Self-Direction and FMS in North Carolina

All states: self-direction map

North Carolina self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in North Carolina offer self-direction?

North Carolina offers self-direction in three Medicaid waivers: the Community Alternatives Program for Disabled Adults (CAP/DA), the Community Alternatives Program for Children (CAP/C) and the NC Innovations Waiver. The two CAP waivers call the option consumer direction. The Innovations waiver calls it Individual and Family Directed Supports. North Carolina has no single self-direction page, so the rules sit in each program's own pages and policies.

• CAP/DA consumer direction: a 1915(c) waiver that serves adults 18 and older with disabilities and older adults who need a nursing facility level of care. It is run by NC Medicaid (Division of Health Benefits) with local case management entities and NC LIFTSS, which is operated by Acentra Health. The beneficiary or a designated representative has employer authority. The CAP/DA page says the employer of record may recruit, hire, supervise and fire the personal assistant, set the pay rate and assign tasks.
• CAP/C consumer direction: a 1915(c) waiver that serves medically fragile and medically complex children. It is run by NC Medicaid with local case management entities and NC LIFTSS. The beneficiary or a designated representative has employer authority, on the same terms as CAP/DA. Attendant Nurse Care is offered through consumer direction. State Plan nursing cannot be consumer directed.
• NC Innovations Waiver, Individual and Family Directed Supports: a 1915(c) waiver that serves children and adults with intellectual or developmental disabilities. It is run by the LME/MCOs and Tailored Plans (Alliance Health, Trillium Health Resources and Vaya Partners) under NC Medicaid. Members have employer authority and choose between two models, Employer of Record and Agency with Choice. Alliance and Vaya Partners list these services as ones that can be self-directed: Community Living and Supports, Community Networking, Natural Supports Education, Supported Employment, Respite, Supported Living, and Individual Goods and Services (only alongside another self-directed service). Community Navigator is available only to members who self-direct.

Employer authority means the participant recruits, hires, schedules and supervises the workers. Budget authority means the participant also manages a set amount of money for services. We did not find a readable state source that uses the term budget authority for any of the three waivers. The policies that would settle it (Clinical Coverage Policies 3K-1, 3K-2 and 8-P) are PDF documents we could not read. For a firm answer, ask the case management entity for the CAP waivers or the member's care manager for Innovations.

In both CAP waivers, the participant or the assigned employer must complete an initial consumer direction training before starting and a refresher every year. NC Medicaid's training schedule says the trainings run through NC LIFTSS.

Who handles financial management services (FMS) in North Carolina?

North Carolina does not use one statewide FMS vendor. Participants work with a financial management agency, and several operate in the state: GT Independence, Acumen Fiscal Agent and Secure Direction NC. In the employer of record model the participant or a designated representative is the legal employer of the workers, and the agency handles payroll and taxes. Which agencies are available depends on the waiver and, for Innovations, on the member's plan.

A financial management agency is the organization that handles the paperwork side of being an employer. It pays the workers and takes care of the employer taxes so that self-directed funds are managed and paid out as intended. The Innovations waiver calls these organizations Financial Support Services agencies.

• Legal employer in the CAP waivers: the beneficiary or a designated representative is the employer of record. This is the only model in CAP/DA and CAP/C.
• Legal employer in Innovations: it depends on the model. Under Employer of Record, the member, a family member or a legally responsible person hires and manages staff, and a Financial Support Services agency pays the workers. Under Agency with Choice, a provider agency hires and pays the staff and the member is the managing employer, which means the member directs the day-to-day work.
• Vendors for CAP/DA and CAP/C: GT Independence, Acumen Fiscal Agent and Secure Direction NC each describe themselves as financial management agencies for the CAP programs.
• Vendors for Innovations (Employer of Record): Vaya Partners lists Acumen Fiscal Agent and Secure Direction NC as its Financial Support Services agencies. We did not find the agencies named on the Alliance Health or Trillium Health Resources web pages. Their lists sit in manuals we could not read, so ask the plan or the member's care manager.

Under Agency with Choice, the agency that employs the staff varies by provider. Those agencies are service providers, not a financial management vendor list.

Who can be a paid caregiver under self-direction in North Carolina?

Relatives can be paid in North Carolina, but the closest family members face limits. In the CAP waivers a legally responsible individual (a spouse, the parent of a minor child or the guardian of a minor child) can be a paid caregiver only when at least one extraordinary circumstance is met, and is limited to 40 paid hours a week. The Innovations waiver has its own limits on relatives, with hour caps tied to one main service.

