What Is NC's 1915(i) Program? A Guide for Individuals, Families, and Care Managers

North Carolina's 1915(i) program can feel like alphabet soup the first time you hear about it. If you are an individual who might qualify, a family member trying to secure support for a loved one, or a care manager explaining the options to someone new to the system, the feeling is often the same: this system is complicated, and you just want to know what to do next. This guide breaks the program down into plain terms so you can understand what it is, who it serves, and how to get started.

Key Takeaways

• The 1915(i) option provides home and community-based services through NC Medicaid.
• It supports people with I/DD, serious mental health conditions, severe substance use disorder, or traumatic brain injury who meet eligibility criteria.
• Services are designed to help people live in their own homes and communities rather than in institutional settings.
• Eligibility is based on need and Medicaid financial criteria, not a waiting list position.
• Care managers and provider agencies like Amivie help connect people to the right services.

What the 1915(i) Option Is

The 1915(i) option is a part of North Carolina's Medicaid program that pays for home and community-based services (HCBS). Unlike a waiver program such as NC Innovations, which has a capped number of slots and a waitlist, 1915(i) is a state plan option. That means anyone who meets the needs-based and financial eligibility requirements can access it, without waiting for an open slot.

At its core, 1915(i) is built around a simple idea: people do better with support that meets them where they live, not in an institution. The services are meant to help someone stay connected to their home, their family, and their community while getting the help they need. It is worth thinking of 1915(i) less as one single service and more as a pathway to a set of supports tailored to the individual's needs.

Who Qualifies for 1915(i)

1915(i) eligibility is open to people with several different needs, including intellectual or developmental disabilities (I/DD), serious mental health conditions, severe substance use disorder, or traumatic brain injury. Having more than one of these conditions does not disqualify someone. It simply means the eligibility evaluation will look at the full picture.

To qualify, a person must undergo a needs-based evaluation that assesses the level of support they require for daily living and community activities. Alongside that, financial eligibility for NC Medicaid must be in place. Importantly, 1915(i) is generally available through Behavioral Health and I/DD Tailored Plans, NC Medicaid Direct, and the Eastern Band of Cherokee Indians Tribal Option.

None of this needs to be sorted out alone. A care manager works alongside individuals and families throughout the evaluation, helping determine whether 1915(i) is the right fit before anything is finalized. Find your Local Management Entity/Managed Care Organization (LME/MCO) to get started.

What Services 1915(i) Covers

Once someone is approved, 1915(i) opens the door to three home and community-based services designed around everyday life: Community Living and Support, Supported Employment, and Respite.

• Community Living and Support helps individuals build the daily living skills and routines that support greater independence at home and in the community.
• Supported Employment helps adults find and keep a job that fits their goals, interests, and abilities.
• Respite gives family members who provide day-to-day care a break, while their loved one continues to receive quality support.

Each of these services is built to support both the individual and the family around them. The focus stays on independence, skill-building, and staying connected to community life rather than being isolated from it.

How to Get Started and the Role of Care Managers

Getting started with 1915(i) begins with a conversation, not a stack of paperwork. Individuals or families can contact their care management entity or health plan to inquire about an eligibility evaluation.

From there, a Tailored Care Manager plays a central role. They coordinate the independent evaluation, help gather any needed documentation, and develop a Care Plan or Individual Support Plan once eligibility is confirmed. This plan outlines which services someone will receive and how those services connect to their goals.

A provider agency, such as Amivie, works alongside the Tailored Care Manager once the plan is in place, delivering the day-to-day support that brings it to life. Families do not have to manage the agency relationship and the care management relationship as two separate, disconnected processes. They work in tandem.

Connect With Amivie to Explore 1915(i) Services in North Carolina

If you are an individual, a family member, or a care manager trying to understand whether 1915(i) services could help, Amivie is here to talk it through. Our team provides I/DD support services across North Carolina, working alongside Tailored Care Managers to deliver the kind of consistent, personalized care that helps people thrive at home and in their community. Reach out to the Amivie North Carolina team today to start the conversation.