North Carolina Medicaid waiver guide
Learn how North Carolina Medicaid waiver services work, which state agency to start with, how the application process usually begins, and where to search for home and community-based services.
Last reviewed July 2026. See something out of date? Use the “Suggest an edit” button to let us know.
North Carolina's main waiver for people with intellectual and developmental disabilities is NC Innovations, administered by regional Local Management Entity/Managed Care Organizations (LME/MCOs). The waitlist — formerly called the Registry of Unmet Needs, and still sometimes referred to as the RUN — is long. But North Carolina is unusually generous at the front end: anyone can apply regardless of age, income, or insurance, so there is no reason to screen yourself out. And there is a second program, 1915(i), with no waitlist at all, that you can use while you wait without affecting your Innovations position.
Search by state, city, or ZIP code to compare provider profiles, services, contact details, and verified status.
People of all ages with an intellectual or developmental disability or related condition, meeting ICF-IID level of care
People who need support now — no waitlist, and enrolling does not affect your Innovations waitlist position
People with traumatic brain injury, in participating regions
The Innovations Waiver serves North Carolinians of all ages with an intellectual or developmental disability or a related condition — including autism, cerebral palsy, Down syndrome, epilepsy, fetal alcohol spectrum disorder, and traumatic brain injury occurring before age 22. You must need substantial support now and going forward, meeting an ICF-IID level of care. There are no income or insurance requirements to apply: you can apply even with private insurance and even without NC Medicaid coverage, because placement on the waitlist happens early in the process.
Qualifying conditions include autism, cerebral palsy, Down syndrome, epilepsy, fetal alcohol spectrum disorder, and traumatic brain injury occurring before age 22.
You must need substantial support now and in the future — help with daily activities like bathing or dressing, or with community living tasks such as cooking or employment — at a level comparable to intermediate care facility residents.
Anyone can apply regardless of age, income, or insurance. You can apply with private insurance and without NC Medicaid. Do not disqualify yourself before applying — placement on the waitlist happens early in the process.
Your LME/MCO conducts eligibility assessments, including the Supports Intensity Scale, and manages the waitlist for your county.
Each LME/MCO manages its own waitlist by county, and people are generally served in the order they applied. A limited number of slots are reserved for people with extraordinary circumstances or emergencies. The list was formerly called the Registry of Unmet Needs, so you will still encounter “RUN” in older materials and conversations.
Use the LME/MCO directory, or call the Division of Mental Health, Developmental Disabilities and Substance Use Services Customer Service Team at 1-855-262-1946.
Open linkAsk to apply for the NC Innovations Waiver. Anyone can apply regardless of age, income, or insurance, and the state encourages people to apply even when unsure about eligibility, because getting on the list happens early.
Depending on your situation the LME/MCO may request medical records and other documentation, and will conduct assessments including the Supports Intensity Scale.
This is the most useful step available in North Carolina. 1915(i) offers similar supports — help with daily activities, job coaching — and has no waitlist for enrollment. Applying does not affect your position on the Innovations waitlist.
Open linkLME/MCOs reach people by phone and mail when slots open. Update your details whenever they change, and notify them if your needs increase — that can matter for the reserved emergency slots.
Exact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.
The Innovations Waiver includes self-direction options that let participants and families hire and manage their own staff and direct parts of their budget. Ask your care manager which services can be self-directed and what the employer responsibilities involve.
Approved waiver services are paid by NC Medicaid, which also brings health coverage, dental benefits, and medical transportation. Once enrolled, there is generally little or no direct cost for covered services.
Applying to the Innovations waitlist does not require NC Medicaid or any particular income level — you can apply with private insurance. Medicaid matters when a slot becomes available, not when you get in line.
1915(i) covers real supports including help with daily activities and job coaching, with no waitlist. Treat it as something to pursue in parallel rather than as a fallback.
North Carolina's Infant-Toddler Program provides early intervention, separately from the Innovations Waiver. You can apply to the Innovations waitlist at the same time.
Because the waitlist generally follows application date and there is no income or insurance barrier, applying early is the highest-leverage step available. The state explicitly encourages applying even when unsure.
Traumatic brain injury qualifies for Innovations if it occurred before age 22. Make sure documentation establishing the timing exists.
Use 1915(i), keep your contact information current with your LME/MCO, and report increases in need — reserved slots exist for extraordinary circumstances and emergencies.
If eligibility or a waiver service is denied, reduced, or ended, you have the right to appeal and to request a Medicaid fair hearing within the deadline printed on your notice. Because services run through an LME/MCO, there is usually a plan-level appeal too — ask for both in writing. Disability Rights North Carolina is the state's designated protection and advocacy organization.
Protection & Advocacy organization for North Carolina
1-877-235-4210Visit siteFind the LME/MCO serving your county
1-855-262-1946Visit siteEligibility, services, waitlist, and what happens when you get a slot
Visit siteNCDHHS's published data on how the waitlist is moving
Visit siteFree advocacy — 919-856-2195 locally, TTY relay 711
1-877-235-4210Visit siteLocal help & referrals — dial 211
Visit siteYes. Anyone can apply for the Innovations Waiver regardless of age, income, or insurance — you can apply with private coverage and without NC Medicaid. The state explicitly encourages applying even when you are unsure, because getting on the waitlist happens early in the process and the wait is long.
Yes, and this is the most important thing to know. 1915(i) services cover help with daily activities and job coaching, and have no waitlist for enrollment. Applying for them does not affect your position on the Innovations waitlist, so there is no downside.
It is the old name for the Innovations waitlist, still abbreviated RUN in many conversations and documents. If someone refers to the RUN, they mean the waitlist.
A limited number of slots are reserved for people with extraordinary circumstances or emergencies. If your situation has changed since you applied, contact your LME/MCO — they cannot consider a change they do not know about.
By phone and mail. That makes keeping your contact information current with your LME/MCO essential — after a long wait, an unreachable phone number or old address is an avoidable way to miss a slot.
The Innovations Waiver serves North Carolinians of all ages with an intellectual or developmental disability or a related condition — including autism, cerebral palsy, Down syndrome, epilepsy, fetal alcohol spectrum disorder, and traumatic brain injury occurring before age 22. You must need substantial support now and going forward, meeting an ICF-IID level of care. There are no income or insurance requirements to apply: you can apply even with private insurance and even without NC Medicaid coverage, because placement on the waitlist happens early in the process.
find the lme/mco serving your county, call and ask to apply — don't pre-screen yourself out, provide requested documentation, apply for 1915(i) services while you wait, then enroll and choose providers. Start with North Carolina Department of Health and Human Services.
Covered services vary by waiver and assessed need, and commonly include in-home supports, respite, supported employment, day services, behavior support, residential supports. Confirm specifics with the state and provider.
Each LME/MCO manages its own waitlist by county, and people are generally served in the order they applied. A limited number of slots are reserved for people with extraordinary circumstances or emergencies. The list was formerly called the Registry of Unmet Needs, so you will still encounter “RUN” in older materials and conversations.
Approved waiver services are generally covered by Medicaid at little or no direct cost once enrolled, though some enrollees may owe a monthly patient responsibility based on income.
Eligibility, services, and what happens when you receive a slot.
North CarolinaHow the waitlist works, reserved emergency slots, and the 1915(i) option while you wait.
North CarolinaFinding your LME/MCO and the steps to apply.
North CarolinaFree protection and advocacy services, including appeals help.
North CarolinaFind waiver providers and services in North Carolina on Waiverly.
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