The NC Innovations Waiver and 1915(i) services, explained
Two North Carolina Medicaid programs can pay for help at home, in the community, at work and for caregiver breaks. Here is what each one is, how they fit together, and how to get started.
General information, not legal or medical advice. Your health plan makes the final decision on eligibility.
The short version
- Apply for the Innovations Waiver as soon as you have a diagnosis. Autism can qualify. You don't need Medicaid first, and your family's income doesn't count. But there is a long waitlist.
- 1915(i) services have no waitlist, but you must already have NC Medicaid through a Tailored Plan, NC Medicaid Direct or the Tribal Option. They are for ages 3 and up.
- You can do both. Getting 1915(i) services while you wait does not change your place on the Innovations waitlist. Once someone starts the Innovations Waiver, they stop 1915(i), because the waiver covers similar services.
Two things families often miss
For 1915(i), you need a diagnosis from a licensed professional, such as a physician or psychologist. An evaluation done by your child's school alone doesn't count.
For the Innovations Waiver, the disability must have started before the person turned 22. Adults can still apply, as long as their condition began in childhood.
Two programs at a glance
Long-term support for people who need a lot of help
For children and adults with an intellectual or developmental disability, including autism, who need a lot of support now and in the future.
- No Medicaid needed to apply, at any income
- Long waitlist; nobody can predict how long
- Broadest set of services, including home and vehicle changes
Medicaid services you can get now
For people with NC Medicaid in a Tailored Plan, NC Medicaid Direct or the Tribal Option, including autistic children and adults ages 3 and up.
- Must already have NC Medicaid in an eligible plan
- No waitlist; services should start within 90 days
- Daily living help, respite, job support and more
Which might fit your family?
Follow the steps. This is a starting point, not a final answer: your health plan decides eligibility.
Step 1 — Does your child or family member have a diagnosis of autism or another developmental disability from a licensed professional?
Yes: Go to step 2.
Not yet: Start with an evaluation from a doctor or psychologist. Both programs need a diagnosis, and a school evaluation alone isn't enough for 1915(i).
Step 2 · Do this now — Apply for the NC Innovations Waiver waitlist
Anyone with a diagnosis whose condition began before age 22 can apply, at any current age, income or type of insurance. Call your local health plan (LME/MCO) and ask to apply for the NC Innovations Waiver. You'll get a letter in a few weeks. Keep it.
Step 3 — Does the person have NC Medicaid, and are they 3 or older?
Yes: Go to step 4.
No Medicaid: 1915(i) isn't available yet. Stay on the Innovations waitlist and check whether you qualify for Medicaid.
Step 4 — Which Medicaid plan are they in?
Tailored Plan, Medicaid Direct or Tribal Option: Call your plan and ask for a 1915(i) assessment. You can get these services while you wait for Innovations.
Standard Plan: 1915(i) isn't offered in Standard Plans. Call the NC Medicaid Enrollment Broker at 1-833-870-5500 to ask about your options.
Side by side
| NC Innovations Waiver | 1915(i) services | |
|---|---|---|
| Who it's for | People with an intellectual or developmental disability or related condition, such as autism, that began before age 22 | People with an intellectual or developmental disability (including autism), traumatic brain injury, serious mental illness or severe substance use disorder |
| Level of need | Needs a lot of support now and in the future (the "ICF-IID level of care") | Does not require that level of care |
| Age | Any age, but the condition must have begun before age 22 | 3 and older |
| Diagnosis | Intellectual or developmental disability or related condition, such as autism | From a licensed professional, such as a physician or psychologist. A school evaluation alone isn't enough. |
| Medicaid | Not needed to apply. Only the person's own income counts, not the family's. | Must already have NC Medicaid in a Tailored Plan, NC Medicaid Direct or the Tribal Option |
| Waitlist | Yes, usually long. Slots open by county and application date. | No waitlist |
| Example services | Community Living and Supports, Supported Living, Residential Supports, Day Supports, Community Networking, Respite, Supported Employment, Assistive Technology, Home and Vehicle Modifications, Crisis Services, Specialized Consultations | For developmental disabilities: Community Living and Supports, Respite, Supported Employment, Community Transition |
| Cost to families | Medicaid benefit | Free, no copays |
| Both at once? | No. But you can be on the Innovations waitlist and get 1915(i) services while you wait, and it won't affect your place in line. | |
What happens after you call
Innovations Waiver
- Call your local health plan Ask to apply for the NC Innovations Waiver. Staff may still call it the "Registry of Unmet Needs."
- Send any records they ask for Such as medical records or evaluations.
- Get a letter in a few weeks It confirms you're on the waitlist. Keep it.
- Wait for a slot Usually first come, first served in your county. A few reserve slots exist for emergencies.
1915(i) services
- Call your Medicaid health plan Ask for a 1915(i) assessment. A care manager can also request it for you.
- Do the assessment About one hour, by phone, video or in person. It decides which services fit.
- Choose providers and start You should get services within 90 days, depending on staff availability.
Who to call
Four health plans (LME/MCOs) run these programs, each for its own counties. Not sure which is yours? Call 1-855-262-1946 (weekdays, 8 a.m. to 5 p.m.).
Tips before you call
- Don't wait to apply for Innovations. NC Medicaid advises applying as soon as you have a diagnosis, because the wait is long.
- Save every letter from your health plan, especially the one confirming your waitlist spot.
- Ask for 1915(i) by name. Say "I'd like a 1915(i) assessment" when you call.
- Check the waitlist by county on the state's Innovations waitlist dashboard.
Find local providers
Looking for respite, Community Living and Supports or job support near you? Browse providers in Charlotte or Raleigh on AutismResources.ai.
Sources
- NC Medicaid: Eligibility for NC Innovations Waiver
- NC Medicaid: How to apply for the NC Innovations Waiver
- NC Medicaid: About the NC Innovations Waiver waitlist
- NC Medicaid: NC Innovations Waiver services
- NC Medicaid: Eligibility for 1915(i) services
- NC Medicaid: How to get 1915(i) services
- NC Medicaid: Questions and answers about 1915(i)
- Alliance Health: Innovations Waiver services
- Disability Rights NC: Am I eligible for an Innovations Waiver?
- Autism Society of NC: 1915(i) services
General information to help you get started, not legal or medical advice. Program rules change. Confirm details with your health plan or NC Medicaid before making decisions.
Can autism qualify for the NC Innovations Waiver?
Autism can qualify. You don't need Medicaid first, and your family's income doesn't count. But there is a long waitlist.
Can I get 1915(i) services while on the Innovations waitlist?
Getting 1915(i) services while you wait does not change your place on the Innovations waitlist. Once someone starts the Innovations Waiver, they stop 1915(i), because the waiver covers similar services.
Is a school evaluation enough for 1915(i)?
For 1915(i), you need a diagnosis from a licensed professional, such as a physician or psychologist. An evaluation done by your child's school alone doesn't count.