NC Innovations Waiver
Are you on the waitlist for the NC Innovations waiver? If you have NC Medicaid, you may be eligible to get similar services while you wait, such as help with daily activities, job coaching and more. Talk to your LME/MCO about “NC Medicaid 1915(i) services.” Your spot on the NC Innovations waiver waitlist will not be affected.
The NC Innovations waiver covers a wide range of services for children and adults with intellectual or developmental disabilities (I/DD). This may include autism, cerebral palsy, Down syndrome, traumatic brain injury (if the injury occurred before age 22) and more.
Anyone can apply regardless of age, income or insurance.
The NC Innovations waiver covers home and community-based services, such as:
- Help with daily activities at home and in the community
- Changes to make your home and car accessible, like ramps or a lift
- Assistive technologies, like communication devices
- Job coaching
- Consultations from I/DD specialists
- Crisis services
- Support for caregivers
Plus: With NC Medicaid, people on the NC Innovations waiver also get health and dental coverage and rides to appointments.
The NC Innovations waiver is an NC Medicaid program, but it “waives” (does not consider) some of the usual Medicaid eligibility requirements, like the family’s income.
Secure your spot by joining the waitlist. Even though the wait is long, we encourage you to apply today, especially if services may be needed in the future.
Resources to share
Visit the Toolkit: NC Innovations Waiver for more resources to share with your community.
In response to the Hurricane Helene natural disaster in September 2024, The Centers for Medicare and Medicaid (CMS) approved several flexibilities to the Innovations waiver to support waiver members to remain safe in their communities. The flexibilities were effective September 26, 2024 through June 30, 2025.
To support Innovations waiver members, families, and health plans in sunsetting flexibilities, this document is provided as a guide to outline the ending of each flexibility effective July 1, 2025.
| Appendix K Hurricane Helene Flexibilities | Will this flexibility change? Yes/No | July 1, 2025, Implementation Guidance |
|---|---|---|
| Plan of Care | ||
| Annual reassessments of level of care that exceed the 60 calendar day approval requirement beginning on September 25, 2024, will remain open and services will continue for three months to allow sufficient time for the care manager/care coordinator to complete the annual reassessment paperwork. Additional time may be awarded on a case-by-case basis when conditions from Hurricane Helene impedes this process. Annual reassessments of level of care may be postponed by 90 calendar days to allow sufficient time to complete the annual reassessment and accompanying paperwork. | Yes | Effective July 1, 2025, no LOC redetermination extensions will be allowed. If this flexibility was utilized and the waiver member is outside of the 90-day time frame, a redetermination must be completed. |
| Allow Support Intensity Scale (SIS) assessment/reassessment to be waived. | Yes | Effective July 1, 2025, no SIS assessments/reassessments will be waived. If the waiver member has not completed a SIS assessment, one must be scheduled by June 30, 2025. |
| Allow utilization review of Individual Support Plans (ISP) and/or revised ISPs to be reviewed and approved (if the request meets medical necessity) retroactively to 09/25/2024 for beneficiaries impacted by Hurricane Helene. | Yes | Effective July 1, 2025, ISP’s will not be reviewed/approved retroactively. |
| Allow Utilization Review and approval of ISPs with care manager/care coordinator signature only. If QP (provider agency) is not able to sign the plan. The care manager or care coordinator should make best efforts to coordinate with QP (telephonically or virtually) to review ISP updates. | Yes | Effective July 1, 2025, all signatures as required (per Clinical Coverage Policy 8P) must be included on the ISP. |
| Services/Service Providers | ||
| Allow beneficiaries to receive fewer than one service per month during this amendment without being subject to discharge. | Yes | Effective July 1, 2025, beneficiaries must receive more than one waiver service monthly. |
| Waive in person face-to-face monthly/quarterly care manager monitoring requirements with the beneficiary, when the beneficiary is not physically accessible. In these cases, virtual and telephonic monitoring will be conducted in accordance with HIPAA requirements. | Yes | Effective July 1, 2025 monthly and quarterly care coordination meetings shall occur face to face. |
| Temporarily include retainer payments to address emergency related issues. | Yes | Effective July 1, 2025, retainer payments will no longer be available. |
