The NC Innovations Waiver is a means of funding services and supports for individuals with intellectual disabilities and other related developmental disabilities who are at risk for institutional care in an Intermediate Care Facility for Individuals with Mental Retardation (ICF-IID) but who chose instead to remain in their own home and community. NC Innovations is authorized by a Medicaid Home and Community-Based Services (HCBS) Waiver granted by the Centers for Medicare and Medicaid Services (CMS) under Section 1915 (c) of the Social Security Act. Federal, State and Local dollars fund Medicaid Waivers. The NC DD/MH/SAS Health Plan functions as a Prepaid Inpatient Health Plan (PIHP) through which all mental health, substance abuse and developmental disabilities services are authorized for Medicaid participants in the Durham, Wake, Cumberland and Johnston Counties.
CMS approves the services provided under NC Innovations, the number of individuals that may participate each year, and other aspects of the program. The waiver can be amended with the approval of CMS. CMS may exercise its authority to terminate the waiver whenever it believes the waiver is not being managed by the MCO properly
The Division of Medical Assistance (DMA), the State Medicaid agency, operates the NC Innovations Waiver. DMA contracts with Alliance Health Care to arrange for and manage the delivery of services, and perform other waiver operational functions under the concurrent 1915 (b)/(c) waivers. DMA directly oversees the NC Innovations Waiver, approves all policies and procedures governing waiver operations and ensures that the NC Innovations Wavier assurances are met.