Eligibility for 1915(i) Services
1915(i) services are for certain people with NC Medicaid. You may be eligible for 1915(i) services if you meet the following requirements:
1. You have an eligible condition.
1915(i) services are for people who need support with activities at home or in the community with the following conditions:
- Serious mental health conditions (such as schizophrenia, bipolar disorder, depression)
- Severe substance use disorder (such as alcohol, opioids or cocaine)
- Intellectual or developmental disabilities (such as Down syndrome, autism, fetal alcohol spectrum disorder)
- Traumatic brain injury (such as from car accidents, falls, sport injuries)
Not sure if you have an eligible condition? Call the Member and Recipient Services line listed on your health plan ID card. Or call the NC Medicaid Ombudsman at 1-877-201-3750.
2. You have an eligible NC Medicaid health plan.
These NC Medicaid health plans offer 1915(i) services. Look for the one listed on your health plan ID card or in your health plan welcome letter:
- Alliance Health
- Partners Health Management
- Trillium Health Resources
- Vaya Health
Is your plan not listed? If you have an eligible condition, you may be able to move to a Tailored Plan to get 1915(i) services. 1915(i) services are only available with Tailored Plans, NC Medicaid Direct or Eastern Band of Cherokee Indians Tribal Option. 1915(i) services are not available with Standard Plans.
Not sure which plan you have? Check your health plan ID card or call the NC Medicaid Enrollment Broker at 1-833-870-5500.
1915(i) services are NOT available with NC Medicaid Standard Plans, which include the following:
- AmeriHealth Caritas
- Carolina Complete Health
- HealthyBlue
- UnitedHealthcare Community Plan
- WellCare
If you have a serious mental health condition, a severe substance use disorder, intellectual or developmental disabilities or a traumatic brain injury, you may be able to move to a Tailored Plan to get 1915(i) services.
Recipients of the NC Innovations Waiver or TBI Waiver are NOT eligible for 1915(i) services. This is because these waivers already provide similar services to 1915(i). However, people waiting for these waivers may be eligible for 1915(i).
Other eligibility requirements may apply.
The best way to find out if you are eligible is to try to get services.
Cannot get Medicaid? You may be able to get services like 1915(i) even if you do not have Medicaid. To find out what services are available to you, call the organization that serves your county (called LME/MCO) and ask about “state-funded services.”
Need help?
These NC Medicaid health plans offer 1915(i) services. Call the number listed on your health plan ID card or health plan welcome letter:
- Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
- Partners Health Management, 1-888-235-4673, TTY: 711
- Trillium Health Resources, 1-877-685-2415, TTY: 711
- Vaya Health, 1-800-962-9003, TTY: 711
Don’t see your plan? 1915(i) services are only available with Tailored Plans, NC Medicaid Direct or Eastern Band of Cherokee Indians Tribal Option. 1915(i) services are not available with Standard Plans. See contact information for all Medicaid health plans.
Not sure which plan you have? Call the NC Medicaid Enrollment Broker at 1-833-870-5500. Hours of operation: 7 a.m. to 7 p.m., Monday through Friday.
If your health plan has not been able to solve your problem or if you need help understanding NC Medicaid, call the NC Medicaid Ombudsman at 1-877-201-3750. Hours of operation: 8 a.m. to 5 p.m., Monday through Friday.
Don’t have NC Medicaid? Apply for NC Medicaid.