| Allow a change in Day Support Group to Day Supports Individual without a change in the Individuals Support Plan (ISP) or prior authorization for waiver beneficiaries impacted by Hurricane Helene. The ISP should be updated as soon as the provider is able to meet with the Waiver beneficiary telephonically or virtually. | Yes | Effective July 1, 2025, a change in the ISP or prior authorization is needed to change Day Support Group to Day Support Individuals. |
| Allow Residential Supports in place of Community Living and Supports, when an individual requires out of home placement, and a Relative as Direct Support Provider or EOR is not providing services. Allow service transition without a change in the Individual Support plan or prior authorization for Waiver individuals impacted by Hurricane Helene. The ISP should be updated as soon as the provider is able to meet with the Waiver member/family telephonically or virtually. | Yes | Effective July 1, 2025, Residential Supports may not be used in place of Community Living and Supports. Any changes to services will require an ISP change and prior authorization. |
| Allow replacement or repair of existing home and vehicle modifications damaged by Hurricane Allow replacement or repair of existing home and vehicle modifications damaged by Hurricane Helene when cost of repair or replacement will exceed the Innovations waiver limit. | Yes | Effective July 1, 2025, replacement or repairs of existing home and vehicle modifications must align with the Innovations waiver limit. |
| Allow relatives or Employer of Records who live in the home of the waiver beneficiary (current waiver only allows for Community Living and Supports) to provide Supported Employment and Supported Living for individuals impacted by Hurricane Helene. This should only be used for cases when the direct support staff is impacted by Hurricane Helene and not able to provide services. | Yes | Effective July 1, 2025, Employers of Record may not provide any waiver services. Relatives residing in the home may only provide Community Living and Support per the waiver requirements. |
| Waive staff training requirements within 90 days of employment, if staff training is unable to be obtained during the state of emergency. | Yes | Effective July 1, 2025, staff training requirements will not be waived. |
| Waive training requirements for existing staff for 90-days to continue providing services, if staff is unable to obtain training during the state of emergency. | Yes | Effective July 1, 2025, staff training requirements will not be waived. |
The Centers for Medicaid & Medicaid Services (CMS) requires individuals in a NC Medicaid waiver program to have a valid, thorough assessment.
NC Medicaid uses the Supports Intensity Scale-Adult Version (SIS-A) for this requirement for individuals age 16 and older and the Supports Intensity Scale-Children’s Version (SIS-C) for individuals ages 5 through 15. The SIS-A is used to find out and measure the supports a person needs to be successful in life.
NC Medicaid will change to a new version of the SIS-A beginning July 1, 2025. At that time those ages 16 and older will begin completing the SIS-A 2nd Edition when it is time for them to be assessed or reassessed based on their regular assessment schedule (every 3 years for the SIS-A). Children ages 5 through 15 will continue to complete the SIS-C based on their regular assessment scheduled (every 2 years for the SIS-C). More information about the SIS-A 2nd edition can be found on AAIDD’s website: aaidd.org/sis/sis-a/sis-a-2nd-edition.
The new SIS-A allows for a more in-depth assessment, so you may see new information when you get the final assessment. We do not expect this to change the supports budget you get.
We expect it will take about 3 years for everyone to move to the SIS-A 2nd Edition and get a new supports budget. The supports budget is a guideline and not a final limit.
If you have questions, contact your Tailored Plan or LME/MCO at the phone number listed below.
- Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
- Partners Health Management, 1-888-235-4673, TTY: 711
- Trillium Health Resources, 1-877-685-2415, TTY: 711
- Vaya Health, 1-800-962-9003, TTY: 711
Need help?
For questions about the NC Innovations Waiver:
Call the Local Management Entity/Managed Care Organization (LME/MCO) that serves your county. These organizations manage the NC Innovations waiver.
- Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962
- Partners Health Management, 1-888-235-4673, TTY: 711
- Trillium Health Resources, 1-877-685-2415, TTY: 711
- Vaya Health, 1-800-962-9003, TTY: 711
Not sure who to call? Use the LME/MCO directory or call the Division of Mental Health, Developmental Disabilities and Substance Use Services Customer Service Team at 1-855-262-1946. Hours of operation: 8 a.m. to 5 p.m., Monday through Friday.
If your LME/MCO has not been able to solve your problem, or if you need help understanding NC Medicaid: Call the NC Medicaid Ombudsman at 1-877-201-3750. Hours of operation: 8 a.m. to 5 p.m., Monday through Friday.
This page was last modified on 06/24/2025