SPECIAL BULLETIN COVID-19 #55: NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community-Based Services

Tuesday, April 21, 2020

NC Medicaid has received federal approval of flexibilities during the COVID-19 pandemic for the:

  • NC Innovations Waiver, for individuals with intellectual and developmental disabilities (IDD)
  • NC Traumatic Brain Injury (TBI) Waiver, for individuals who have a TBI diagnosis after age of 21
  • Community Alternatives Program for Disabled Adults (CAP/DA), for disabled adults
  • Community Alternatives Program for Children (CAP/C), for medically fragile children

During federally declared emergencies, states can submit requests to ease certain waiver requirements through an Appendix K. NC Medicaid received approval of Appendix Ks for all four of its waivers from the Centers for Medicare & Medicaid Services (CMS), effective March 13 to March 12, 2021. LME/MCOs and CAP agencies will evaluate the needs of their waiver participants and use the right flexibilities to meet beneficiary’s needs during this pandemic. Flexibilities include:

  • Plan of care 
    • Covers telephonic contact with waiver beneficiary
    • Simplifies the person-centered plan development process
    • Waives program assessments during the emergency (level of care, Supports Intensity Scale)
  • Provider changes
    • Allows payment of providers even if a waiver beneficiary is at home and not receiving in-home services
    • Allows payment of legal responsible persons or guardians, if not already allowed in the waiver, and waives some provider requirements for family members (this does not apply to the TBI waiver)
  • Place of service
    • Allows services to be provided in alternative settings, and allows providers to provide services in settings not previously allowed
    • Allows payment of services provided in an institution where personal care services are not available in the home or for respite care 
  • Service changes
    • Allows beneficiaries to receive less than required services without losing waiver slot
    • Allows beneficiaries to receive more services when maximums are reached, as needed
    • Waives face-to-face meeting requirements
  • Other goods and services
    • Allows payment for disinfectant wipes and spray, hand sanitizers, facial tissue, thermometer and specific colored trash liners to manage the spread of COVID-19 (CAP/C and CAP/DA)
    • Provides training on personal protective equipment, bloodborne pathogens and CPR for a family member, legally responsible person or close kinship relative to prevent the spread of COVID-19 (CAP/C and CAP/DA)

For more detailed information about these flexibilities, please see:
SPECIAL BULLETIN COVID-19 #22: CAP/C and CAP/DA Home and Community-Based Services (HCBS) Flexibilities for Waiver Beneficiaries Enrolled in 1915(c) and HCBS Waivers - March 27, 2020

SPECIAL BULLETIN COVID-19 #23: NC Innovations and NC TBI Waivers Community-Based Services (HCBS) Flexibilities for Waiver Beneficiaries Enrolled in 1915(c) HCBS Waivers – March 27, 2020

For additional Medicaid bulletins related to COVID-19, visit https://medicaid.ncdhhs.gov/about-us/coronavirus-disease-2019-covid-19-and-nc-medicaid/covid-19-special-medicaid-bulletins.