A North Carolina Family Guide
NC Innovations Waiver
Long-term home and community-based support for a loved one with an intellectual or developmental disability, including how the waitlist actually works and what to do while you wait.
Start Here
The program families ask about most.
If you are raising or caring for someone with an intellectual or developmental disability (IDD), the NC Innovations Waiver is often described as the goal: the program that funds long-term, individualized support so your loved one can live at home and in the community rather than in a facility.
It is also the program families have the most questions about, largely because of the waitlist. Here is the short version: the Innovations Waiver offers a broad menu of long-term services, but the number of funded slots is limited, so most families join a waitlist first. Understanding how eligibility, the waitlist, and the application work, and what support you can access while you wait, puts your family in the strongest possible position.
The waiver is offered only through Behavioral Health and IDD Tailored Plans. You must have a Tailored Plan to access waiver services.
The NC Innovations Waiver is a Medicaid 1915(c) Home and Community-Based Services waiver that funds long-term, individualized supports so people with IDD can live as independently as possible in their own homes and communities.
The Basics
What the Innovations Waiver actually is
The Innovations Waiver is North Carolina's Medicaid 1915(c) waiver for individuals with intellectual and other developmental disabilities. It was designed as an alternative to placement in an intermediate care facility, giving people the services and supports they need to remain in their communities and live as independently as possible. The current waiver is federally approved through June 30, 2029.
Its defining feature is breadth. Where some programs cover a focused set of services, the Innovations Waiver spans daily living, employment, community participation, caregiver relief, equipment, and home or vehicle modifications, coordinated around each person through a single plan. You and your family help decide which supports matter most.
Who Qualifies
Who is eligible for the Innovations Waiver?
Quick answerEligibility rests on three things: a qualifying IDD diagnosis, meeting an institutional (ICF/IID) level of care, and having NC Medicaid through a Tailored Plan. Anyone can apply regardless of income or insurance.
1. A qualifying disability
The individual has an intellectual disability, or a developmental disability that results in similar support needs, such as autism, Down syndrome, or cerebral palsy, that began before adulthood. You can review the state's full Innovations Waiver eligibility criteria.
2. An institutional level of care
The person must need support at the level an intermediate care facility for individuals with intellectual disabilities (ICF/IID) would provide. This is confirmed through an assessment of daily support needs.
3. NC Medicaid through a Tailored Plan
Waiver services are only available through a Tailored Plan. Anyone can apply regardless of income or insurance, and Medicaid financial eligibility is determined if a slot becomes available. Apply as soon as you have a diagnosis to secure your place in line.
What It Covers
A comprehensive menu of supports
The Innovations Waiver is known for its range. Services are grouped below to show how broad the support can be; a person receives only the services their plan calls for. See the state's full list of Innovations Waiver services for details.
Living & daily support
Community Living and Supports, Residential Supports, and Supported Living help a person build daily living skills and receive the level of in-home or residential support they need.
Work & community
Supported Employment, Day Supports, and Community Networking help individuals find meaningful work, build skills, and take part in community life.
Family & caregiver support
Respite, Natural Supports Education, and Community Transition give caregivers relief and help families plan for greater independence over time.
Equipment & environment
Assistive Technology, Home Modifications, Vehicle Modifications, and Specialized Consultation adapt a person's tools and surroundings so they can do more on their own.
The Part Families Worry About
How the waitlist really works
Quick answerBecause funded slots are limited and demand is high, most families are placed on the Registry of Unmet Needs, commonly called the "Innovations waitlist," after being found potentially eligible.
A few things are important to understand about how it works. Each county keeps its own waitlist, and people who have waited the longest are generally served first. New slots open only when someone no longer needs the waiver or when the North Carolina General Assembly funds additional slots. A limited number of slots are held back for emergencies and extraordinary circumstances.
- Apply early. Being added to the registry secures your place in line, so apply as soon as you have a diagnosis, even if a slot is years away.
- Staying on the list costs you nothing else. Being on the waitlist does not affect other Medicaid services your loved one receives.
- Keep your contact information current. Your Tailored Plan reaches out as your name nears the top, so make sure they can find you.
- Check county counts. NC Medicaid publishes waitlist numbers by county on the Innovations Waitlist Dashboard.
