Pyx Health banner
With the passage of the budget, Medicaid Expansion is launching December 1st, 2023. More information about Medicaid Expansion can be found here.
1-888-235-4673
Training Resource and Collaborative
Provider Knowledge Base
Find a Provider

NC Innovations Waiver Services

This is a list of services possibly covered by NC Innovations. Your eligibility for different services is based on your individualized support plan (ISP).

To make sure everyone gets exactly the help they need, the state will now use Individual Budgets to guide service planning.

Budgets are based on:

  • Age
  • Whether the consumer lives in a group home, other Medicaid-funded home, or private home
  • Support needs measured by the Supports Intensity Scale (SIS).
  • Other behavioral and medical factors

Individual budgets are a guideline only. The budget amounts do not constitute a limit on the amount of services that may be requested or authorized. All services covered under the Innovations waiver, including Residential Supports and Supported Living, should be requested to the full extent of the individual’s level of medical necessity, regardless of the individual’s budgeting category.

Assistive Technology, Equipment & Supplies

  • Buy equipment to help with daily life tasks
  • Buy smart technology
  • May also cover repairs

The range of covered items and services changes with new technology. There is a $50,000 limit in combination with Home Modifications over the 5-year waiver period.

Community Living and Supports

  • Learn skills for independent living (habilitation)
  • Get necessary assistance
  • Build supports by connecting with others in the community

Community Navigator

  • Learn about your community
  • Find new things to do
  • Build connections

Community Networking

  • Find volunteer work
  • Join a group or club
  • Pay for transportation to these activities

The service links to people to volunteer groups even when participating may require additional services.

Crisis Services

  • Learn safety skills
  • Get help day or night
  • Stay out of a facility or hospital
  • Gain out-of-home service for a short time
  • Make a plan to help avoid a crisis

Day Supports

  • Learn, keep, or improve skills in a licensed day program
  • Generally provided in a group setting; one-to-one services are available

Members receiving day supports must go to the Day Supports facility at least once a week unless enrolled in adult basic education classes. All individuals participating in Day Supports must receive education about alternatives.

Financial Support Services

  • File claims
  • Process payroll
  • Pay for staff supplies and training
  • Complete background checks

Home Modifications

  • Make changes to your home that keep you healthy and safe
  • Add things that make it easier to get around in your home, such as ramps and stair lifts

There is a $50,000 limit in combination with Assistive Technology over the 5-year waiver period.

Individual Goods and Services

  • Help people who self-direct pay for items or supplies need less Medicaid services
  • Become more included in the community
  • Increase your safety at home

You can only use Individual Goods and Services if you do not have any other way to pay for the item or the supplies. The cost limit for this service is $2,000 per year.

Natural Supports Education

  • Help family caregivers learn new or different ways to help you
  • Help family caregivers learn how to use new equipment or supplies
  • Provides family caregivers access to conferences and classes

Residential Supports

  • Learn how to stay healthy and safe in the community
  • Teaches and refines skills
  • Support daily life activities
  • Get to community activities and day programs

Respite

  • Provides caregivers relief from responsibilities
  • Allows caregivers to participate in planned or emergency activities and appointments
  • Supports caregiver with planning time for themselves or other family members

This service may be used in Alternative Family Living (AFL) settings, but not on the same day as Residential Supports.

Specialized Consultation Services for Caregivers

  • Provides caregivers with training and technical assistance in a specialty area such as psychology, behavior intervention, occupational therapy, physical therapy, or nutrition
  • Helps family caregivers learn how to use specialized equipment such as assistive technology, home modifications, and vehicle modifications.
  • May involve observation to determine needs
  • Family and consultant will create intervention plans and revise them through team meetings

Provides tele-consultation for behavioral and psychological care if distance is an issue.

Supported Employment

  • Find a paying job
  • Learn new job skills
  • Start your own business
  • Helps employers comply with Americans with Disabilities Act (ADA) rules

Supported employment can be provided long-term for ongoing job support and includes long-term follow-up.

Supported Living

  • Helps members live independently in a home they own or rent
  • Provides assistance meeting personalized needs
  • Assists with daily activities, such as chores, budgeting, keeping appointments, and socializing

Vehicle Modifications

  • Pay for changes to a vehicle that make it easier and safer for you to get around in the community

Vehicle Modifications can only be used on a vehicle that you already have and the vehicle must be insured. There is a $20,000 limit over the 5-year waiver period.

X