Disability services in North Carolina

This program is closed. People who used 1915(b)(3) services, including people with I/DD, now get similar services through 1915(i).

Start with: Ended: replaced by 1915(i) services through your LME/MCO · (833) 870-5500 · Website (opens in a new tab)

This program ended; people now use 1915(i) services instead.

Apply for Medicaid first.

Steps

1. Know that 1915(b)(3) services have ended.
2. Apply for NC Medicaid if you do not have it.
3. Call the number on your health plan ID card and ask about 1915(i) services instead.

Have these ready

• Medicaid ID card
• Diagnosis records

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NC Medicaid members age 3 and older with I/DD, TBI, serious mental illness, serious emotional disturbance or severe substance use disorder who need the services. People already on a 1915(c) waiver cannot use it.

Start with: Your LME/MCO or Tailored Plan (Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health) · (833) 870-5500 · Website (opens in a new tab)

1915(i) is a Medicaid benefit, not a waiver with slots; people on the Innovations waitlist can use it while they wait.

Apply for Medicaid first.

Steps

1. Apply for NC Medicaid if you do not have it.
2. Call the number on your health plan ID card or welcome letter.
3. Ask for a 1915(i) assessment.
4. Work with your care manager to add 1915(i) services to your plan.
5. If you are unhappy with the answer, call the NC Medicaid Ombudsman at 1-877-201-3750.

Have these ready

• Medicaid ID card
• Diagnosis records
• List of help you need at home, at work or in the community
• Names of current providers

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NC Medicaid members with I/DD, TBI, serious mental illness or serious substance use disorder who meet Tailored Plan rules, including everyone on NC Innovations or the TBI waiver.

Start with: Behavioral Health and I/DD Tailored Plans run by the four LME/MCOs · (833) 870-5500 · Website (opens in a new tab)

Tailored Plans are Medicaid health plans, not waivers, so there is no waitlist to join.

Apply for Medicaid first.

Steps

1. Apply for NC Medicaid.
2. NC Medicaid checks if you qualify for a Tailored Plan.
3. You are enrolled in the Tailored Plan run by the LME/MCO for your county; the plan is based on where you live.
4. Call the Enrollment Broker to ask about your plan or to ask to move to or from a Tailored Plan.
5. Pick a primary care provider in the plan and ask for a care manager.

Have these ready

• Medicaid ID card
• Diagnosis records
• Names of current doctors and providers
• List of medicines

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People of any age with an intellectual or developmental disability who meet ICF/IID level of care. Family income is not counted for the waiver.

Start with: Your county LME/MCO (Tailored Plan): Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health · (855) 262-1946 · Website (opens in a new tab)

The waitlist is the NC Innovations waitlist (formerly the Registry of Unmet Needs); the wait is long, so apply as soon as you have a diagnosis.

Medicaid eligibility is decided as part of the waiver.

Steps

1. Find the LME/MCO for your county in the LME/MCO directory.
2. Call the LME/MCO and ask to apply for the NC Innovations waiver (it may be called the Registry of Unmet Needs application).
3. Send the medical and school records they ask for.
4. Watch for a letter in a few weeks saying if you were added to the waitlist. Keep that letter.
5. If you have Medicaid, ask the LME/MCO about 1915(i) services while you wait.
6. If you are denied, use the appeal form in the letter.

Have these ready

• Proof of diagnosis (psychological or medical evaluation)
• School records such as an IEP
• Medicaid card or Medicaid application number
• Social Security number and proof of address
• Guardianship papers, if any

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Adults 18 and older with a traumatic brain injury who live in Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange or Wake County and meet nursing facility or specialty hospital level of care.

Start with: Alliance Health (Tailored Plan), TBI Waiver · (800) 510-9132 · Website (opens in a new tab)

The TBI waiver has a limited number of slots and only serves the Alliance Health area.

Medicaid eligibility is decided as part of the waiver.

Steps

1. Check that you live in one of the seven Alliance Health counties.
2. Call Alliance Health at 1-800-510-9132 and ask about the TBI waiver.
3. Send records that show the brain injury and when it happened.
4. Take part in the level of care review.
5. Work with your care coordinator on an Individual Support Plan.

Have these ready

• Medical records of the brain injury
• Date and cause of the injury
• List of help you need each day
• Medicaid card or application number

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Adults 18 and older with physical disabilities and adults 65 and older who meet nursing facility level of care and need at least one CAP/DA service to live at home.

Start with: NC LIFTSS (Acentra Health) CAP referral line, or a local CAP/DA case management entity in your county · (833) 522-5429 · Website (opens in a new tab)

CAP/DA has a set number of slots, so some counties have a wait; ask your local case management entity.

Medicaid and this program are applied for together.

Steps

1. Contact the CAP/DA case management entity in your county, or call NC LIFTSS at 1-833-522-5429, and ask for a CAP/DA referral.
2. Apply for Medicaid at your county DSS if you do not have it.
3. Take part in the level of care assessment.
4. Choose agency services or consumer-directed care.
5. Work with your case manager on a service plan.

Have these ready

• Medical records and list of diagnoses
• List of medicines
• Doctor names
• Proof of income and assets
• Medicaid card or application number

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Children and youth from birth through age 20 who are medically fragile or medically complex and would otherwise need a hospital or nursing facility.

Start with: NC LIFTSS (Acentra Health) CAP referral line, or a local CAP/C case management agency in your county · (833) 522-5429 · Website (opens in a new tab)

CAP/C has a set number of slots; ask the case management agency if there is a wait in your county.

Medicaid eligibility is decided as part of the waiver.

Steps

1. Call NC LIFTSS at 1-833-522-5429, or contact the CAP/C case management agency for your county, and ask for a CAP/C referral.
2. A doctor or provider can also send the referral form by fax to 1-833-470-0597.
3. Apply for Medicaid at your county DSS if your child does not have it.
4. Take part in the assessment.
5. Work with the case manager on a service plan.

Have these ready

• Child's medical records and diagnoses
• Doctor and specialist names
• List of medicines, equipment and nursing needs
• Social Security number
• Medicaid card or application number

Apply or start here (opens in a new tab) · About this program (opens in a new tab) · Providers in the Atlas