While You Wait
The Innovations Waiver and 1915(i), together
Don't wait with nothingIf the waitlist feels daunting, you are not stuck. NC Medicaid 1915(i) offers a smaller set of home and community-based services with no waiver-slot waitlist, and many families use it while on the Innovations list.
Think of the two programs as complementary. The Innovations Waiver is the long-term, comprehensive goal; 1915(i) provides practical support that improves daily life in the meantime. When an Innovations slot opens, your care team helps you decide whether transitioning is right, since a person generally cannot receive both at the same time.
| Feature | NC Innovations Waiver | NC Medicaid 1915(i) |
|---|---|---|
| Waiting list | Yes, statewide waitlist | No waiver-slot waitlist |
| Medicaid structure | 1915(c) HCBS Waiver | State Plan HCBS benefit |
| Range of services | Comprehensive long-term supports | Four primary IDD services |
| Residential services | Yes | Limited |
| Best thought of as | The long-term goal | Support while you wait |
How to Apply
Getting on the waitlist, step by step
NC Medicaid outlines the official process on its How to Apply page. Here is how it works in practice.
Contact your Tailored Plan
Reach the Tailored Plan or LME/MCO serving your county and ask to apply for the NC Innovations Waiver, and to be added to the Registry of Unmet Needs. Anyone can apply, regardless of income or insurance.
Complete screening and assessment
You will provide diagnosis documentation and complete a level-of-care assessment. Support needs are measured with the Supports Intensity Scale (SIS), typically reassessed every three years for adults and every two years for children age 16 and younger.
Join the Registry of Unmet Needs
If no slot is available, your loved one is placed on the county waitlist. Keep your contact information current so you do not lose your place, and ask about 1915(i) and other supports you can use while you wait.
When a Slot Opens
What happens next
The good partWhen a slot becomes available, your team builds an Individual Support Plan around your loved one's goals. Once the care plan is approved, services generally begin within 45 calendar days.
You, your care manager, and your chosen providers develop the plan together, and you can select and change providers within your Tailored Plan's network. The state describes the full process on its What Happens When You Get a Slot page. This is the moment years of planning pays off, and preparation makes the transition smoother.
Your Advocate
Choosing a case management partner
The Innovations Waiver rewards preparation, and the right partner helps you apply, stay ready on the waitlist, and coordinate support in the meantime. 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
How long is the NC Innovations Waiver waitlist?
Wait times vary widely by county and can be several years. Each county keeps its own Registry of Unmet Needs, and people who have waited longest are generally served first. Slots open only when someone no longer needs the waiver or when the North Carolina General Assembly funds new slots. County counts are published on the Innovations Waitlist Dashboard.
Can I get help while I am on the waitlist?
Yes. Many families use NC Medicaid 1915(i) services, Tailored Care Management, and state-funded services while they wait. These supports do not affect your place on the waitlist.
Who is eligible for the NC Innovations Waiver?
People with an intellectual or developmental disability who meet an intermediate care facility (ICF/IID) level of care and have NC Medicaid through a Tailored Plan. Anyone can apply regardless of income or insurance.
How do I apply for the NC Innovations Waiver?
Contact the Tailored Plan or LME/MCO serving your county and ask to be added to the Registry of Unmet Needs (the Innovations waitlist). Apply as soon as you have a diagnosis to secure your place in line.
What happens when a slot opens?
Your team develops an Individual Support Plan built around the person's goals. Once the care plan is approved, services generally begin within 45 calendar days.
How can Covenant Case Management Services help?
We help families apply, get on the waitlist, coordinate 1915(i) and other supports while waiting, and prepare for a smooth start when a slot opens.
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.
The Innovations Waiver can feel like a long road, but you do not have to walk it alone or empty-handed. With the right guidance, a place on the waitlist, and support in the meantime, your family can keep moving toward the life your loved one deserves.
Let's Navigate This Together
You have a partner in North Carolina.
Whether you are applying for the Innovations Waiver, waiting for a slot, or coordinating 1915(i) support in the meantime, Covenant Case Management Services is here to help. Together, we can build a plan that fits your family and keeps you moving forward.
