I/DD Waivers in North Carolina

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North Carolina I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in North Carolina?

Two parts of the North Carolina Department of Health and Human Services (NCDHHS) share the work. NC Medicaid (the Division of Health Benefits) is the Medicaid agency and owns the waiver. The Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMH/DD/SUS) oversees the I/DD service system. Day to day, regional Local Management Entity/Managed Care Organizations (LME/MCOs) run the services, take applications and pay providers.

• NC Medicaid: runs the NC Innovations Waiver and the 1915(i) program and enrolls providers through NCTracks, the state Medicaid provider system.
• DMH/DD/SUS: oversees I/DD systems and services and runs a customer service line (1-855-262-1946) that helps people find their LME/MCO.
• LME/MCOs: regional public plans that also run behavioral health services. They operate as Behavioral Health and I/DD Tailored Plans. As of October 1, 2026 there are three: Alliance Health, Trillium Health Resources and Vaya Partners.
• Front door: a person or family calls the LME/MCO for their county and asks to apply for the Innovations waiver.
• Case management: Tailored Care Management, through the Tailored Plan or NC Medicaid Direct. Care managers build each person's Individual Support Plan.

What Medicaid waivers and programs serve people with I/DD in North Carolina?

North Carolina has one 1915(c) waiver for I/DD: the NC Innovations Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The state also offers I/DD services through a 1915(i) state plan program, which has no waitlist. Both are available only through the LME/MCOs.

• NC Innovations Waiver (1915(c), control number 0423.R04.00): serves people of any age with an intellectual or developmental disability (for example autism, cerebral palsy, Down syndrome, or a brain injury before age 22) who meet the level of care for an intermediate care facility. Family income rules are waived. CMS approved the current renewal on June 21, 2024, and it runs from July 1, 2024 to June 30, 2029, alongside federal 1915(b) and 1115 managed care approvals, according to the CMS waiver record. Services include Residential Supports, Supported Living, Community Living and Supports, Day Supports, Community Networking, Supported Employment, Respite, crisis services, benefits counseling, community navigator, community transition, assistive technology, home and vehicle modifications and individual goods and services. The 2024 renewal added remote support, supported employment phases, benefits counseling and reserved slots for children with complex needs. The waiver cap is $184,000 per waiver year, raised from $135,000. Adults who live on their own with Supported Living Level III and need 24-hour support can go over the cap. There are 14,736 approved slots for state fiscal year 2025-26.
• 1915(i) services for I/DD: a state plan option in place since July 1, 2023. It covers Community Living and Supports and Respite (ages 3 and up, Respite up to 300 hours a year), Supported Employment (ages 16 and up) and Community Transition (up to $5,000). A care manager must complete a 1915(i) assessment first. It is offered through Tailored Plans, NC Medicaid Direct, the Eastern Band of Cherokee Indians (EBCI) Tribal Option and the Children and Families Specialty Plan, but not through Standard Plans.

Related programs not counted here: the TBI waiver (1326.R01.00) serves adults 18 and older with a traumatic brain injury, and the Community Alternatives Programs (CAP/C for medically fragile children and CAP/DA for adults) are not specific to I/DD. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) remain the institutional option, and ICF/IID coverage requires a Tailored Plan.

Does North Carolina pay for I/DD services through managed care?

Yes. The LME/MCOs are capitated prepaid plans, which means the state pays them a set amount per member and they pay providers. Since Tailored Plans launched on July 1, 2024, only Tailored Plans offer the Innovations waiver, the TBI waiver and ICF/IID care. Providers contract with the plan for each region they serve.

• Plans: Alliance Health, Trillium Health Resources and Vaya Partners. Vaya Health and Partners Health Management merged into Vaya Partners on October 1, 2026. The state's Tailored Plans page, last updated before the merger, still lists four plans.
• NC Medicaid Direct: the state's name for Medicaid outside a health plan. People in NC Medicaid Direct still get I/DD services such as 1915(i) through an LME/MCO.
• Children and Families Specialty Plan: run by Healthy Blue Care Together since December 1, 2025 for children in foster care and related groups. It covers 1915(i) and I/DD services, but not Innovations Community Living and Supports.
• Who coordinates: Tailored Care Management care managers coordinate services and write the Individual Support Plan.

