The NC Medicaid 1915(i) Assessment form, available on NC Medicaid’s website, identifies a beneficiary’s needed services and supports and informs the independent evaluation of 1915(i) eligibility determination and development of the Care Plan or Individual Support Plan.
The updated form includes new fields for the “Date Individual Requested 1915(i) Service” and the “Date 1915(i) Assessment Completed.”
Effective Oct. 1, 2025, the revised NC Medicaid 1915(i) Assessment must be completed for a beneficiary requesting a 1915(i) service and for eligibility reassessments. Previous versions of the NC Medicaid 1915(i) Assessment published prior to Aug. 1, 2025, will not be processed and returned marked as “unable to process.”
Please note the updated version can be utilized prior to Oct. 1, 2025.
Contact
NC Medicaid Contact Center: 1-888-245-0179