Albemarle, NC 28001
A North Carolina Family Guide
NC Innovations Waiver
Long-term home and community-based support for a loved one with an intellectual or developmental disability, including how the waitlist actually works and what to do while you wait.
Start Here
The program families ask about most.
If you are raising or caring for someone with an intellectual or developmental disability (IDD), the NC Innovations Waiver is often described as the goal: the program that funds long-term, individualized support so your loved one can live at home and in the community rather than in a facility.
It is also the program families have the most questions about, largely because of the waitlist. Here is the short version: the Innovations Waiver offers a broad menu of long-term services, but the number of funded slots is limited, so most families join a waitlist first. Understanding how eligibility, the waitlist, and the application work, and what support you can access while you wait, puts your family in the strongest possible position.
The waiver is offered only through Behavioral Health and IDD Tailored Plans. You must have a Tailored Plan to access waiver services.
In one sentenceThe NC Innovations Waiver is a Medicaid 1915(c) Home and Community-Based Services waiver that funds long-term, individualized supports so people with IDD can live as independently as possible in their own homes and communities.
The Basics
What the Innovations Waiver actually is
The Innovations Waiver is North Carolina's Medicaid 1915(c) waiver for individuals with intellectual and other developmental disabilities. It was designed as an alternative to placement in an intermediate care facility, giving people the services and supports they need to remain in their communities and live as independently as possible. The current waiver is federally approved through June 30, 2029.
Its defining feature is breadth. Where some programs cover a focused set of services, the Innovations Waiver spans daily living, employment, community participation, caregiver relief, equipment, and home or vehicle modifications, coordinated around each person through a single plan. You and your family help decide which supports matter most.
Who Qualifies
Who is eligible for the Innovations Waiver?
Quick answerEligibility rests on three things: a qualifying IDD diagnosis, meeting an institutional (ICF/IID) level of care, and having NC Medicaid through a Tailored Plan. Anyone can apply regardless of income or insurance.
1. A qualifying disability
The individual has an intellectual disability, or a developmental disability that results in similar support needs, such as autism, Down syndrome, or cerebral palsy, that began before adulthood. You can review the state's full Innovations Waiver eligibility criteria.
2. An institutional level of care
The person must need support at the level an intermediate care facility for individuals with intellectual disabilities (ICF/IID) would provide. This is confirmed through an assessment of daily support needs.
3. NC Medicaid through a Tailored Plan
Waiver services are only available through a Tailored Plan. Anyone can apply regardless of income or insurance, and Medicaid financial eligibility is determined if a slot becomes available. Apply as soon as you have a diagnosis to secure your place in line.
What It Covers
A comprehensive menu of supports
The Innovations Waiver is known for its range. Services are grouped below to show how broad the support can be; a person receives only the services their plan calls for. See the state's full list of Innovations Waiver services for details.
Living & daily support
Community Living and Supports, Residential Supports, and Supported Living help a person build daily living skills and receive the level of in-home or residential support they need.
Work & community
Supported Employment, Day Supports, and Community Networking help individuals find meaningful work, build skills, and take part in community life.
Family & caregiver support
Respite, Natural Supports Education, and Community Transition give caregivers relief and help families plan for greater independence over time.
Equipment & environment
Assistive Technology, Home Modifications, Vehicle Modifications, and Specialized Consultation adapt a person's tools and surroundings so they can do more on their own.
The Part Families Worry About
How the waitlist really works
Quick answerBecause funded slots are limited and demand is high, most families are placed on the Registry of Unmet Needs, commonly called the "Innovations waitlist," after being found potentially eligible.
A few things are important to understand about how it works. Each county keeps its own waitlist, and people who have waited the longest are generally served first. New slots open only when someone no longer needs the waiver or when the North Carolina General Assembly funds additional slots. A limited number of slots are held back for emergencies and extraordinary circumstances.
- Apply early. Being added to the registry secures your place in line, so apply as soon as you have a diagnosis, even if a slot is years away.
- Staying on the list costs you nothing else. Being on the waitlist does not affect other Medicaid services your loved one receives.
- Keep your contact information current. Your Tailored Plan reaches out as your name nears the top, so make sure they can find you.
- Check county counts. NC Medicaid publishes waitlist numbers by county on the Innovations Waitlist Dashboard.