Is there a waiting list for I/DD services in North Carolina?

Yes. NCDHHS reported 21,997 people on the Innovations Waiver Waitlist for the April to June 2026 quarter, up from 18,457 for July to September 2024. The state has 14,736 approved slots for fiscal year 2025-26, and the General Assembly added no new slots that year. About 14,189 slots were in use at the end of June 2026.

• How the list works: each LME/MCO keeps its own county-based Innovations Waiver Waitlist (formerly called the Registry of Unmet Needs). People who have waited longest are usually served first.
• Reserved slots: a limited number of reserve slots are held for emergencies or extraordinary circumstances, and the 2024 renewal reserved slots for children with complex needs.
• While waiting: the state says people on the waitlist can use 1915(i) services, which have no waitlist and do not affect their place on the Innovations list. The October 15, 2026 Inclusion Connects report says 47.9% of people on the waitlist were receiving some services.

The counts come from LME/MCO data in that quarterly report. We did not find slot numbers for fiscal year 2026-27. For a person's place on the list, ask their LME/MCO.

How do people apply for I/DD services in North Carolina, and how are budgets set?

People apply by calling the LME/MCO for their county and asking to join the Innovations waiver. Within a few weeks they get a letter saying whether they were added to the waitlist, with appeal rights if they were denied. When a slot opens, final eligibility is decided and the Supports Intensity Scale (SIS) is used to set a budget guideline.

• Eligibility: an intellectual or developmental disability, an ICF/IID level of care (at risk of institutional placement, with community care cost effective compared with ICF/IID care) and Medicaid eligibility, with family income rules waived.
• Assessment: from July 1, 2025, people 16 and older move to the SIS-A 2nd Edition at their regular reassessment every three years. Children 5 to 15 use the SIS-C every two years. The resulting supports budget is a guideline, not a final limit. DMH/DD/SUS also describes NC-SNAP as a needs assessment tool.
• 1915(i): the care manager completes a 1915(i) assessment before services start.
• Self-direction: Innovations members can direct their own services through Individual and Family Directed Supports, using an Employer of Record model or an Agency with Choice model. We did not find whether 1915(i) services can be self-directed.

What day and residential services can I/DD providers offer in North Carolina?

Innovations covers Day Supports, Community Networking and Supported Employment for the day, and Residential Supports and Supported Living for housing. National accreditation (from COA, CQL, the Joint Commission or CARF) is required to bill these Innovations services. Details below come from Clinical Coverage Policy 8-P; the copy we could read is dated May 1, 2022, before the 2024 renewal, so check the current version with NC Medicaid.

Day and employment services

• Day Supports: habilitation for social and daily living skills, either in a facility or in the community. Facility-based programs may include prevocational activities. Facility-based Day Supports must come from a licensed Day Supports provider serving people with I/DD and meet the federal HCBS settings rule. Billed in 1-hour units, with at least 15 minutes delivered before an hour can be billed, and transportation is included in the rate. For children, Developmental Day is provided in a licensed child care center. The research did not find a published staff ratio or the exact facility license rule.
• Community Networking: support to take part in community activities, classes and groups, billed in 15-minute units (individual). The research did not find a published staff ratio.
• Supported Employment: job coaching to find, get and keep a job, in three phases (pre-employment, employment stabilization and long-term employment). Under 1915(i) it is for ages 16 and up, requires prior services through Employment and Independence for People with Disabilities, and does not take place in licensed day programs or sheltered workshops. We did not find a confirmed billing unit or staff ratio.
• Adult day programs: for older members, Day Supports can be delivered in an adult day health or adult day care program. These are certified by the NCDHHS Division of Aging under 10A NCAC 06R and 06S, with staff ratios of 1:5 for adult day health, 1:6 for combination and day care homes and 1:8 for day care centers. The state directory of September 2, 2026 lists 92 certified centers.

Residential services

• Residential Supports: supports, skill building and supervision for a person living in a group home or an Alternative Family Living (AFL) home, which is the AFL provider's own home. Paid per diem at four levels (Level 1 H2016, Level 2 T2014, Level 3 T2020, Level 4 H2016 H1). Group homes are licensed as supervised living under 10A NCAC 27G .5600. AFL homes may be licensed or unlicensed, and unlicensed homes are reviewed with the plan's AFL health and safety checklist.
• Supported Living: supports for adults 18 and older in a home they control (not a licensed group home, ICF/IID or nursing facility). Paid per diem by level, with a Supported Living Periodic option. Relatives may provide Supported Living.
• ICF/IID: the institutional option, covered through Tailored Plans.

