The Innovations Waiver is a Home and Community-Based Service Waiver under the Medicaid program that provides services to people with intellectual and/or developmental disabilities (like Autism, Cerebral Palsy, Down Syndrome, etc.). The purpose of the Waiver is to provide services in the community rather than providing services in an institution.
Neither you nor your family member need to be on Medicaid before you can apply for this program. The best way to see if you are eligible is to contact your Local Management Entity/Managed Care Organization (LME/MCO).
This Medicaid Waiver serves children and adults who might not otherwise qualify for Medicaid because their family income is too high. The family’s income is “waived” and only the income of the person with the disability is counted. There is a wait list for this program. The wait list is also sometimes referred to as the Registry of Unmet Needs or “RUN”.
Criteria #1 – The individual must r equire active treatment in, or the level of support provided by an intermediate care facility for intellectual disabilities (ICF-I/DD), but doesn’t need to be living in an ICF. An individual might be eligible if their disability is severe enough that they need services to address issues like :
Criteria #2 – The individual must h ave a diagnosis of intellectual disability (formerly known as mental retardation ) or a closely related condition other than mental illness that results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with intellectual disabilities. A utism and Cerebral Palsy are examples of closely related conditions that might negatively impact adaptive behavior or functioning, regardless of the individual’s I Q or cognitive ability .
Criteria #3 – The condition must have manifested before the individual turned age 22.
Criteria #4 – The condition is like ly to continue indefinitely.
Criteria #5 – The condition must result in “substantial functional limitations” in three or more areas of major life activity in these six categories:
You can read more a bout how someone would qualify as having a “substantial functional limi tation ” in these categories here: NCMedicaid: Intermediate Care Facilities for Individuals with Intellectual Disabilities, 8E. Generally, a psychologist or physician determines whether an individual has a sub stantial functional limitation in a major life activity.
Some of the s upports available to individuals who are on the Innovations Waiver include :
Please be aware that some of these services (or others) may be available to you while you wait for a waiver slot to become available. You will need to check with your LME/MCO about services that might be available while you are on the wait list.
Unfortunately, there are not enough Waiver “slots” for everyone who needs one in NC. Each of the state’s six Local Management Entities/Managed Care Organizations (LM E / M C O) keeps a wait list of people who have requested the Waiver. The wait list can be ten years long or longer. Waiver slots are awarded on a first come-first served basis, so the sooner you get on the list the better .
Although you will not receive Waiver services while on the wait list, your LME/MCO may refer you to other resources that can help while you are waiting for a slot.
You must contact the LME/MCO that provides behavioral health services for your county to request that you (or your child or ward) receive services under the Waiver. If you are eligible, t he LME/MCO will add your name to its wait list. Y ou should ask that they confirm the date of placement on the wait list in writing.
The state determines specific and very limited circumstances where a person can sometimes jump to the head of the Waiver wait list line. Here are some examples :
Learn more about the Innovations Waiver, including your right to appeal i f the LME/MCO refuses to add you to its wait list.