By Taylor Knopf
For families of people with severe mental health needs, a frustrating pattern emerges. Mobile crisis teams come to the home repeatedly. Trips to the emergency room add up. Involuntary commitments lead to short psychiatric hospital stays. And the cycle repeats itself.
Some say their loved ones are harder to reach because of delusions, hallucinations or homelessness. Other patients say they’ve been burned by their experience with psychiatric treatment and now they refuse all help. Family members are often left nervously waiting for the next emergency.
Intensive, long-term mental health services do exist in North Carolina, but options are rarely explained to the families who need them. Additionally, the quality and availability of certain interventions varies from county to county.
Desperate family members frequently find NC Health News’s coverage of mental health issues, and they reach out looking for help for their loved one. Many don’t know where to even start.
Because we receive so many calls and emails, we looked into the availability of services beyond crisis interventions — such as the ER or mobile crisis — and the steps to connect to them.
What mental health crisis services are available in North Carolina and how to reach them
Here’s a breakdown of how to apply for intensive, community-based mental health services in North Carolina.
Medicaid versus private insurance
It may come as a surprise to some that the most intensive, comprehensive services for people with mental illness and disabilities are covered by the publicly funded Medicaid program.
Medicaid uses federal money, and by law must cover services for people with mental illness and disabilities. Private insurers are regulated by a different law and don’t have all the same requirements for coverage. The federal government does set a handful of requirements for private insurers under mental health parity laws, meaning insurers must cover mental health services at the same level that they cover physical health services if they decide to offer mental health coverage, but many private insurers fail to meet these thresholds.
Many times intensive, in-home services for those with mental illness and disabilities aren’t covered at all by private insurance companies, or the private plans put such strict limits on how many times someone can use a service that the coverage becomes useless. Many private plans also have copays and deductibles that make it too expensive. All of this adds up to people with severe and complex mental illness or disabilities who are on private insurance often not getting the care they need.
North Carolina health leaders talk consistently with private insurers about contributing more to behavioral health services, but progress has been slow.
Medicaid was built to serve people with low incomes and those with disabilities — including severe and persistent mental illness — so it tends to cover more of the care these patients actually need.
How to apply for Medicaid
The first step to accessing a wider array of intensive mental health services is to apply for Medicaid.
- You can apply online here.
- You can apply in person at your county Department of Social Services office. Linked is a map and directory of NC’s county DSS offices.
- You can apply over the phone by calling the N.C. Medicaid Contact Center at 1-888-245-0179.
The N.C. Department of Health and Human Services has a list of information and documents needed to apply for Medicaid.
Tailored plans for intensive services
For those in need of the most intensive mental health services, the state’s Medicaid Tailored Plans, which launched in July 2024, have the widest array of service options. Tailored Plans can include in-home services, care for those with traumatic brain injuries and intellectual and developmental disabilities, as well as breaks for caregivers. Tailored Plans also come with a case manager who can help schedule and arrange transportation to appointments or help people find supportive housing.
If a person with Medicaid meets a certain number of qualifying events, such as psychiatric hospitalizations, there is a process at the state level to switch them over to a Tailored Plan for more intensive behavioral health services. This switch would trigger outreach to that Medicaid participant. Health providers can also fill out a form to ask that a Medicaid recipient be transferred to a Tailored Plan for a higher level of outpatient mental health care.
North Carolina has several types of Medicaid programs, listed and explained at this link. The North Carolina Enrollment Broker is available to talk through Medicaid plan options, eligibility criteria and can change someone over to a different plan.
The enrollment broker can be reached at 1-833-870-5500.
Contact your LME-MCO
The state has four managed care organizations, known as LME-MCOs, that coordinate publicly funded services for those with disabilities or behavioral health and substance use needs. If you have Medicaid or are uninsured, you can call the LME-MCO that manages the care for your county to find out what mental health services are available to you and how to get connected to them.
(In October 2026, Vaya Health and Partners Health Management will consolidate to serve western North Carolina, and there will be three LME-MCOs.)
Each LME-MCO has a member service line for anyone asking about services for themselves or a loved one. The LME-MCOs also have a 24/7 crisis line staffed by licensed clinicians. The LME-MCO map and phone numbers for each county are on DHHS’ website.
“As the state has diversified health plans and systems to manage people, it complicates it a little bit for the individual person out there that just wants to get help,” said Donald Reuss, former vice president of behavioral health and I/DD network operations at Vaya Health, the LME-MCO in western North Carolina.
“I’ve been in this system for 30 years, and I was there when the state originally came out with the blueprint for change and privatizing the system,” Reuss said. “And every year it’s gotten more complex than the previous year. They’re always introducing new things.”
He noted that as soon as someone comes into one of the LME-MCO plans, they can opt into receiving a care manager to help them navigate the system.
Reaching the hard-to-reach
Even when families know who to call and have the coverage plan, getting a loved one connected to services isn’t always easy. Many don’t trust the system, have had a bad experience in the past or don’t like the idea of outsiders getting involved in their lives.
“It’s great that people are taking steps to call, but I think, more often than not, people kind of suffer silently or they show up in emergency departments,” said Sean Schreiber, chief of innovation and strategy at Alliance Health, the LME-MCO that manages the Triangle area and Cumberland and Mecklenburg counties.
That’s why the LME-MCOs have staff connected to crisis centers and hospitals around the state to engage with people when they come for help.
The LME-MCOs have learned to lean heavily on peer support specialists — people who have lived with mental illness and can help patients navigate recovery. Behavioral health leaders have found these professionals can build trust where clinical providers often can’t. The LME-MCOs pay peer support staff at behavioral health crisis facilities, hospitals and jails to help patients navigate what comes next and get connected to services.
Some LME-MCOs are experimenting with reaching people where they are.
Alliance Health is piloting a street psychiatry program in Mecklenburg County, bringing care directly to the unhoused population. Partners Health Management, the dominant LME-MCO in the Piedmont area, has staff working in at least seven jails in its region, using care coordinators and peer support workers to reconnect incarcerated people with their Medicaid benefits and line up services before they’re released. At least 20 counties have a MORES program, which brings mobile crisis services and follow-up care to the homes of families with children and young adults dealing with mental health challenges.
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