State Funded Services – 1915i

Members ages 3 and older with Intellectual/Developmental Disabilities (IDD), Traumatic Brain Injury (TBI), Severe Mental Illness (SMI, including Severe and Persistent Mental Illness (SPMI)), Severe Emotional Disorder, or Severe Substance Use Disorder (SUD) are the target group for 1915i services.

  • Individuals who are enrolled in the Innovations or TBI waiver are not eligible for 1915(i) services, as they have access to similar services through those waivers.
  • Individuals on the waitlist for the Innovations or TBI waiver are eligible to obtain 1915(i) services if they are part of a target group and meet the functional limitation and eligibility requirements.

  • Individuals who are enrolled in (Community Alternatives Program for Children) CAP/C or Community Alternatives Program for Disabled Adults (CAP/DA) can receive some 1915(i) services. They cannot receive Respite or Community Transition but are eligible to receive all other services.

Needs-based Home & Community Based Services (HCBS) 1915(i) Eligibility Criteria include the need for support in acquiring, maintaining, and retaining skills needed to live and work in the community, as evidenced by at least one functional deficit in Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), social and/or work skills. For an individual to be determined to need the 1915(i) benefit, they must require:

  • The provision of at least one 1915(i) service, as documented in their Care Plan/Individual Service Plan (ISP), and

  • The provision of 1915(i) services at least monthly.

Members may obtain 1915(i) services in the following settings: private homes, the community, group homes, integrated employment sites, or micro-enterprise. All settings where the members obtain and receive 1915(i) services must be in integrated settings. This rule applies to all individuals in residential supports and Supported Employment (SE)/Individual Placement Support (IPS) except where such activities or abilities are contraindicated specifically in an individual’s Care Plan/ISP and applicable due process has been executed to restrict any of the standards or rights.

To learn more: https://www.trilliumhealthresources.org/members-recipients/member-benefit-plans-service-definitions/home-community-based-services-1915i-services

North Carolina Innovations Waiver

North Carolina Innovations Waiver services is a resource for funding services and supports for a Medicaid beneficiary with intellectual and other related developmental disabilities who are at risk for institutional care in an Intermediate Care Facility for Individuals with Intellectual Disability.

Application: https://www.trilliumhealthresources.org/members-recipients/intellectualdevelopmental-disabilities-idd/nc-innovations

Additional Resources