About the N.C. Innovations Waiver and What’s New
The Home and Community Based Services Waiver for North Carolina is called “NC Innovations”. The waiver is, essentially, an agreement between the state of North Carolina and the federal government — Medicaid or “CMS”, specifically — about the service offerings available to persons with disabilities on the waiver. Currently, there are about 13,000 people in NC on the waiver, and approximately the same number on the Registry of Unmet Needs — the waiting list.
If you or your family member is currently on the waiver, you should know that the waiver is updated periodically, and when it is, it is posted for public comment. It so happens, that we are in a public comment period right now. You can read the proposed changes to the NC Innovations waiver by visiting this website and the actual proposed policies can be found here (warning — large file).
Our provider leadership has reviewed the proposed waiver changes, and, in case you’re interested, is providing the following feedback to the state.
First, a few positives…
Throughout the new waiver, there is a heightened emphasis on competitive employment for people with disabilities. This is great! NC is a “work first” state, meaning that people who want to work should be supported to seek jobs that pay at least minimum wage. Work and meaningful daily activities are key quality of life outcomes for everyone — you, me, our staff, and the people we serve. Having more opportunities to support people towards competitive employment in Day Supports, Supported Employment, Community Networking, and other services, is good for people with disabilities.
Another positive is enhanced support for individuals with disabilities to live more independently. Community Navigation could include tenancy supports, which would provide assistance in seeking affordable housing — a major barrier to Supported Living services. The Supported Living definition itself does not change much, but, there is a lot of support required before Supported Living can even begin, and these additions could help meet that need.
On the downside…
Family members (non-parents) would not be allowed to support persons on the waiver under 18 living in the same home. Outside of the current COVID-19 easing of restrictions, this has been the case for parents. We do, however, have some siblings who are serving in this role, and there is no grandfathering provision in the waiver to allow this to continue.
Also, while the Individual Budgets section (Appendix F) has been amended to clarify that a person’s individual budget should not be tied to his/her Supports Intensity Scale score, we think the language could be stronger. The budget is not a cap on annual spending; it is only a guideline.
Overall…
There is a lot to like about the direction the state is going with the NC Innovations Waiver. There is an increasing emphasis on meaningful daily activity, employment, independent living — and broadening the availability and flexibility of supports to achieve these outcomes, including through expanded telehealth options.
NC has been sincere in its outreach for individual and family member input, so I would encourage you to review the proposed changes and share your perspectives.
Together, we make the difference —
Richard Edwards
CBC Regional Vice President, North Carolina
