A North Carolina Family Guide
NC Medicaid 1915(i) Services
Plain-language answers for families supporting a loved one with an intellectual or developmental disability, without the jargon or the guesswork.
Start Here
You have questions. Let's make this simple.
If you support a child or adult with an intellectual or developmental disability (IDD), you have probably spent hours untangling Medicaid programs, waiver lists, and community resources. Somewhere along the way, the term NC Medicaid 1915(i) likely came up, technical-sounding and easy to mistake for one more waitlist.
Here is the short version: 1915(i) is designed to make home and community-based support easier to reach. Unlike the NC Innovations Waiver and its lengthy waitlist, 1915(i) allows many eligible individuals to receive meaningful services without waiting years for a waiver slot. These services help people build daily living skills, take part in their communities, pursue employment, and give family caregivers real relief.
North Carolina created these services so people can remain in their own homes and neighborhoods rather than relying on institutional care. Today, 1915(i) is available through Behavioral Health and IDD Tailored Plans, NC Medicaid Direct, and the Eastern Band of Cherokee Indians (EBCI) Tribal Option, not through Standard Plans.
1915(i) is a North Carolina Medicaid State Plan benefit that provides Home and Community-Based Services so eligible individuals can live, learn, work, and take part in their own communities.
The Basics
What a 1915(i) program actually is
The term comes from Section 1915(i) of the Social Security Act, which lets states provide Home and Community-Based Services (HCBS) through their Medicaid programs (see NC Medicaid's official 1915(i) overview). The legal language sounds complex, but the goal is straightforward: help people get the support they need while living in their own homes and taking part in community life.
Instead of requiring someone to qualify for institutional-level care before receiving services, 1915(i) offers community-based support earlier, and works to prevent that level of need from ever developing. North Carolina uses this authority to reach several populations:
Built around everyday life
For families of individuals with IDD, support is tailored to real daily living rather than medical tasks alone. A trained professional might help someone learn to cook meals, manage personal care, build social skills, navigate public transportation, prepare for a first job, or take part in community activities. Every plan is individual, because every person's goals, strengths, and challenges are different.
Who Qualifies
Who can receive 1915(i) services?
Quick answerHaving Medicaid alone is not enough. Eligibility rests on three things: the right Medicaid plan, a qualifying condition, and an independent assessment of support needs.
1. Full NC Medicaid in an eligible plan
The individual must have full North Carolina Medicaid and be enrolled in an eligible plan: a Tailored Plan (Alliance Health, Partners Health Management, Trillium Health Resources, or Vaya Health), NC Medicaid Direct, or the EBCI Tribal Option. Standard Plan members must transition to an eligible plan first, which you can do through the NC Medicaid Enrollment Broker. For the full criteria, see NC Medicaid's 1915(i) eligibility page.
2. A qualifying condition
For the IDD population, this may include autism spectrum disorder, Down syndrome, fetal alcohol spectrum disorder, or another intellectual or developmental disability that substantially affects daily functioning.
3. An independent assessment
A clinical assessment confirms whether the person's support needs meet the criteria for 1915(i). It exists to match services to genuine need, not to fit everyone into the same box.
One important note on the waiver: receiving the NC Innovations Waiver generally makes someone ineligible for 1915(i), since the programs overlap. However, individuals on the Innovations Waiver waiting list may still qualify, making 1915(i) a meaningful resource while you wait.
What It Covers
Four services for individuals with IDD
Families often ask, "What exactly does 1915(i) pay for?" The answer depends on the person's needs, but North Carolina currently offers four primary service categories for individuals with intellectual and developmental disabilities.
Community Living & Supports
The foundation of the program. Direct support professionals work with individuals at home and in the community to build daily living skills: meal preparation, budgeting, communication, personal care, and community participation. The goal is confidence and independence over time, not just completed tasks.
Supported Employment
Meaningful work. Employment specialists help individuals explore careers, prepare for interviews, learn workplace responsibilities, and receive on-the-job coaching, reflecting North Carolina's emphasis on competitive, integrated employment at competitive wages.
Respite
Something every caregiver deserves but rarely receives: time to recharge. Temporary, quality care allows caregivers to attend appointments, spend time with other family members, or simply rest, knowing their loved one is receiving person-centered support.
Community Transition
A move toward independence. This service assists eligible individuals moving from approved settings into their own community homes by covering certain one-time transition expenses and supports (up to a $5,000 transition credit).
Know the Difference
1915(i) vs. the NC Innovations Waiver
Quick answerBoth provide home and community-based services for people with IDD. The key difference: 1915(i) is a State Plan benefit with no waiver-slot waitlist, while the Innovations Waiver has limited funded slots and a long statewide waiting list.
