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We provide services under the North Carolina Innovations Waiver (NC Innovations) as a resource for funding and supports for Medicaid beneficiaries with intellectual and other related developmental disabilities who are at risk for institutional care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID). NC Innovations is authorized by a Medicaid Home and Community-Based Services (HCBS) Waiver granted by the Centers for Medicare and Medicaid Services (CMS) under Section 1915 (c) of the Social Security Act.
We also provide State Funded services, also known as IPRS, for those who are not Medicaid eligible. State Funded services have similar eligibility requirements to NC Innovations, however, funding is very limited as allocated by the LME/MCO.
There are also private pay services available.
Adult Day Activities
Alternative Family Living (AFL) Homes
Day Supports is primarily a group service that provides assistance to the beneficiary with acquisition, retention, or improvement in self-help, socialization and adaptive skills. Day Supports are furnished in a non-residential setting, separate from the home or facility where the beneficiary resides. Day Supports focus on enabling the beneficiary to attain or maintain his or her maximum functional level and is coordinated with any physical, occupational, or speech therapies listed in the Individual Support Plan.
Day Activity provides supervision and an organized program during a substantial part of the day in a group setting. Participation may be on a routine or occasional basis. The service is designed to support the individual's personal independence and promote social, physical and emotional well-being.
Community Networking services provide individualized day activities that support the individual’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. This service is provided separate and apart from the individual’s private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the beneficiary the opportunity to develop meaningful community relationships with non-disabled individuals. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the individual to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As individuals gain skills and increase community connections, service hours should fade.
Respite services provide periodic support and relief to the primary caregiver(s) from the responsibility and stress of caring for the individual. This service enables the primary caregiver to meet or participate in planned or emergency events, and to have planned time for him/her and/or family members. Respite may be utilized during school hours for sickness or injury. Respite may include in and out-of-home services, inclusive of overnight, weekend care, or emergency care (family emergency based, not to include out of home crisis). The primary caregiver is the person principally responsible for the care and supervision of the individual and must maintain his/her primary residence at the same address as the individual.
Medicaid beneficiaries only; Home Modifications are physical modifications to a private residence that are necessary to ensure the health, welfare, and safety of the individual or to enhance the individual’s level of independence. A private residence is a home owned by the individual or his/her family (natural, adoptive, or foster family). Items that are portable may be purchased for use by an individual who lives in a residence rented by the individual or his/her family. This service covers purchases, installation, maintenance, and as necessary, the repair of home modifications required to enable individuals to increase, maintain or improve their functional capacity to perform daily life tasks that would not be possible otherwise. A written recommendation by an appropriate professional is obtained to ensure that the equipment will meet the needs of the individual. A physician’s signature certifying medical necessity shall be included with the written request for Home Modifications.
Items that are not of direct or remedial benefit to the individual are excluded from this service. Repair of equipment is covered for items purchased through the waiver or purchased prior to waiver participation, as long as the item is identified within this service definition and the cost of the repair does not exceed the cost of purchasing a replacement piece of equipment. The waiver beneficiary or his/her family must own any equipment that is repaired.
Habilitation Services aimed at assisting the beneficiary to acquire, improve, and retain skills in self-help, general household management and meal preparation, personal finance management, socialization and other adaptive areas. Training outcomes focus on allowing the individual to improve his/her ability to reside as independently as possible in the community. Assistance in activities of daily living when the individual is dependent on others to ensure health and safety. Habilitation services that allow the individual to participate in home life or community activities.
Personal Care Services under North Carolina State Medicaid Plan differs in service definition and provider type from the services offered under the waiver. Personal Care Services under the waiver include support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living. Engaging the individual in activities that may encourage the individual to maintain skills gained during habilitation while also providing supervision for independent activities. This service may include preparation of meals, but does not include the cost of the meals themselves.
Supported Employment Services provide assistance with choosing, acquiring, and maintaining a job for beneficiaries ages 16 and older for whom competitive employment has not been achieved and /or has been interrupted or intermittent.
Community Guide (B3)
Community Guide Services provide support to individuals and planning teams that assist individuals in developing social networks and connections within local communities. The purpose of this service is to promote self-determination, increase independence and enhance the individual’s ability to interact with and contribute to his or her local community. Community Guide Services emphasize, promote and coordinate the use of natural and generic supports (unpaid) to address the individual’s needs in addition to paid services.
These services also support individuals, representatives, and Managing Employers who direct their own waiver services by providing direct assistance in their beneficiary direction responsibilities. Community Guide Services are intermittent and fade as community connections develop and skills increase in individual direction. Community Guides assist and support (rather than direct and manage) the individual throughout the service delivery process. Community Guide Services are intended to enhance, not replace, existing natural and community resources.