Vaya Health does not provide treatment services to members directly. Instead, we ensure those who need treatment receive the right care, in the right amount, at the right time. These services are delivered by a network of high-quality providers who contract with Vaya Health.
We offer three distinct health plans:
- We manage a benefit plan funded with local, state and federal grant dollars allocated to us by the NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services to meet the behavioral health and I/DD needs of eligible individuals who are uninsured or underinsured. Eligibility is based on income, citizenship, availability of other insurance and other factors.
- We have a contract with the NC Division of Medical Assistance to manage the North Carolina 1915(b)/(c) Waiver, which is a mental health, substance use disorder and IDD benefit plan for people whose Medicaid eligibility is based in one of our 23 counties. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. County departments of social services determine Medicaid eligibility.
- The Medicaid Waiver includes a 1915(c) Home & Community Based Services (HCBS) Waiver, called the Innovations Waiver, which offers services and supports to help individuals with IDD live successfully in the community. Eligibility for the Innovations Waiver is based on clinical factors and the availability of a Waiver slot. The number of Innovations Waiver slots is allocated by the State and there is currently a waiting list for persons seeking to participate in the Innovations Waiver.
We operate a 24-hour crisis hotline for anyone who needs help or has concerns/questions about mental health, intellectual/developmental disabilities or substance use.
At Vaya Health, our goal is to embrace innovation, adapt to a changing environment and maximize resources for the long-term benefit of the people and communities we serve.
We maintain a network of highly qualified providers, respond to individual and family needs on a local level and effectively manage public service dollars. Additionally, through a robust public outreach program, we educate the community about mental health, substance use disorder and I/DD issues and available services — and how individuals in need can speak with a representative any time. Through reinvestment initiatives, we are demonstrating every day how public managed care can benefit both the people who receive our services and the taxpayers of North Carolina.
Every day, we work with each other, our providers, our partners and the people we serve to develop the best and most-needed services for a healthier western North Carolina.
Vaya Health Mental Health, Developmental Disabilities and Substance Abuse Services was officially established on July 1, 1972. Initially, Vaya Health operated in only seven counties: Cherokee, Clay, Graham, Haywood, Jackson, Macon and Swain. At the time, we provided direct services and operated group homes and other facilities. We continued to grow as a community-based behavioral health services organization throughout the seventies, eighties and nineties.
In 2001, the state of North Carolina embarked on plans to reform the delivery of mental health, substance use and intellectual/developmental disability services. Local management entities (LMEs) such as Vaya Health divested of resources and became managers, not providers, of care.
As a wave of LME consolidations took place statewide, our focus turned eastward. In 2006, we began the process of merging with New River LME, eventually bringing five additional counties into the Smoky fold: Alleghany, Ashe, Avery, Watauga and Wilkes. In 2007, we began a consolidation with Foothills LME, adding Alexander, Caldwell and McDowell counties.
In June 2011, the state Legislature passed into law a bill that expanded the Medicaid 1915(b)/(c) waiver statewide. We transitioned to a full managed care organization (MCO) on July 1, 2012, now serving both state-funded individuals and Medicaid beneficiaries.
In 2013, Vaya Health assumed management of the Asheville-based Western Highlands Network MCO, and began a process to consolidate the two entities. With the completion of that merger, Vaya Health assumed management duties for eight additional counties: Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania and Yancey, for a total of 23 counties covering nearly one quarter of the state.