How to Qualify for Respite Care in NC | Medicaid & IDD Guide
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Short answer: To qualify for respite care in North Carolina, an individual age 3 or older needs a documented intellectual or developmental disability (IDD) or traumatic brain injury (TBI), a need for continuous supervision, a caregiver who needs relief, and no other natural supports. The fastest route is 1915(i) respite through a NC Medicaid Tailored Plan, which covers up to 300 hours per plan year. The NC Innovations Waiver is a second route with a waitlist.
Caregiving for an individual with IDD or TBI is a full-time commitment, and planned breaks protect the whole family. North Carolina funds respite through two Medicaid pathways. Knowing which one fits, and what to have ready, removes most of the delay.
Two NC Medicaid Routes to Respite Care
NC Medicaid offers respite through the 1915(i) State Plan service and through the NC Innovations Waiver. The chart below compares them side by side.
NC Respite Care: Two Medicaid Routes Compared
Both routes fund respite for individuals with IDD. They differ in who qualifies, how fast, and which plan you need.
| 1915(i) Respite | NC Innovations Waiver | |
|---|---|---|
| What it is | State Plan Medicaid service under Clinical Coverage Policy 8H-4 | Home and community-based services waiver (1915(c)) with respite among its services |
| Core eligibility | Age 3 or older, documented IDD or TBI, need for continuous supervision, caregiver needs relief, no other natural supports available | IDD diagnosis, ICF-IID level of care, and Medicaid eligibility |
| Health plan needed | Tailored Plan (not available through Standard Plans) | Request through your LME/MCO; a slot must be open |
| Wait | No registry; assessments then prior approval | Registry of Unmet Needs; slots open as funding allows |
| Respite limit | 1,200 units (300 hours) per plan year | Set in your person-centered plan and approved by the LME/MCO |
| Who can apply | Medicaid beneficiary through the Tailored Plan | Anyone may ask to be placed on the registry; Medicaid is not required to apply |
| Can you hold both? | No. Individuals receiving respite through the Innovations Waiver are not eligible for 1915(i) respite. | |
Source: NC Medicaid Clinical Coverage Policy 8H-4 and NC Medicaid Innovations Waiver pages. Current as of October 2026. Confirm details with your health plan.
Who Qualifies for 1915(i) Respite Care?
1915(i) respite is governed by NC Medicaid Clinical Coverage Policy 8H-4. The individual must meet all of these criteria:
- Is age 3 or older
- Has a documented IDD or TBI
- Needs continuous supervision
- Has a caregiver who needs relief
- Has no other natural supports available to provide that relief
Eligibility is confirmed through an independent evaluation by the Division of Health Benefits and an independent assessment by a tailored care manager. The individual must be enrolled in a Tailored Plan. Standard Plans do not offer 1915(i) services. Our 1915(i) family guide explains the full service array.
Who Qualifies for the NC Innovations Waiver?
The Innovations Waiver serves individuals with IDD who meet ICF-IID level of care and are eligible for Medicaid. Anyone can ask their LME/MCO to be placed on the registry of unmet needs, regardless of age, income, or insurance, and Medicaid is not required to apply. Slots open as state funding allows, so the wait can be long. Review NC Medicaid’s Innovations eligibility page and our Innovations Waiver family guide.
One rule matters here. Individuals who receive respite through the Innovations Waiver cannot also receive 1915(i) respite. Most families use 1915(i) while they wait for an Innovations slot.
Which Route Should You Start With?
Which NC Respite Route Should You Start With?
Answer in order. Start the route that fits, and ask about the other in parallel.
Educational guide only. Eligibility decisions are made by NC Medicaid and your health plan. Current as of October 2026.
How to Apply for 1915(i) Respite, Step by Step
How to Get 1915(i) Respite in NC: 6 Steps
From first call to first respite shift.
Confirm Medicaid and plan type
Call the NC Medicaid Enrollment Broker at 1-833-870-5500 if you are not sure which plan you have. 1915(i) requires a Tailored Plan.
Contact your Tailored Plan or LME/MCO
Ask for a 1915(i) eligibility review and respite services. Say you need caregiver relief and continuous supervision for the individual.
Pull your documentation
Gather the IDD or TBI diagnosis, recent evaluations, and records that show supervision needs and the absence of other natural supports.
Complete the independent reviews
An independent evaluation by the Division of Health Benefits and an independent assessment by a tailored care manager confirm eligibility.
Get the service order and prior approval
Respite needs a service order, valid for one year, and prior approval from the health plan.
Choose a provider and start
Pick an enrolled respite provider. A relative or guardian who lives in the home cannot be the respite provider. Track your hours against the annual limit.
