Innovations Waiver Amendment Update

Appendix K flexibilities to continue if waiver amendment is not approved by Nov. 11, 2023

On Sept. 1, 2023, the Division of Health Benefits (DHB) submitted an Innovations Waiver Amendment to extend various Appendix K flexibilities.  In August, the Centers for Medicare & Medicaid Services (CMS) provided guidance that all Appendix K flexibilities will continue if a state’s amendment is not approved by Nov. 11, 2023.  NC Medicaid will comply with CMS guidance and extend Appendix K if approval is not received before the end of Appendix K authority.  

NC Medicaid acknowledges needed systems changes are required in preparation for the ending of Appendix K.  NC Medicaid continues engagement with CMS to expedite the approval of the various flexibilities.  We intend to keep all stakeholders updated.

The 1915 (C) Innovations Waiver was amended to include the following Appendix K flexibilities to continue after CMS approval. 

Added flexibilities

  • Allow home delivered meals (up to seven meals per week/one per day)
  • Allow real time two-way interactive audio and video telehealth for Community Living Support; Day Support, Supported Employment; Supported Living and Community Network to be delivered via telehealth must follow the requirements and guidance in Clinical Coverage Policy 1-H.
  • Allow waiver individuals to receive services in alternative locations: hotel, shelter, church, or alternative facility-based settings.   

Amended flexibilities

  • Remove the requirement for the beneficiary to attend the day supports provider once per week.
  • Allow Community Navigator to note that individuals may not receive this support unless they are self-directing one or more of their services through the agency with choice or employer of record model.
  • Increase the Innovations waiver cap from $135,000 to $157,000 per waiver year.
  • Allow parents of minor children receiving Community Living and Support to provide this service to their child who has been indicated as having extraordinary support needs up to 40 hours/week.
  • Allow supported living to be provided by relatives.  
  • Allow relatives as providers for adult waiver individuals to provide above 56 hours/week, not exceeding 84 hours/week of Community Living and Supports. 


NC Medicaid Contact Center, 888-245-0179 

Related Topics: