The North Carolina Department of Health and Human Services (NC DHHS) has made policy changes in order to better serve children who are dually diagnosed with both mental illness and intellectual or developmental disabilities (I/DD) (also called “children with complex behavioral health needs.”)

Children with complex needs

For this fact sheet, children with complex needs are those who meet these four criteria:

  1. Diagnosed with both a mental illness and I/DD,
  2. At risk of not being able to enter or stay in a community setting (that is, they are institutionalized or are at risk of being institutionalized),
  3. Have Medicaid, and
  4. Are between 5 and 20 years old (eligibility ends on one’s 21st birthday).

Children are covered by a provision in federal Medicaid law called Early and Periodic Screening, Diagnostic and Treatment (EPSDT). This provision requires NC DHHS to provide Medicaid eligible children (including those with complex needs) with “necessary health care, diagnostic services, treatment and other measures in order to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services.”

Who do I contact if my child has complex needs?

LME/MCOs (local management entities/managed care organizations) contract with NC DHHS to manage behavioral health services. These are the kind of services these kids need. There are seven LME/MCOs in NC.

Find out which LME/MCO covers your county and get contact information.

Services for children with complex needs

NC DHHS provides the following services for children who meet the four criteria listed above.

Access to help

Almost anyone who works with or is related to a child can call the local LME/MCO to talk about whether the child may have complex needs, including

  • Family members
  • Pediatricians
  • Social workers
  • School employees
  • Employees of the Department of Social Services
  • Employees of the Department of Juvenile Justice, etc.

LME/MCO staff will assess the child’s indicators and risk factors. If the child meets the “complex needs” criteria, the LME/MCO will assign a Care Coordinator to begin services. Those who do not meet the criteria but qualify for other services will receive referrals for those services.


In addition, families throughout the state facing a crisis involving a child with complex needs have access to NC START (Systemic, Therapeutic Assessment, Respite and Treatment). This is a comprehensive program that provides community-based crisis prevention and intervention services for people with I/DD and a co-occurring mental illness who have challenging behaviors. You can get connected with NC START by asking the LME/MCO for a referral. For children ages 18 and over you can contact NC START directly.

Outpatient services

Families also can access an Outpatient Assessment Clinic at the Murdoch Developmental Center in Butner or at the J. Iverson Riddle Center in Morganton. The clinic staff includes clinicians who have expertise in working with children with complex needs. In other words, they are experienced at treating mental health disabilities in children who also have I/DD. They will work the LME/MCO to ensure that the child gets the services they need.


You do not have to have your child assessed at Murdoch or Riddle, but a comprehensive assessment is is critical to making sure that a child has the right diagnoses and services. In this case, the licensed or credentialed professional who conducts the child’s assessment must have experience diagnosing and treating children with both I/DD and mental health issues.

Additionally, the professional doing the assessment must not be a direct employee of an LME/MCO.

Case Management

Navigating the services and supports a child needs can be difficult—especially when different agencies and systems are involved. A Case Manager helps families get the medical, behavioral, social, and other services they need. Although children with complex needs receive Care Coordination through the LME/MCO, they can also have Case Management if it is medically necessary. The activities of the case manager do not duplicate services provided by the care coordinator.

If you need help

Contact Sharon Bell at or 704-880-2295. She is the child behavioral health manager for the Division of Child and Family Well-Being. It is her job to help you if you have trouble getting services for your child or if your LME/MCO refuses to make a referral to NC START.

If you still cannot get the services your child needs, contact us.