SPECIAL BULLETIN COVID-19 #213: Direct Care Worker ICF-IID Wage Increase
Eligible direct care workers to receive wage increase from eligible ICF-IID providers

Jan. 28, 2022. Updated to include per diem rate increase and changes to the for submission of baseline wage data requirement regarding eligible direct care worker wage increase from eligible ICF-IID providers.

Feb. 1, 2022. This bulletin was updated to provide further clarity regarding ICF-IID per diem rates. Refer to SPECIAL BULLETIN COVID-19 #225 for a list of modifications.

Jan. 28, 2022. This bulletin was updated to include the amount of the per diem rate increase and changes to the requirement for submission of baseline wage data. Refer to SPECIAL BULLETIN COVID-19 #225 for a list of modifications.

The Current Operations Appropriations Act of 2021 (S.L. 2021-180) approved a Medicaid budget provision to implement the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) direct care worker wage increases. To meet the administrative and reporting requirements of that Act, NC Medicaid will require eligible Medicaid enrolled providers to submit some standard information. The details of the rate increase, provider and worker eligibility, and the process for the required provider submissions are outlined below.

Amount of Rate Increase Effective Feb. 1, 2022

NC Medicaid has determined that the total ICF-IID per diem rate increase effective Feb. 1, 2022, will be $102.06. This rate increase is composed of the following two components:

  • $68.76 funded by the recurring Legislated Appropriations
  • $33.30 funded through March with appropriated funds and from April 1, 2022, forward by an increase in the ICF-IID per bed assessment (NC Medicaid will provide additional information regarding the assessment increase closer to the date of implementation)

This recurring increase to the ICF-IID per diem rate replaces the temporary COVID-19 rate increases in effect in January 2022.  That temporary COVID-19 rate increase is end-dated Jan. 31, 2022.

Note: The requirement to pass on 80% of the rate increase to direct care worker wages applies only to the $68.76 increment.

Eligibility and Requirements

Providers must be Medicaid-enrolled and recognized by NC Medicaid as an in-state privately owned intermediate care facility for individuals with intellectual disabilities (ICF-IIDs), including ICF-IID-level group homes. NC Medicaid will distribute the funding for direct care worker wage increases to NC Medicaid Managed Care organizations (LME/MCOs and PHPs) through capitation rate increases. NC Medicaid Managed Care organizations are required to increase reimbursement rates for eligible providers consistent with the increases above. Providers within NC Medicaid Direct will have funds distributed through NC Medicaid Direct rate increases.

Per legislation, eligible providers must distribute no less than 80% of funds received through the rate increases to increase the rate of pay paid to its direct care worker employees.  This wage increase must be in addition to the rate of pay each employee was receiving as of Oct. 1, 2021 (excluding any temporary wage increases made in response to COVID-19), and providers must implement the wage increase within the next practicable pay period after the provider rate increase is effective, not to exceed 45 days.  

To facilitate documenting that the incremental funding from the rate increase is used consistent with legislative requirements, all eligible providers must identify each of the direct care workers employed by their facility who meet the following direct care worker definition:

NC Medicaid defines a direct care worker as “a non-licensed individual who by virtue of employment generally provides to individual Medicaid enrolled patients, clients or residents direct contact assistance with personal care or activities of daily living.”

Consistent with legislation, eligible providers must provide NC Medicaid with data documenting baseline direct care worker pay levels and also attest formally (through the submission process described below) that they will meet the standards outlined above for direct care worker wage increases. Providers receiving a rate increase through this funding must also keep documentation of the use of that rate increase to be able to report on wages of direct care workers, as defined above, upon request. Provider records of wage increase are subject to audit and are required to be made available upon request by NC Medicaid or by the relevant LME/MCO or PHP paying the increased provider rates. NC Medicaid reserves the right to request accounting/payroll information, such as payroll journals, for auditing purposes.

Timelines: Adjusted Due Date for Submission of Baseline Wage Data

Based on feedback from providers regarding the time-intensiveness of pulling together wage data to document baseline pay levels for the direct care workers who will receive wage increases, NC Medicaid is moving the due date for this data from Monday, January 31 to Friday, March 4.

Note: Providers are still required to submit attestations by 5 p.m. ET on January 31, as posted previously. There is no change to that requirement.

Submission Process

NC Medicaid has established a Direct Care Worker Eligibility Portal to intake the required attestation and data for the ICF-IID Wage Increase. The portal will be made available for registration and submissions on Jan. 18, 2022; a link will be distributed through a Special Bulletin.

All providers should identify one executive or authorized employee as the point of contact (POC) to register for access to the eligibility portal. The designated POC will request access through the Direct Care Worker Eligibility Registration page establishing themselves as the authorized submitter. These individuals will request access through the Direct Care Worker Eligibility Portal by submitting one of the following registration codes.

  • Single Provider Service Location: Authorized users submitting an attestation for a single provider service location will use a combination of NPI and location code; example: 123456789-001. If the authorized user does not know the location code, they should contact the Medicaid.DCW.HelpDesk@dhhs.nc.gov.
  • Single Provider with Multiple Provider Service Locations: Authorized users submitting an attestation for a single provider with multiple provider service locations will use a combination of NPI and location code; example: 123456789-001.
  • Multiple Providers: Authorized users submitting attestations for multiple providers using multiple NPIs should use one provider NPI as the registration code. Upon registration, the user must email Medicaid.DCW.HelpDesk@dhhs.nc.gov with the following information to receive the ability to submit for multiple provider NPIs:
    • Registration username
    • Registration email
    • All NPIs submitting for
    • Corporate name

Upon registration, the authorized submitter will receive access to the portal and the Direct Care Worker ICF-IID Eligibility Form. The authorized submitter must download, sign, and attach a PDF copy of the Direct Care Worker ICF-IID Wage Increase Attestation to each submission. Providers are also required to download, complete, and attach the ICF-IID Wage Baseline Template to each submission. Both the attestation and baseline template will be located in the knowledge base on the home page of the Portal. Please note that all entry fields on the eligibility form must be completed prior to submission.


NC Medicaid will hold webinars to provide an overview of the direct care worker ICF-IID wage increase submission requirements on Jan. 19, 2022 and Jan. 20, 2022. Registration is now available for the webinars below:

For more information

  • Providers may contact Medicaid.DCW.HelpDesk@dhhs.nc.gov with any inquiries.
  • Direct care workers should talk with their employer to resolve all inquiries on eligibility and payout.

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