Questions and Answers: 1915(i)

1915(i) services are for certain people with NC Medicaid. They are for children and adults with serious mental health conditions, severe substance use disorders, intellectual or developmental disabilities or traumatic brain injuries.

You may be eligible for 1915(i) services if you have NC Medicaid and your health plan ID card or welcome letter lists one of the following:

• Alliance Health
• Partners Health Management
• Trillium Health Resources
• Vaya Health

If you have a different NC Medicaid health plan, you can request to move to a Tailored Plan in order to get 1915(i) services. Fill out this form or call the NC Medicaid Enrollment Broker at 1-833-870-5500.

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.

If you do not know which plan you have, check your health plan ID card or welcome letter. Or call the NC Medicaid Enrollment Broker at 1-833-870- 5500.

Other eligibility requirements may apply.

1915(i) services are offered to people ages 3 and older.

Yes, you must have full NC Medicaid to get 1915(i) services. To learn how to apply for NC Medicaid, visit medicaid.ncdhhs.gov/apply.

If you cannot get Medicaid, you may be able to get services similar to 1915(i). Call the organization (called LME/MCO) that serves your county and ask about “state-funded services.”

People on the NC Innovations Wavier waitlist can be eligible for 1915(i) services. Having 1915(i) services will not affect your place on the waitlist.

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 on the waitlist for these waivers may be eligible for 1915(i).

You are not eligible for 1915(i) services if you have a Standard Plan, which includes:

• AmeriHealth Caritas
• Carolina Complete Health
• HealthyBlue
• UnitedHealthcare Community Plan
• WellCare

If you have a serious mental health condition, severe substance use disorder, intellectual or developmental disabilities or traumatic brain injury, you may ask to move to a Tailored Plan so you can get 1915(i) services.

First, you need to have NC Medicaid. Apply for NC Medicaid, if you do not already have it. Visit medicaid.ncdhhs.gov/apply or call the NC Medicaid Contact Center at 1-888-245-0179.

Then, you need to call to schedule an assessment. Call your Medicaid health plan’s Member and Recipient Service Line (listed on your health plan ID card or welcome letter) and ask for a 1915(i) assessment:

• 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

If you are not sure which plan you have, call the NC Medicaid Enrollment Broker at 1-833-870- 5500.

If you have someone who is assigned to help you with your Medicaid (like a Tailored Care Manager or Care Coordinator), you can call them instead.

Yes, the 1915(i) assessment is required to see which services you need. Call your NC Medicaid health plan’s Member and Recipient Service Line (listed on your health plan ID card) or your Care Manager to schedule your assessment.

The assessment can be done in person, or through a telemedicine appointment. It can take up to an hour. You can do the assessment in your home or at a convenient place.

You should get services within 90 days of approval. There may be other factors, like staff availability, that determine when services can start. 

The person who helped you with your assessment can give you updates (this could be your Tailored Care Manager). Or you can call the Member and Recipient Service Line on your health plan ID card.

No, you do not need a Tailored Care Manager to get 1915(i) services. If you do not have a Tailored Care Manager, you will be assigned someone (like a Care Coordinator) to help you with the 1915(i) assessment process.

Yes, 1915(i) services are free because they are a Medicaid benefit. There are no copays.

These are the 1915(i) services for mental health:  

• Individual and Transitional Support (skills for living in the community)
• Individual Placement and Support (job coaching)
• Respite (breaks for you and your caregivers)
• Community Transition (supports for moving to your own home)

For details on these services, please visit 1915(i) Services for Mental Health.

These are the 1915(i) services for substance use:

• Individual and Transitional Support (skills for living in the community)
• Individual Placement and Support (job coaching)
• Respite (breaks for you and your caregivers)
• Community Transition (supports for moving to your own home)

For details on these services, please visit 1915(i) Services for Substance Use.

These are the 1915(i) services for intellectual or developmental disabilities:

• Community Living and Supports (skills and supports for living in your home or community)
• Supported Employment (job coaching)
• Respite (breaks for you and your caregivers)
• Community Transition (supports for moving to your own home)

For details on these services, please visit 1915(i) Services for Intellectual or Developmental Disabilities.

These are the 1915(i) services for traumatic brain injury:

• Community Living and Supports (skills and supports for living in your home or community)
• Supported Employment (job coaching)
• Respite (breaks for you and your caregivers)
• Community Transition (supports for moving to your own home)

For details on these services, please visit 1915(i) Services for Traumatic Brain Injury.

Community Transition gives you funds (up to $5,000 in credit) to help you move from an  approved setting to your own private home.

Approved settings include a state-operated health care facility, a foster or group home, a psychiatric residential treatment facility, a community intermediate care facility (ICF-IID) and more.

Yes, you must have gone through services provided by Employment and Independence for People with Disabilities (EIPD), formerly known as Division of Vocational Rehabilitation Services before you can get job coaching services through 1915(i). This is a requirement for the Supported Employment service and Individual Placement and Support service.

If you have not completed EIPD yet, you can still schedule a 1915(i) assessment and get other services. If you need job coaching services, you will get a referral for EIPD first.

No, 1915(i) does not offer transportation services.  

However, you can get free rides to and from medical appointments through Non-Emergency Medical Transportation (NEMT). For more information, visit medicaid.ncdhhs.gov/nemt.

Yes. Service hour limits depend on other factors, such as age and whether services are combined. Someone will be assigned to you (like a Care Manager or Care Coordinator) to help track your service hours.

When you apply for 1915(i) services, someone will be assigned to you to help you find service providers. Or you can call the Member and Recipient Service Line on your health plan ID card for help with finding service providers.

Service providers must meet requirements and work with a 1915(i) provider agency.

In certain situations, friends and family members can be paid by NC Medicaid to provide the services. For more information, call the Member and Recipient Service Line on your health plan ID card.