NC Innovations Waiver

The NC Innovations Waiver is specifically designed to cater to the needs of Individuals with Intellectual or Developmental Disabilities (I/DD). As a Federally approved 1915(c) Medicaid Home and Community-Based Services (HCBS) Waiver, it empowers individuals to seek long-term care services and support in their preferred home or community environments rather than institutional settings. Under the administration of local management entities/managed care organizations (LME/MCOs), this program promotes person-centered care, fosters autonomy, and creates a network of community-based service providers.

Overview of NC Innovations Waiver

The NC Innovations Waiver operates alongside the 1915(b) NC MH/DD/SUS Health Plan, facilitated by Managed Care Organizations (LME-MCOs) functioning as area authorities, county programs, or consolidated human services agencies. These entities are the coordinating locus for publicly funded mental health, intellectual/developmental disabilities, and substance misuse services in their respective catchment areas. As a fully capitated prepaid inpatient health plan (PIHP), LMEs deliver State Plan MH, SA, IDD services, and Innovations waiver services.

The overarching goals of the NC Innovations Waiver are multifaceted:

1. Community Inclusion: To value and support waiver beneficiaries to become fully functioning members of their communities.
2. Real-Life Outcomes: To promote promising practices that lead to tangible improvements in beneficiaries' lives.
3. Choice and Independence: To offer service options that allow beneficiaries to live in homes of their choice, find employment or engage in purposeful activities, and achieve their life goals.
4. Self-Directed Services: To allow beneficiaries to direct their services to the extent they prefer.
5. Building Support Networks: To offer educational opportunities and support, fostering the development of natural solid support networks that reduce reliance on formal support systems.
6. Safety and Well-being: To ensure the well-being and safety of the individuals served.
7. Empowerment: To maximize beneficiaries' self-determination, self-advocacy, and self-sufficiency.
8. Community Integration: To increase opportunities for community integration through work, lifelong learning, recreation, and socialization.
9. Person-Centered Approach: To deliver person-centered services leveraging natural and community supports.
10. Quality Improvement: To provide quality services and continually enhance outcomes.

The NC Innovations Waiver also outlines specific objectives to achieve its goals, including enhancing person-centered planning, reforming residential services for smaller community living settings, promoting integrated living and employment, and implementing outcome-based quality assurance systems. Through these efforts, the waiver aims to support individuals with Intellectual or Developmental Disabilities in living the life they choose while recognizing the vital role of family caregivers in their care and advocating for fair compensation for their significant contributions.

Eligibility Requirements

To be eligible for North Carolina's Innovations Waiver, individuals must meet specific criteria as follows:

1. Level of Care Requirement: The applicant must meet the eligibility criteria for an Intermediate Care Facility for Individuals with Intellectual Disabilities level of care. This determination ensures that the individual requires a certain level of care and support due to their intellectual or developmental disabilities.
2. Residential Status: The individual must either reside in an ICF-IID or risk being placed in an ICF-IID. This criterion is crucial in identifying those who need or are at risk of institutionalization and aims to provide them with an alternative home or community-based care option.
3. Community Suitability: The applicant should be capable of staying safe, healthy, and well while residing in the community, with the support of NC Innovations Waiver services. This requirement ensures that the individual can thrive in a non-institutional setting.
4. Frequency of Service Use: The individual must need and utilize NC Innovations Waiver services outlined in their person-centered plan at least once a month. This criterion validates the ongoing need for waiver services to cater to their specific requirements.
5. Choice of Services: The applicant must prefer NC Innovations Waiver services over residing in an ICF-IID. This criterion is instrumental in determining the individual's desire for community-based care and willingness to participate actively in the program.

Meeting these eligibility requirements ensures qualified individuals can benefit from the NC Innovations Waiver, receiving the necessary support and services tailored to their unique needs and preferences, allowing them to lead fulfilling lives in their chosen communities.

Services and Supports

The NC Innovations Waiver offers a comprehensive range of services. It supports tailored to meet the diverse needs of individuals with Intellectual or Developmental Disabilities (I/DD) who prefer home and community-based care over institutional settings. These services foster independence, community inclusion, and improved quality of life. Services and supports include:

1. Residential Supports: Assisting individuals in finding suitable living arrangements, including group homes, shared living, or individual-supported living.
2. Community Networking: Facilitating opportunities for socialization, recreational activities, and community engagement to enhance integration.
3. Supported Employment: Helping beneficiaries explore employment opportunities, job training, and ongoing support for successful job placement.
4. Day Supports: Providing structured activities and skill-building programs during the day to promote personal growth and independence.
5. Personal Care Services: Offering assistance with activities of daily living, such as bathing, dressing, and medication management.
6. Behavioral Supports: Addressing challenging behaviors through behavior analysis and positive support strategies.
7. Therapies: Access to physical, occupational, and speech-language therapy to address specific needs.
8. Assistive Technology: Supplying aids and devices that enhance communication, mobility, and independence.
9. Respite Care: Offering temporary relief to caregivers, allowing them to take a break and recharge.
10. Transportation: Facilitating access to medical appointments, community activities, and work.
11. Family Training and Counseling: Providing education, training, and counseling to support families caring for their loved ones.
12. Financial Management Services: Assisting beneficiaries or their representatives in managing their waiver budgets.

The person-centered planning process enables beneficiaries to select the services that best align with their individual preferences and goals, ensuring a tailored approach to meet their unique needs. Through the NC Innovations Waiver, individuals with I/DD can receive the necessary support to lead fulfilling lives within their communities, supported by the dedication of family caregivers who play a crucial role in their well-being and happiness.

Compensation for Caregivers

The NC Innovations Waiver is a self-directed program. Self-direction, also known as participant-directed or consumer-directed care, allows individuals or their representatives to control the services they receive, including deciding how their waiver funds are allocated.

In a self-directed program like the NC Innovations Waiver, individuals with Intellectual or Developmental Disabilities (I/DD) have greater flexibility in choosing the specific services and supports that best meet their needs and preferences. They can decide how their allocated funds are used to purchase services from approved providers or, in some cases, even hire and manage their caregivers, including certain family members, including siblings, adult children, or other relatives.

Self-direction empowers individuals and their families to design a care plan tailored to their unique circumstances, promoting greater autonomy and independence. It's important to note that self-direction may come with specific guidelines and regulations to ensure funds are used appropriately, and services meet quality standards. Participants typically receive assistance and support from a fiscal intermediary or case manager to navigate the self-directed care process.

Learn more about Medicaid self-directed care >>

A Note from Givers

If you are a caregiver seeking assistance, we urge you to take action and explore potential options. Fill out this form to determine if you may be eligible for compensation or other caregiver support programs in your area.