Our two Medicaid plans are based on the North Carolina’s 1915(b)(c) Waiver, which allows the state to modify certain program requirements. To learn more about our benefit plans, call our Access to Care Line at 1-800-849-6127 or download our Member and Caregiver Handbook.
N.C. Medicaid | 1915(b) Waiver
North Carolina’s 1915(b) Medicaid Waiver allows for regional behavioral health managed care plans. It allows Vaya to manage mental health, substance use and intellectual/developmental disability services for Medicaid beneficiaries in 22 western N.C. counties. Medicaid beneficiaries are automatically eligible for basic benefits, and individuals in need of an advanced level of care may receive services under our enhanced benefit plan.
N.C. Innovations | 1915(c) Waiver
North Carolina’s 1915(c) Innovations Waiver is a home and community-based services waiver for people with intellectual/developmental disabilities. We manage this waiver in our 22 counties for Medicaid recipients who are eligible for the N.C. Innovations program. Innovations allows long-term care services to be provided in home and community-based settings for people with intellectual/developmental disabilities who meet institutional level of care criteria.
Eligibility for our non-Medicaid services are typically based on income, citizenship and the availability of other insurance. Non-Medicaid services are not an entitlement and are based on funding availability. Through sound fiscal management, we strive to serve as many individuals as possible through the use of non-Medicaid funds, which includes state, county and federal funding.