cumberland, Durham, Johnston and Wake
Cardinal Innovations Healthcare Solutions: 1-800-939-5911
Counties served: Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Person, Rockingham, Rowan, Stanly, Stokes, Union, Vance, and Warren
Counties Served: Bladen, Columbus, Duplin, Edgecombe, Greene, Lenoir, Nash, Robeson, Sampson, Scotland, Wayne, and Wilson
Partners Behavioral Health Management: 1-888-235-4673
Counties Served: Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Surry, and Yadkin
Sandhills Center for MH/DD/SAS: 1-800-256-2452
Counties Served: Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, and Richmond
Trillium Health Resources: 1-877-685-2415
Counties Served: Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, and Washington Counties
Vaya Health: 1-800-849-6127
Counties Served: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes, and Yancey