NC Innovations Waiver & Registry of Unmet Needs
The N.C. Innovations Waiver allows individuals with intellectual/ developmental disabilities to receive services and supports in their own community. This helps people live as independently as possible, rather than in an institution like a developmental center.
Innovations is a home and community-based service. Vaya Health manages the Innovations program in our region.
Innovations is designed to promote independence, choice, community integration and the ability to realize life goals. It includes services that:
- Support you to live where you choose
- Support you to spend your day in a way that you choose
- Provide education on how to be more integrated into your community
- Teach and support you to live more independently and manage your own services, if you choose
To better serve you and your family, we host quarterly N.C. Innovations Stakeholders meetings to share news information about the program
Am I eligible for Innovations?
To be eligible for Innovations, you must first have a psychological evaluation that documents an intellectual/developmental disability that impairs functioning, other than mental illness, and be at risk of placement in a developmental center.
Participation in the N.C. Innovations Waiver is based on eligibility criteria and availability, with state and federal Medicaid authorities fund a limited number of slots. People who are potentially eligible for Innovations may have to wait for a slot to become available. Individuals who have not received a waiver slot can be placed on the Registry of Unmet Needs.
What services are available under Innovations?
Innovations supports daily activities such as bathing, eating, working, developing friendships and living an active lifestyle within you. The program includes some non-medical services, like respite and home modification. These are not available under traditional Medicaid and may help keep people out of institutional settings.
Innovations services are based on your individual needs and may include:
- Community networking
- Day support
- In-home intensive support
- In-home skill building
- Personal care services
- Supported Living
- Assistive technology equipment and supplies
- Community guides
- Transition from a facility to your community
- Crisis services
- Home modifications
- Vehicle modifications
- Natural support education
- Specialized consultation services
- Individual goods and services needed to live independently
What are individual and family-directed supports?
Self-direction is an opportunity to make your own decisions and take responsibility for them. It can provide more flexibility and the opportunity to take greater control of your life. You, a parent or a legally responsible person may choose to direct one or more of these Innovations services:
- Community living and support
- Community networking
- Natural supports education
- Supported employment
- Individual goods and services
- Supported living
A community navigator helps you advocate for yourself while providing support to pursue a life meaningful to you. Community navigators can help you meet people, identify local activities and find resources to achieve your goals. If needed, a representative may be selected to help you direct your services.
Who manages my services and supports?
You may choose between two models: Agency with Choice or Employer of Record.
Agency with Choice
Under this model, you partner with a healthcare provider to hire, supervise and manage support workers. The provider provides support with training, payment and administrative duties. You or your legally responsible person is known as the managing employer.
Employer of Record
Under this model, you, your family or legally responsible person will hire, supervise and manage support workers. A financial support service provider will pay staff and handle administrative duties and assist in managing your budget. The Employer of Record participates in developing your plan and schedules, trains and supervises staff, as well as ensures your health and safety.
Self-directing your own services may help you:
- Maintain greater control and flexibility about your services
- Make your own decisions and plans for your future
- Decide what type of support you want and need to live your life
- Choose who to hire and how to train service providers
- Improve the quality of services
- Increase your independence and self-sufficiency
Remember, you may return to provider-directed services at any time. Innovations participants who would like more information on how to begin self-directing services may talk with their Vaya care coordinator. Individuals and providers seeking additional information may call the provider number at 828-225-2785, ext. 1512.
What is the Supports Intensity Scale (SIS)?
The Supports Intensity Scale (SIS) is a nationally-recognized assessment tool that identifies your support needs. Assessments are conducted by certified SIS assessors. All assessments include people you know well, such as family members, guardians, friends, staff from residential settings or day programs, teachers and personal caregivers.
The information gathered from SIS interviews is used to help develop your Individual Support Plan (ISP). After the first assessment, children receive new assessments every two years. Adults receive new assessments every three years. A major life change or event may mean a new SIS will be conducted prior to your scheduled re-assessment date.
When will more waiver slots be available?
The General Assembly of North Carolina has approved more waiver slots. NCDHHS’ Division of Health Benefits will make those slots available to the LME/MCOs. Vaya will contact families as soon as new slots have been assigned to us.
NC Innovations Allocation Process Update
On March 30, 2023, the North Carolina Department of Health and Human Services (NCDHHS) issued LME/MCO Joint Communication Bulletin (JCB) #J450, “Clarification on the NC Innovations Slot Allocation Process.” On August 29, 2023, Vaya received our Innovations slot allocation for FY 2023-24 and began the process of identifying eligible individuals based on NCDHHS guidance.
We will complete initial outreach and mail information to eligible individuals on the Innovations waitlist, the Registry of Unmet Needs, by October 28, 2023. If slots remain, we will continue identifying and contacting eligible individuals until all slots are filled. If you have questions about Innovations Waiver slots, call Vaya’s Member and Recipient Service Line at 1-800-962-9003 (TTY 711) or our Utilization Management Intellectual/Developmental Disability Team at 1-800-893-6246, ext. 1514.
On January 1, 2022, the following counties joined Vaya Health – Alamance, Caswell, Chatham, Franklin, Granville, Person, Rowan, Stokes, and Vance County. Members of the N.C. Innovations Waiver and families on the Registry of Unmet needs living in these counties now have services and supports managed by Vaya Health.
What is the N.C. Innovations Waiver?
The N.C. Innovations Waiver is a benefit plan designed for individuals with intellectual/developmental disabilities (I/DD). It is designed to promote independence, choice, community integration and the ability to realize life goals.
What is the RUN?
The Registry of Unmet Needs is a first-come, first-serve list maintained by Vaya to keep track of people waiting to be assigned a N.C. Innovations Waiver slot.
Will Vaya honor the date that my family was placed on the RUN with Cardinal?
Yes. The date that you were added to the RUN by Cardinal will be honored by Vaya.
Will all of my family member’s information transfer from Cardinal to Vaya?
Yes. The records that are available from Cardinal will be transferred to Vaya and they will have access to the same information that Cardinal had on record. You should not have to resubmit any information that was previously submitted.
Will my family member need to reapply for the Innovations Waiver?
No. If your family member was placed on the RUN by Cardinal, they will not need to request or reapply for the Innovations Waiver.
How long is the wait time to get an Innovations slot?
The exact wait time is unknown and based on availability. Families are encouraged to get their family member started on the RUN as soon as they find out the member may need services. Due to the fact that we have consolidated the two RUN waitlists (Cardinal and Vaya), the wait time may be different than you were originally told.
If I have Standard Plan Medicaid or Private insurance will my coverage change to Vaya when I get put on the RUN?
A person with a Standard Plan will remain with Standard Plan until an Innovations slot opens for them – then they will switch to Vaya. The only time a person on the RUN may switch to Vaya prior to receiving Innovations is if the services they need are not offered through the Standard Plan.