NC Section 1115 Demonstration Waiver

North Carolina received CMS approval to extend the Medicaid 1115 Demonstration Waiver for another five-year period. During the first demonstration period, North Carolina began its transition to managed care and invested in innovative programs to better respond to the diverse needs of North Carolinians who are enrolled in Medicaid.

North Carolina is ready to build on early successes and lessons learned to continue this progress over the next five years. The State’s overarching goal for the renewal demonstration is to improve health and well-being for all North Carolinians through a person-centered, well-coordinated system of care that addresses both medical and non-medical drivers of health and advances health access by reducing disparities for historically marginalized populations.

The effective dates for the renewed demonstration are December 10, 2024 – December 9, 2029.

Approved 1115 Waiver Demonstration Extension (2024-2029)

Section 1115 Waiver Renewal Webinar

A virtual post-award forum for NC Medicaid’s 1115 waiver was held May 21, 2025 to provide updates on the 1115 Waiver.

• View the slide deck 

For more information, please email Medicaid.NCEngagement@dhhs.nc.gov

• Read the NC Medicaid Section 1115 Monitoring Report 

Background on Section 1115 Waiver Renewal

In December 2024, North Carolina received federal approval to renew its Section 1115 Medicaid demonstration waiver for another five-year period. The waiver aims to improve health and well-being for all North Carolinians through a whole-person, well-coordinated system of care that addresses both medical and non-medical drivers of health and advance health access.

The new waiver extends federal authority for North Carolina’s Medicaid Managed Care program and its efforts to improve access evidence-based substance use disorder treatments. It also allows the option of Healthy Opportunities Pilots, which invest in non-medical drivers of health like food, transportation and housing, to be taken statewide.

Finally, North Carolina now has the option to implement four new initiatives, in line with the State’s overarching goals, focused on streamlining Medicaid enrollment for children and youth, improving care for the reentry population, investing in behavioral health and intellectual and development disabilities (I/DD) technology and bolstering the behavioral health and long term services and supports (LTSS) workforce. 

NC Section 1115 Demonstration Waiver Application

Renewal Application
Previously Approved Application
Full public notice 
Abbreviated public notice 
Managed Care Interim Evaluation Report - The draft Managed Care Interim Evaluation Report was submitted to CMS for review Oct. 14, 2023. Therefore, it was not included in the state public comment period but can be found with the application out for federal public comment.

Fact Sheets

NC 1115 Waiver Renewal Fact Sheet
NC 1115 Waiver Renewal Healthy Opportunities Pilot Fact Sheet
NC 1115 Waiver Renewal Justice-involved Fact Sheet

For more information on the pending Substance Abuse Disorders (SUD) waiver extension request, visit the Proposed Program Design website page.