Source: NC Medicaid Clinical Coverage Policy 8H-4 (amended 2/1/2024). Current as of October 2026.
Documents to have ready
- Medicaid ID and health plan information
- Written diagnosis of IDD or TBI from a qualified clinician
- Recent psychological, medical, or functional evaluations
- A short written description of daily supervision needs
- A list of family, friends, or community supports and why they cannot provide relief
- Guardianship papers, if applicable
What 1915(i) Respite Covers and Its Limits
Respite is capped at 1,200 units, or 300 hours, per plan year. Each unit is 15 minutes. The service requires prior approval, and the service order is valid for one year. It is not available to individuals living in institutions. The chart shows how the annual limit breaks down.
What 300 Hours of 1915(i) Respite Looks Like
1,200 units at 15 minutes each equals 300 hours per plan year. Spread evenly, that is about 25 hours a month.
Illustrative even spread. You can use hours unevenly, for example for a planned week away. Limit applies per plan year and requires prior approval. Source: NC Medicaid Clinical Coverage Policy 8H-4, section 5.2.2.
If You Do Not Meet the Criteria Yet
- Ask for the Innovations registry. Request placement now. Time on the registry matters.
- Ask about state-funded respite. North Carolina law (G.S. 143B-181.10) establishes a state respite care program. Ask your LME/MCO and local Area Agency on Aging what funding exists in your county.
- Appeal or ask for help. If your plan cannot solve a problem, call the NC Medicaid Ombudsman at 1-877-201-3750.
- Confirm your plan. The NC Medicaid Enrollment Broker at 1-833-870-5500 can tell you which plan you have and how to change it.
How Covenant Helps Families Get Respite
Covenant Case Management Services is a CARF-accredited provider serving families across North Carolina. Our GracePause respite care gives caregivers dependable time to rest. Our IDD and TBI case management team helps you understand your options and gather what your plan needs. Call us to confirm which funding sources and settings apply to your situation.
Talk With Our Team(704) 780-4552 • info@covenantcms.com • 421 West Main Street, Albemarle, NC 28001
Frequently Asked Questions About NC Respite Care
Who qualifies for respite care in North Carolina?
Individuals age 3 or older with a documented intellectual or developmental disability (IDD) or traumatic brain injury (TBI) who need continuous supervision, whose caregivers need relief, and who have no other natural supports can qualify for 1915(i) respite through a Tailored Plan. The NC Innovations Waiver is a second route for individuals with IDD who meet ICF-IID level of care.
How many respite hours does NC Medicaid cover?
NC Medicaid 1915(i) respite is limited to 1,200 units, or 300 hours, per plan year, with prior approval. Respite hours under the Innovations Waiver are set in the individual’s person-centered plan and approved by the LME/MCO.
Do I need a Tailored Plan to get respite care?
For 1915(i) respite, yes. The service is not available through Standard Plans. Call the NC Medicaid Enrollment Broker at 1-833-870-5500 to confirm which plan you have.
Can I get respite care without Medicaid?
Not through 1915(i), which is a Medicaid service. Anyone can ask to be placed on the Innovations Waiver registry without having Medicaid, and North Carolina also offers state-funded respite. Ask your LME/MCO what is available in your county.
Can a family member be the respite provider?
A relative or guardian who lives in the home cannot provide 1915(i) respite. A qualified provider outside the household delivers the service.
Can I have both 1915(i) respite and the Innovations Waiver?
No. Individuals who receive respite through the Innovations Waiver are not eligible for 1915(i) respite. Many families use 1915(i) respite while they wait for an Innovations slot.
How long does it take to get approved for respite in NC?
Timelines vary by health plan. The process includes an independent evaluation, an independent assessment by a tailored care manager, a service order, and prior approval. Starting the request early and having your diagnostic records ready shortens the wait.
How can Covenant Case Management Services help with respite care?
Covenant offers GracePause respite care and IDD/TBI case management across North Carolina. Our team helps families understand their options, gather documentation, and connect with the right services. Call (704) 780-4552 or use our contact form.
Related Guides
- NC Medicaid 1915(i) Services: Family Guide
- NC Innovations Waiver: Family Guide
- IDD and TBI Caregiver Resources in NC
- More How-To Guides
- Covenant FAQ
Sources
- NC Medicaid Clinical Coverage Policy 8H-4: 1915(i) Respite
- NC Medicaid: 1915(i) Services
- NC Medicaid: NC Innovations Waiver
- NC Medicaid: Tailored Plans
Information current as of October 2026. This guide is educational and is not legal, medical, or financial advice. Eligibility, approval, and service limits are determined by NC Medicaid and your health plan and can change. Confirm details with your plan before you act.
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