NC Personal Care Services Alignment Demonstration (Section 1115)

The North Carolina Department of Health and Human Services (NCDHHS) intends to submit a new Section 1115 demonstration application to the federal Centers for Medicare & Medicaid Services (CMS) entitled the North Carolina Personal Care Services Alignment Demonstration: Targeted PCS Coverage for Adult Care Home and Special Care Unit Residents. The demonstration is required by Session Law 2025-64 (House Bill 546).

The proposed demonstration would allow North Carolina Medicaid to cover personal care services (PCS) for certain Medicare beneficiaries who live in, or are seeking admission to, a licensed adult care home or special care unit, and whose income is above the current State/County Special Assistance Program limit.

NCDHHS is seeking public comment as required by 42 CFR 431.408. The public comment period is open from Sept. 10, 2026 through 5 p.m. on Nov. 9, 2026.

What would the demonstration do?

Create a targeted Medicaid eligibility pathway for adults who live in, or are seeking admission to, a licensed adult care home (including one within a combination home) or a special care unit.
Set the income limit for that pathway at 180 percent of the federal poverty level for adult care home residents and 200 percent of the federal poverty level for special care unit residents.
Cover a limited benefit consisting only of personal care services — not full Medicaid coverage.
Require that a person be enrolled in Medicare, meet all State/County Special Assistance requirements other than income, and be assessed as needing PCS.
Serve an estimated 6,000 people statewide once fully implemented, phasing in over approximately 11 months.
Operate statewide for five years through NC Medicaid Direct, the state’s existing fee-for-service delivery system.

What the demonstration would not change

The demonstration does not change the personal care services benefit itself. Service definitions, amount, duration, scope, provider qualifications, assessment requirements, and payment rates stay the same as the NC Medicaid State Plan.
Medicare remains the primary payer for participants.
Residents continue to pay room and board directly to their adult care home or special care unit; Medicaid does not cover room and board.
The demonstration does not add premiums, copayments, or deductibles.
Eligibility or benefits for anyone currently covered by NC Medicaid would not change.

Demonstration Application and Public Notices

Public Notice

The full public notice and abbreviated notice for this demonstration is posted on this page for the duration of the comment period.

Tribal notice has been provided to federally recognized tribes and to Indian healthcare providers in North Carolina.

Two in-person public hearings will be held in separate locations, and two webinars will also be held. Dates, times and access information appear below. NCDHHS will review all comments received and will include a summary of the issues raised, and the State’s responses, in the application submitted to CMS.

NCDHHS anticipates submitting the application to CMS in late November. CMS then conducts its own review, which includes a separate federal comment period. This page will be updated throughout the comment period and the CMS review.

Public Comment

The draft demonstration application is open for public comment from Sept. 10, 2026 until 5 p.m. (Eastern Time) on Nov. 9, 2026. All comments received during the comment period will be reviewed and considered before the application is submitted to CMS.

Comments may be emailed to Medicaid.NCEngagement@dhhs.nc.gov. Please indicate “NC Section 1115 Waiver” in the subject line of the email message.

Written comments may be sent to the following address (please indicate “NC Personal Care Services Alignment Demonstration” in the written message):

North Carolina Department of Health and Human Services
NC Medicaid Section 1115 Waiver Team
1950 Mail Service Center
Raleigh, NC 27699-1950

You may also request a copy of the proposed demonstration application and/or a copy of submitted public comments, once available, by requesting it in writing to the mailing or email addresses listed in this notice.

Public Hearings and Webinars

NCDHHS will hold two in-person public hearings and two webinars to give beneficiaries, families, providers, county departments of social services, and other interested parties an opportunity to comment on the proposed demonstration. All four sessions will cover the same material; you may attend any one of them. Comments made at a hearing or webinar carry the same weight as written comments.

First Public Hearing

Sept. 16, 2026 from 5:30-7 p.m.
Virtual via Microsoft Teams (Join on your computer, mobile app or room device)

Click here to join meeting

Call in (audio only)
+1 984-204-1487, 438242315# (United States)
Phone conference ID: 438 242 315#

Second Public Hearing (in person)

Sept. 29, 2026 from 2:30-4 p.m.

Greenville Convention Center
303 SW Greenville Blvd, Greenville NC 27834

Third Public Hearing (in person)

Oct. 12, 2026 from 2:30-4 p.m.

Mountain Area Health Education Center (MAHEC)
Blue Ridge A & B in the Education Building
121 Hendersonville Road, Asheville NC 28803

Fourth Public Hearing

Oct. 22, 2026 from 11:30 a.m. - 12:30 p.m.-NC Medicaid Advisory Committee (MAC) Meeting

Virtual via Microsoft Teams (Join on your computer, mobile app or room device)
Click here to join the meeting

Call in (audio only)
+1 984-204-1487, 352166225# United States
Phone conference ID: 352 166 225#

Additional Information on Public Hearings

To ask questions about accessibility or request accommodations, please email Medicaid.NCEngagement@dhhs.nc.gov.

More information about the demonstration—including the full application, public comments, and hearing materials—is available at:
medicaid.ncdhhs.gov/meetings-notices/proposed-program-design/nc-section-1115-demonstration-waiver

Recordings and presentation materials will be posted here after each hearing and webinar.

Questions

Questions about the proposed demonstration may be directed to Medicaid.NCEngagement@dhhs.nc.gov.