North Carolina Medicaid Waivers & Home and Community Based Programs Overview
- Waiver Policy Analyst
- Oct 28, 2024
- 2 min read
Updated: Apr 2
North Carolina, known as The Tar Heel State, has a well-established Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.
Administered by the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (NC Medicaid), and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional facilities.
Key waiver programs include the Community Alternatives Program for Disabled Adults (CAP/DA) Waiver, which provides personal care, respite, and assistive technology for seniors and adults with physical disabilities, and the Innovations Waiver, which offers residential, employment, and behavioral health support for individuals with intellectual and developmental disabilities (IDD). Other major programs include the Traumatic Brain Injury (TBI) Waiver, the Community Alternatives Program for Children (CAP/C) Waiver, and the Self-Directed Care Option, all of which promote independent living and community integration.
Regulatory oversight in North Carolina is managed through NCDHHS and NC Medicaid, with additional provider licensing and compliance enforcement handled by the Division of Health Service Regulation (DHSR). North Carolina operates under a Managed Care model, with HCBS services integrated through NC Medicaid Managed Care and the Tailored Plans for individuals with IDD and behavioral health needs, ensuring comprehensive and cost-effective service delivery.
The state has also implemented Electronic Visit Verification (EVV) for personal care services, reinforcing accountability and compliance in home-based care programs. Providers must navigate Medicaid enrollment, waiver-specific service authorizations, and rigorous quality assurance measures to successfully participate in the state’s HCBS system.
With a strong emphasis on community-based care, person-centered planning, and expanding access in rural areas, North Carolina’s Medicaid waiver programs ensure that individuals receive high-quality, sustainable long-term care while promoting independence, dignity, and inclusion in their communities.
Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.
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