The Innovations Waiver offers a broader array of long-term supports, including residential services, assistive technology, specialized therapies, and home or vehicle modifications. Because demand exceeds funding, thousands of North Carolinians wait years for a slot. 1915(i) offers a smaller but highly valuable set of services, with no waitlist in the way.
| Feature | NC Medicaid 1915(i) | NC Innovations Waiver |
|---|---|---|
| Waiting list | No waiver-slot waitlist | Yes, statewide waitlist |
| Medicaid structure | State Plan HCBS benefit | Home & Community-Based Waiver |
| Range of services | Four primary IDD services | Comprehensive long-term supports |
| Residential services | Limited | Yes |
| Supported employment | Yes | Yes |
| Community living & supports | Yes | Yes |
| Respite | Yes | Yes |
New to the waiver, or waiting for a slot? Read our companion NC Innovations Waiver family guide for eligibility, services, and how the waitlist works.
Why It Matters & How to Apply
Real benefits, and how to apply
For individuals, 1915(i) creates opportunities to build independence: preparing meals, using public transportation, or communicating confidently at work. For caregivers, respite offers rest and peace of mind. And for the whole family, it enables a shift from crisis management to planning ahead: employment, independent living, and personal goals.
NC Medicaid outlines the official process on its How to Get 1915(i) Services page. Here is how it works in practice.
Three steps to services
Confirm Medicaid eligibility and plan
Your loved one needs full NC Medicaid and enrollment in an eligible plan: a Tailored Plan, NC Medicaid Direct, or the EBCI Tribal Option. If they are on a Standard Plan, use the NC Medicaid Enrollment Broker to determine whether a Tailored Plan or NC Medicaid Direct is the right fit.
Complete the independent assessment
A clinical assessment reviews daily support needs, behavioral health needs when applicable, and the ability to live and participate safely in the community. Documentation from physicians, psychologists, therapists, or schools may be requested.
Build the Person-Centered Plan
If approved, the individual works with their care manager and providers to develop a plan built around goals, strengths, and preferences, then selects the services that support those priorities.
Your Advocate
Choosing a case management partner
Even when families qualify, the terminology, assessments, and provider networks can feel overwhelming. A knowledgeable case manager becomes an advocate who helps you understand resources, connect with providers, coordinate services, and prepare for future transitions. Learn more about Covenant and how our case management services work. When evaluating a provider, look for these strengths:
- Person-centered planning that starts with the individual's goals, not the paperwork
- Strong community partnerships and a real, working provider network
- Responsive, plain-language communication your family can rely on
- Genuine experience supporting individuals with IDD across the lifespan
Common Questions
Frequently asked questions
What is NC Medicaid 1915(i)?
A Home and Community-Based Services State Plan benefit that provides Community Living and Supports, Supported Employment, Respite, and Community Transition to help eligible individuals live successfully in their communities.
Who qualifies for 1915(i) services?
Individuals with full NC Medicaid, enrollment in an eligible plan (a Tailored Plan, NC Medicaid Direct, or the EBCI Tribal Option), and qualifying support needs related to an intellectual or developmental disability, confirmed through an independent assessment.
Can someone receive both 1915(i) and the NC Innovations Waiver?
No. Individuals actively receiving Innovations Waiver services cannot also receive 1915(i), because the programs offer similar supports. However, individuals on the Innovations Waiver waiting list may qualify for 1915(i), and many use it as a bridge while they wait.
Does NC Medicaid 1915(i) have a waiting list?
Unlike the Innovations Waiver, 1915(i) is not limited by waiver slots. Eligible individuals who meet the program requirements can receive services without joining a statewide waiver waiting list.
How can Covenant Case Management Services help?
We help individuals and families understand Medicaid programs, coordinate care, develop person-centered plans, connect with community resources, and navigate services like 1915(i) and the NC Innovations Waiver, so you can make informed decisions with confidence.
Go Deeper
Official resources and next steps
Official NC Medicaid resources
Primary sources from the NC Department of Health and Human Services. These open in a new tab.
Related from Covenant
Our Promise
Every person deserves the chance to thrive with purpose.
Behind the terminology, 1915(i) has a simple aim: helping individuals with intellectual and developmental disabilities live meaningful lives at home and in their communities. With the right guidance and a person-centered plan, your family can move from navigating a system to building a future.
Let's Navigate This Together
You have a partner in North Carolina.
If you are exploring 1915(i) services or want to understand how they compare to the NC Innovations Waiver, Covenant Case Management Services is here to help. Together, we can identify the supports that best meet your family's needs.
Albemarle, NC 28001