Innovations Waiver

The Innovations Waiver is a home and community-based Medicaid program. It provides services and supports for individuals with intellectual and/or developmental disabilities, like autism, who are at risk of needing institutional care. The goal of the Waiver is to promote choice, control, and community integration as an alternative to institutionalization.

It is called a Waiver because some rules that apply to recipients of the regular Medicaid program are waived for recipients of the waiver program. For example, regular Medicaid considers the income of a spouse or parents in determining an individual’s eligibility. Under the waiver, this requirement is waived. Eligibility for the Innovations Waiver is not dependent on income.

Most services that individuals get with the Waiver are not otherwise available under the State Medicaid Plan. These are services that can improve their options for housing, employment, and habilitative services throughout their lifetimes.

What is the Wait List?

Unfortunately, there are not enough Waiver “slots” to provide services to everyone in North Carolina who qualifies. The wait list (also called the Registry of Needs) in some areas of the state is ten years long or longer. Waivers are awarded on a first-come, first-serve basis, so the sooner you get on the wait list, the sooner you will get services.

Many parents do not put their children’s names on the wait list because it is so long or because they feel their children do not need the services right now. However, for an individual with an intellectual or developmental disability, waiver services can greatly improve his or her quality of life into adulthood. Therefore, getting on the wait list today can have positive effects years from now. You have nothing to lose by signing up for the Waiver, and you can always decline services if you determine you do not need them.

How Do I Get My Child on the Wait List?

To get on the Waiver wait list, contact your local Managed Care Organization (MCO) and tell them you want your child to be considered for the Waiver. You can find out which MCO serves your county at www.ncdhhs.gov/providers/lme-mco-directory.

Services Available Under the Waiver

  • Community Living and Support provides assistance with daily living skills, personal care tasks, and community activities in a private home (usually a family home).
  • Residential Supports provides assistance for those living in out-of-home placements, such as group homes. This service makes more money available to the group home provider, which can mean more hours of services or better quality services for the individual. Also, group homes that accept Waiver participants must meet higher standards than those that do not.
  • Supported Living provides support for those living in a home of their own that is not their family home. It provides an alternative to those who need support for most or all of the day but do not want to live in a group home.
  • Day Supports provide assistance learning or improving skills, usually in a group setting.
  • Supported Employment can help the individual find a paying job in an integrated setting and provide ongoing, long-term job support.
  • Assistive Technology, Home Modifications, and Vehicle Modifications will pay for equipment to help with daily life tasks, changes to a home or vehicle to make them safer and to make getting around easier, or smart-home technology.
  • Community Transition will pay for expenses related to setting up a new home.

Additional Services:

  • Community Navigator
  • Community Networking
  • Crisis Services
  • Respite
  • Individual Goods and Services
  • Natural Supports Education

You can get details about Waiver services at www2.ncdhhs.gov/ncinnovations/.

Resources on the Innovations Waiver

The information on this webpage is available as a PDF here.

Our guide to Budget Reductions and Changes to the Innovations Waiver outlines some of the changes that went into effect on November 1, 2016. It also explains how your individual budget is developed, your right to request services in excess of your budget, and tips on completing your Individual Support Plan.

Innovation services are funded by Medicaid. Therefore, you have the right to appeal any denial, reduction, suspension, or termination of services. Our guide, Medicaid Appeals Involving Managed Care Organizations, walks you through the process.

 

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