While You Wait
The Innovations Waiver and 1915(i), together
Don't wait with nothingIf the waitlist feels daunting, you are not stuck. NC Medicaid 1915(i) offers a smaller set of home and community-based services with no waiver-slot waitlist, and many families use it while on the Innovations list.
Think of the two programs as complementary. The Innovations Waiver is the long-term, comprehensive goal; 1915(i) provides practical support that improves daily life in the meantime. When an Innovations slot opens, your care team helps you decide whether transitioning is right, since a person generally cannot receive both at the same time.
| Feature | NC Innovations Waiver | NC Medicaid 1915(i) |
|---|---|---|
| Waiting list | Yes, statewide waitlist | No waiver-slot waitlist |
| Medicaid structure | 1915(c) HCBS Waiver | State Plan HCBS benefit |
| Range of services | Comprehensive long-term supports | Four primary IDD services |
| Residential services | Yes | Limited |
| Best thought of as | The long-term goal | Support while you wait |
How to Apply
Getting on the waitlist, step by step
NC Medicaid outlines the official process on its How to Apply page. Here is how it works in practice.
Contact your Tailored Plan
Reach the Tailored Plan or LME/MCO serving your county and ask to apply for the NC Innovations Waiver, and to be added to the Registry of Unmet Needs. Anyone can apply, regardless of income or insurance.
Complete screening and assessment
You will provide diagnosis documentation and complete a level-of-care assessment. Support needs are measured with the Supports Intensity Scale (SIS), typically reassessed every three years for adults and every two years for children age 16 and younger.
Join the Registry of Unmet Needs
If no slot is available, your loved one is placed on the county waitlist. Keep your contact information current so you do not lose your place, and ask about 1915(i) and other supports you can use while you wait.
When a Slot Opens
What happens next
The good partWhen a slot becomes available, your team builds an Individual Support Plan around your loved one's goals. Once the care plan is approved, services generally begin within 45 calendar days.
You, your care manager, and your chosen providers develop the plan together, and you can select and change providers within your Tailored Plan's network. The state describes the full process on its What Happens When You Get a Slot page. This is the moment years of planning pays off, and preparation makes the transition smoother.
Your Advocate
Choosing a case management partner
The Innovations Waiver rewards preparation, and the right partner helps you apply, stay ready on the waitlist, and coordinate support in the meantime. 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
How long is the NC Innovations Waiver waitlist?
Wait times vary widely by county and can be several years. Each county keeps its own Registry of Unmet Needs, and people who have waited longest are generally served first. Slots open only when someone no longer needs the waiver or when the North Carolina General Assembly funds new slots. County counts are published on the Innovations Waitlist Dashboard.
Can I get help while I am on the waitlist?
Yes. Many families use NC Medicaid 1915(i) services, Tailored Care Management, and state-funded services while they wait. These supports do not affect your place on the waitlist.
Who is eligible for the NC Innovations Waiver?
People with an intellectual or developmental disability who meet an intermediate care facility (ICF/IID) level of care and have NC Medicaid through a Tailored Plan. Anyone can apply regardless of income or insurance.
How do I apply for the NC Innovations Waiver?
Contact the Tailored Plan or LME/MCO serving your county and ask to be added to the Registry of Unmet Needs (the Innovations waitlist). Apply as soon as you have a diagnosis to secure your place in line.
What happens when a slot opens?
Your team develops an Individual Support Plan built around the person's goals. Once the care plan is approved, services generally begin within 45 calendar days.
How can Covenant Case Management Services help?
We help families apply, get on the waitlist, coordinate 1915(i) and other supports while waiting, and prepare for a smooth start when a slot opens.
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.
The Innovations Waiver can feel like a long road, but you do not have to walk it alone or empty-handed. With the right guidance, a place on the waitlist, and support in the meantime, your family can keep moving toward the life your loved one deserves.
Let's Navigate This Together
You have a partner in North Carolina.
Whether you are applying for the Innovations Waiver, waiting for a slot, or coordinating 1915(i) support in the meantime, Covenant Case Management Services is here to help. Together, we can build a plan that fits your family and keeps you moving forward.
Albemarle, NC 28001