Benefit Plans | Service Definitions

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Benefit Plan Information

Medicaid Benefit Plan

State-Funded Benefit Plan

Physical Health Plan

Personal Care Services

About Personal Care Services (PCS)

Starting July 1, 2024, Trillium Health Resources also coordinates Personal Care Services for Medicaid members placed on the Tailored Plan.

If you are seeing a member in need of these services, please complete the following information for questions related to NC State Plan Personal Care Services.  Please complete the DHB 3051 Request for Independent Assessment Form when referring for a PCS assessment or reassessment. The form can be emailed to LTSS@trilliumnc.org using the “Submit” button on the form, or by saving to your desktop and emailing as an attachment.

If you have general questions about the Personal Care Services, please submit using the link below and someone will contact you within 1-3 business days with a response. 

If you have general questions about the Personal Care Services, please submit using the link below and someone will contact you within 1-3 business days with a response. 

Personal Care Services Questions

Prior Authorization Services

Please use this tool to determine if prior authorization is required for specific services and codes. However, using this tool does NOT guarantee payment. Member eligibility, benefit plans, codes in provider contracts, and other details may impact payment. Please refer to the provider manual or call the Provider Support Service Line at 1-855-250-1539 for more information.

Behavioral Health Services   |  Physical Health Services 

Service Definitions 

In Lieu of Services (ILOS)

Tailored Plan Medicaid Member Pharmacy Benefits

Medicaid Member Pharmacy Benefits - Prescription drugs, over-the-counter medicines, and other supplies covered for Medicaid members.

Services for Medicaid–Eligible Children: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

  • Medicaid covers a broad array of health and dental services for those under age 21. A federal law requires Medicaid to provide all medically necessary health care services to Medicaid-eligible children. This is called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), which is known in North Carolina as "Health Check." The services are required even if the services are not normally covered by the children's Medicaid.
  • For more information about Health Check and EPSDT in North Carolina, visit our page Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Trillium welcomes feedback regarding the current Benefit Plans and Service Definitions. Feedback and recommendations will be taken into consideration and can be sent to QMinfo@TrilliumNC.org.

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