• CAP/DA and CAP/C, legally responsible individuals: NC Medicaid's requirements page says a legally responsible individual may be paid only when at least one extraordinary circumstance is met. Medical fragility alone does not qualify. The CAP FAQs set the limit at 40 paid hours a week regardless of living arrangement. A legally responsible individual may not be paid for a child under 3 when the care needs fall within the normal developmental range.
• CAP/C, added oversight: when a legally responsible person is the paid caregiver, the participant is enrolled in coordinated caregiving or self-directed care, and the case management entity must make weekly contacts and monthly in-person visits.
• Innovations, parents of minor children: parents of minor children with extraordinary support needs may be paid for Community Living and Supports up to 40 hours a week.
• Innovations, relatives of adult members: since March 1, 2024, relatives who live in the home of an adult member may be paid only for Community Living and Supports. NC Medicaid's Innovations provider page describes relatives of adult members providing that service for more than 56 and up to 84 hours a week, and says relatives may provide Supported Living. We did not confirm whether hours at that level need approval case by case, so ask the member's plan.
• Innovations, Vaya Partners region: a provider or Employer of Record needs written plan approval before a relative who lives with the member is paid for more than 40 hours a week of Community Living and Supports. Forty hours or fewer must be reported to the care manager and listed in the care plan.

One Innovations rule lets family provide services when no other provider is available. NC Medicaid's 2024 guidance says that rule does not apply to parents of minor children who are also the Employer of Record.

We did not find readable rules on who else may be hired, such as other relatives, people holding power of attorney or the participant's representative, or on overtime. Those details sit in policy documents we could not read. Ask the case management entity for the CAP waivers or the care manager for Innovations.

Does EVV apply to self-directed workers in North Carolina?

Yes. Electronic visit verification (EVV) applies to self-directed in-home services in North Carolina. In the CAP waivers the employer of record is treated as the provider agency for EVV reporting, and workers record visits through their financial management agency. A paid caregiver who lives in the home is exempt.

• CAP/DA and CAP/C: self-directed personal attendant care has been subject to EVV since January 1, 2021. All employees must use EVV except one who lives in the home. In CAP/C, in-home aide and pediatric nurse aide services are covered, while nurse respite and private duty nursing are outside EVV.
• What must match: NC Medicaid's 2021 bulletin for CAP beneficiaries says that for consumer direction only the approved service and the hired worker must match the authorization. The employer of record or the financial management entity may manually update a visit when a signed paper timesheet backs it up.
• Innovations: in-home Community Living and Supports and Supported Living are subject to EVV through the member's plan. NC Medicaid's EVV page says members who live with a paid live-in caregiver are exempt, whether the caregiver works for a provider or is self-directed, and including a relative working as a direct support employee. Staff who do not live in the home must use EVV.

Payment is tied to EVV. CAP/C and CAP/DA claims under Medicaid Direct for dates of service from June 1, 2021 must validate against EVV data before they are processed. That bulletin does not mention consumer-directed claims by name, either to include them or to leave them out. Secure Direction NC says on its own site that billing claims are denied when no verification is found.

The agencies that publish details use their own tools. Secure Direction NC says caregivers clock in and out through a system called On Target. Acumen links workers to its DCI portal and publishes an EVV Live-In Caregiver Attestation form for both the CAP and Innovations programs. We did not find which EVV system GT Independence workers use in North Carolina, or whether a financial management agency may use a third-party EVV system. Ask the agency or NC LIFTSS.

What is changing next for self-direction in North Carolina?

We did not find an upcoming, dated change to self-direction in North Carolina as of October 13, 2026. The waivers that carry self-direction were renewed recently, and the renewal announcements we read list no change to consumer direction. One item is in development with no date.

• In development: NC Medicaid says in its CAP FAQs that training for legally responsible individuals who are paid caregivers, and more guidance on documenting extraordinary circumstances, are being developed. No date has been given, so the details may change.
• Paid family caregiving is staying: the same FAQs say NC Medicaid is not planning to phase out paid caregiving by legally responsible individuals under consumer direction.
• Already in effect, plan merger: Vaya Health and Partners Health Management merged on October 1, 2026 to form Vaya Partners. Three organizations now run Innovations self-direction: Alliance Health, Trillium Health Resources and Vaya Partners.
• Waiver terms: the CAP/DA renewal approved by CMS runs from November 1, 2024 through October 31, 2029. The Innovations renewal runs from July 1, 2024 through June 30, 2029, with an amendment on August 1, 2025 about provider accreditation that the state describes as non-substantive.

If you are affected by the merger, check with Vaya Partners or the member's care manager for current forms and contacts.

North Carolina self-direction sources

• NC Medicaid: Community Alternatives Program for Disabled Adults (CAP/DA)
• NC Medicaid: Community Alternatives Program for Children (CAP/C)
• NC Medicaid: Requirements for legally responsible individuals as paid caregivers
• NC Medicaid: Community Alternatives Program (CAP) FAQs
• NC Medicaid: Information for providers, NC Innovations Waiver
• NC Medicaid: Guidance on sunsetting Innovations Waiver Appendix K flexibilities (January 30, 2024)
• NC Medicaid: Electronic Visit Verification
• NC Medicaid: EVV for CAP/C and CAP/DA waiver beneficiaries (March 23, 2021)
• Vaya Partners: Individual and Family Directed Services

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• Why Do Self-Directed Participants Choose Your FMS as Their Fiscal Intermediary?
• Self-direction in every state (map)
• North Carolina EVV requirements

Other states with a choice of FMS vendors

Alaska, Colorado, Georgia, Idaho, Kentucky, Louisiana, Maryland, Minnesota, Texas, Utah. See every state on the self-direction map.

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.