How are I/DD provider rates set and how do agencies enroll in North Carolina?

The LME/MCOs pay providers out of the capitation they receive from the state. The General Assembly funds direct care worker rate add-ons, which NC Medicaid builds into capitation and requires the plans to pass through as the same per-unit increase. We did not find a single statewide Innovations fee schedule, so agencies should ask each LME/MCO for its rates.

• Latest rate change: under S.L. 2026-41, Section 9E.14, NC Medicaid added $0.30 per 15-minute unit to seven Innovations services (Community Networking, Residential Supports, Supported Employment, Respite, Community Living and Supports, Day Supports and Supported Living), effective October 1, 2026 and retroactive to July 1, 2026. Providers sign an attestation with their LME/MCO, and plans report to NC Medicaid by December 1, 2027.
• Earlier increase: a 2023 increase under S.L. 2023-134 added $1.13 per 15-minute unit to the same seven services from July 1, 2023.
• 2025 cut and reversal: the state's October 1, 2025 Medicaid rate reductions set a 3% cut for Innovations, 1915(i) and TBI waiver services. On December 10, 2025 the state announced a reversal of the October 2025 reductions, without naming Innovations specifically. Agencies should confirm with their LME/MCO that the 3% was restored.
• Enrollment: agencies enroll in NC Medicaid through NCTracks (see the provider enrollment page) and contract with the LME/MCO in each region. Since a waiver amendment on August 1, 2025, national accreditation is required to enroll. Since April 20, 2026, providers under taxonomy 251S00000X choose from 39 Innovations service options in NCTracks and report accreditation for services that need it, according to the state's April 2026 bulletin. More is on the information for providers page.
• EVV: in-home Community Living and Supports (T2013 TF, T2013 TF HQ) and Supported Living Periodic (T2033 U1), plus the 1915(i) and TBI in-home equivalents, require electronic visit verification (EVV) through the plan's HHAeXchange system, which feeds the state's Sandata aggregator. Members who live with a paid live-in caregiver, including a relative, are exempt.

What is changing next for I/DD services in North Carolina?

The next dated change is April 20, 2027. On that date the old Community/Behavioral Health service under taxonomy 251S00000X ends in NCTracks. Innovations providers that have not chosen the new Innovations service options and reported national accreditation lose Innovations reimbursement eligibility.

• Assessment change in progress: people 16 and older are moving to the SIS-A 2nd Edition at their regular reassessments, which began July 1, 2025.
• Wage add-on reporting: LME/MCOs report on the 2026 direct care worker add-on to NC Medicaid by December 1, 2027.
• Workforce grants: NCDHHS awarded $3 million in a first round of direct support professional (DSP) recruitment and retention grants. A second round pays half its funds from July 2026 and half in July 2027.
• Waiver term: the current Innovations waiver runs through June 30, 2029.

We did not find confirmed action on new Innovations slots for fiscal year 2026-27. For the latest, check NC Medicaid's Innovations page or ask your LME/MCO.

North Carolina I/DD sources

• NC Medicaid: NC Innovations Waiver
• CMS: NC Innovations waiver record (0423.R04.00)
• NC Medicaid: About the Innovations Waiver Waitlist
• NCDHHS: Inclusion Connects quarterly report (October 15, 2026)
• NC Medicaid: Tailored Plans
• NC Medicaid: 1915(i) services for intellectual or developmental disabilities
• NC Medicaid: How to apply for the NC Innovations Waiver
• NC Medicaid: Innovations waiver providers, updated service and national accreditation requirements (April 16, 2026)
• NC Medicaid: Innovations waiver direct care worker wage increase (September 25, 2026)
• NC Medicaid: Electronic Visit Verification

Related reading

• Disability Services and Independent Living Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• I/DD services in every state (map)
• North Carolina EVV requirements

Other states that use managed care for I/DD services

Arizona, Arkansas, Iowa, Kansas, Michigan, Tennessee. See every state on the I/DD services map.

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.