Q&A on Tailored Care Management
by: Jacki Agusta, TCM Supervisor, LCSW, LCAS, CCS
SouthLight’s Tailored Care Management (TCM) Program is a community- and team-based program designed to help clients with case management needs. Our goal is to be a bridge, helping clients get connected and stay connected to the services they need.
Q: I have Tailored Care Management (TCM). What can the program do for me?
A: In SouthLight’s Tailored Care Management Program, you will be assigned a primary care manager and a peer support specialist. Your care manager will be the main person managing your services, needs, and goals, while your peer support specialist is there for additional support, coaching, and education as needed.
Once enrolled, your care manager will go over a brief history and explore your current needs so they can address the things that are most important to you and get a sense of what services or resources you may be eligible for. They will talk with you about your goals, which both your care manager and your peer support specialist will help you work toward.
Our SouthLight team can meet with you as often as you like, wherever you like. If you prefer meeting in-person, we can meet you in your home, in the community, or in the office. If you prefer telehealth or phone calls, we can do that as well, or a mix of all three. We will also be there to help you transition in or out of the hospital, making sure you have support while you’re there and have a solid plan for when you are discharged.
Some of the most common needs we help clients address range from medical care, substance use and/or mental health care, recovery support, food, transportation, housing, clothing/diapers, and more.
Q: Who is eligible for SouthLight’s Tailored Care Management Program (TCM)?
A: Most people will be eligible for Tailored Care Management if they have “Tailored Plan” Medicaid. Some people with the “Medicaid Direct” plan will also be eligible; you can check with your counselor or provider to find out.
Medicaid plans that are not eligible for Tailored Care Management are: Medicaid Family Planning and the Medicaid Standard Plans (AmeriHealth, Carolina Complete Health, Healthy Blue, UnitedHealthcare Community Plan, and WellCare).
Q: How does Medicaid Expansion affect Tailored Care Management services?
Medicaid Expansion should allow more people to become eligible for Tailored Care Management!
A: Most people who have Medicaid Family Planning will likely be automatically moved to a full Medicaid plan as of December 1, 2023, and many people who don’t have Medicaid at all will be eligible and can apply on or after December 1. With a significant number of people registering for Medicaid for the first time or being moved to full Medicaid, more people should be enrolled in Tailored Care Management.
If you become eligible for full Medicaid in December and want to participate in Tailored Care Management, and you’re given the option to sign up for Medicaid Direct vs. a Standard Plan, then choose Medicaid Direct.
Q: How can I (or how can my loved one) get connected to Tailored Care Management?
Anyone eligible for Tailored Care Management is automatically enrolled in the service by the State. The State assigns eligible people to an agency for Tailored Care Management.
A: If you are a SouthLight client and would like to see if you have Tailored Care Management services with SouthLight, or would like to move your Tailored Care Management services to SouthLight, please reach out to Jacki Agusta, Tailored Care Management supervisor, at 919-348-3163.
If you’re not a SouthLight client and you think you may be eligible but aren’t sure, or aren’t sure what agency you’re assigned to, you can reach out to the Managed Care Organization for your county (such as Alliance Health for Wake, Durham, Johnston, Orange, Mecklenburg, or Cumberland) and ask them to verify for you.
Jacki Agusta, LCSW, LCAS, CSI
“I started at SouthLight as an Opioid Treatment Program Counseling Intern working toward my Masters in social work and upon graduation, I was immediately hired as an Opioid Treatment Program counselor. At a time when I wasn’t sure where my place in the world would be, SouthLight showed me a world of opportunity for myself by exposing me to the world of opportunity we create for the clients we serve.” —Jacki Agusta
Jacki now serves as the SouthLight Tailored Care Management Supervisor.
