NC Innovations Waiver

The NC Innovations Waiver is a Federally approved 1915 C Medicaid Home and Community-Based Services Waiver (HCBS Waiver) designed to meet the needs of Individuals with Intellectual or Development Disabilities (I/DD) who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting. 

The Medicaid Innovations Waiver supports Individuals with I/DD to live the life they choose. Waiver services are administered by a local management entity/managed care organization (LME/MCO) which facilitate services and oversee a network of community-based service providers. Individuals who receive waiver funding work with their team to develop a Person Centered Plan of Care and request the services and supports they need. 

COVID-19 Appendix K Flexibilities for the NC Innovations and TBI Waivers

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver.

• I/DD & TBI COVID-19 Frequently Asked Questions
• Email your question or comments to: BHIDD.COVID.Qs@dhhs.nc.gov

Medicaid previously hosted two webinars to discuss the flexibilities, one for providers and one for beneficiaries, families and natural supports. More information is available here.

NC Innovations Waiver Renewal - Updated Apr. 1, 2023

NC Innovations Waiver

The Centers for Medicare and Medicaid Services (CMS) approved a technical amendment to North Carolina’s 1915(c) Innovations which allows exception to the $135,000 waiver limit.  This change is effective May 1, 2020. 
NC Innovations beneficiaries may exceed $135,000 Waiver Cost Limit to ensure health, safety and wellbeing, if the follow criteria is met: 
• The individual lives independently without his or her family in a home that s/he owns, rents or leases and 
• The individual receives Supported Living Level III and 
• The Individual requires 24 hour support 
Individuals requesting services and supports in excess of the $135,000 cost limit must make this request through the Individual Support Plan or Plan Update process.  Services and Supports that exceed the $135,000 must be prior approved by the beneficiary’s LME/MCO and must be related to the beneficiary’s needs and not for the convenience of the provider agency or caregiver
 

Eligibility

To be part of North Carolina’s Innovations Waiver, you must:

• Meet the requirements for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) level of care
• Live in an ICF-IID or be at risk of being placed in an ICF-IID
• Be able to stay safe, healthy and well in the community while using NC Innovations Waiver services
• Need and use NC Innovations Waiver services listed in your person centered plan at least once a month
• Want to use NC Innovations Waiver services instead of living in an ICF-IID

How to Apply

If you are eligible, your LME-MCO can help you get services. There are only a certain number of NC Innovations Waiver slots. If the slots are full, your name will be added to the Registry of Unmet Need.

Additional Resources

• Supported Living Service Definition
• Resources and Training
• Supports Intensity Scale®
• Home and Community Based Services Final Rule

Contact

• NC Medicaid Recipient Services: 919-855-4000
• Division of Mental Health, Developmental Disabilities and Substance Abuse Services Customer Service: 855-262-1946
• Email:IDDListeningSessions@dhhs.nc.gov