Key Resources

This is a list of key state-funded or Medicaid resources and organizations for individuals with intellectual and other developmental disabilities (I/DD) and their families.

This list of resources is not comprehensive and some key resources are likely missing. Please visit NC DHHS, your local LME/MCO, and other organizations that explain or share resources for additional information. These resources regularly change.

NC Innovations Waiver

The NC Innovations Waiver is a comprehensive Medicaid Home and Community-Based Services (HCBS) waiver for people of all ages who have an intellectual or other developmental disability (I/DD) or a closely related condition. This includes individuals with diagnoses such as autism, cerebral palsy, Down syndrome, and traumatic brain injury if the injury occurred before age 22. The waiver "waives" some typical Medicaid eligibility requirements, such as family income, by considering only the individual's income, making it accessible to more individuals with I/DD regardless of their family's financial status. There is a multi-year waiting list for people with I/DD for the Innovations Waiver. Some people wait for more than ten years. For this reason, individuals should join the waiting list but also look into CAP-DA and 1915(i) services. It is critical to apply for the Innovations Waiver as early as possible due to the multi-year waiting list.

For more information: https://medicaid.ncdhhs.gov/beneficiaries/nc-innovations-waiver

NC Medicaid 1915(i) services

NC Medicaid 1915(i) services are designed to help individuals live in their own homes and communities rather than in care facilities. These services are available to children and adults who have mental health conditions, substance use disorders, traumatic brain injuries, or intellectual/developmental disabilities. A key advantage of 1915(i) services is their status as an entitlement program, meaning they do not run out of funds or have waiting lists, unlike the Innovations Waiver. This makes them a crucial alternative or bridge for individuals who are on the Innovations Waiver waitlist.

For more information: https://medicaid.ncdhhs.gov/beneficiaries/1915i

Community Alternatives Program for Disabled Adults (CAP-DA)

CAP-DA is a Medicaid Home- and Community-Based Services (HCBS) waiver for medically fragile or complex disabled adults aged 18 and older who are determined to require a level of institutional care under the State Medicaid Plan. This is different from the Innovations Waiver, which is specifically designed for people with intellectual and other developmental disabilities. Some individuals with developmental disabilities may qualify for both CAP-DA and the Innovations Waiver. The Innovations Waiver has a multi-year waiting list so some people with developmental disabilities have CAP-DA or 1915i Medicaid while they are on the waiting list. Even if you have CAP-DA or 1915i Medicaid, you should still join the Innovations Waiver waiting list if you qualify.

For more information: https://medicaid.ncdhhs.gov/providers/programs-services/long-term-care/community-alternatives-program-for-disabled-adults

Tailored Plans

Tailored Plans are a specific type of North Carolina Medicaid Managed Care plan designed for individuals with complex health needs related to serious mental illness, severe substance use disorders, intellectual/developmental disabilities, or traumatic brain injuries. These plans are essential Managed Care Insurance Plans, which offer a combination of physical health, pharmacy, care management, and behavioral health services, including some additional services not available in standard Medicaid plans.

For more information: https://medicaid.ncdhhs.gov/tailored-plans

Tailored Care Managers

Tailored Care Managers are trained to help people with serious mental illness, severe substance abuse disorder, intellectual/developmental disabilities or traumatic brain injury. Your Tailored Care Manager helps you navigate your health care, so you do not have to do it all yourself.

For more information:

LME/MCOs, or Local Management Entity/Managed Care Organizations

Local Management Entity/Managed Care Organizations (LME/MCOs) do the following:

Manage NC Medicaid Tailored Plans;
Coordinate certain services for NC Medicaid Direct beneficiaries; and
Coordinate certain services for EBCI Tribal Option members.

There is one LME/MCO for each county.

For more information: https://www.ncdhhs.gov/providers/lme-mco-directory

Employment and Independence for People with Disabilities (NC DHHS Division of Vocational Rehabilitation Services)

Vocational Rehabilitation (VR) Services in North Carolina are provided by the Division of Employment and Independence for People with Disabilities (EIPD), a part of the NC Department of Health and Human Services (NCDHHS). These services promote employment and independence for people with disabilities through customer partnership and community leadership. To be eligible, an individual must have a disability that presents a barrier to obtaining or maintaining employment and require VR services to prepare for, secure, retain, or regain employment.

For more information: https://www.ncdhhs.gov/eipd

Early Periodic Screening, Diagnostic and Treatment Medicaid Services for Children (EPSDT)

EPSDT is a federal Medicaid mandate that requires states to provide all medically necessary health care services to eligible children under the age of 21. This program is critical because it ensures that even if a service is not typically covered under the standard NC Medicaid State Plan, it can be covered for recipients under 21 years of age if it is medically necessary and listed in the Social Security Act.

For more information:

NC Infant-Toddler Program (ITP)

The NC Infant-Toddler Program (ITP) provides supports and services for families and their children from birth to three years old who have special needs. Eligibility extends to children with certain levels of developmental delay or established conditions, such as autism. As part of the NC Division of Child and Family Well-Being, the ITP offers early intervention services coordinated locally by 16 Children's Developmental Services Agencies (CDSAs) across North Carolina.

For more information: https://www.ncdhhs.gov/divisions/child-and-family-well-being/north-carolina-infant-toddler-program-nc-itp/about-nc-itp

Community Alternatives Program for Children (CAP-C)

CAP-C is a Medicaid Home and Community-Based Services (HCBS) waiver program designed for children from birth through 20 years old who are considered medically fragile or complex. To be eligible, these children must be determined to require a level of institutional care under the North Carolina Medicaid State Plan, meaning they would qualify for care in a hospital or skilled nursing facility if not for the supports provided by the waiver. A key feature of this waiver is that Medicaid eligibility is determined solely on the child's income, not the entire family's income, which broadens access for many families who might otherwise be ineligible.

For more information: https://medicaid.ncdhhs.gov/providers/programs-services/long-term-care/community-alternatives-program-for-children

NC Department of Public Instruction - Office of Exceptional Children

Exceptional Education services in North Carolina are mandated for all students with disabilities from birth to age 21 who require special education and related services. It is operated through local school districts but the state Office of Exceptional Children has limited responsibilities supporting local school districts. Exceptional Children services include early intervention services for infants and toddlers and the provision of a Free, Appropriate Public Education (FAPE) to children aged 3 to 21 determined eligible for special education and related services. Most school districts and schools have additional information on their websites.

For more information: https://www.dpi.nc.gov/districts-schools/classroom-resources/exceptional-children

Visit NC DHHS and your LME/MCO to learn more or explore other services.