Yes, Medicaid may pay for certain support services provided in an eligible North Carolina group home, but it usually does not pay the resident’s room and board.
For people with intellectual or developmental disabilities, group home services may be funded through the NC Innovations Waiver under a benefit called Residential Supports. Eligibility, service authorization, provider participation, funding availability, and the person’s approved support plan all affect whether Medicaid will pay.
NC Medicaid does not automatically cover every group home, every resident, or every expense. Before choosing a home, it is important to understand the difference between Medicaid-funded care services and ordinary living expenses.
Quick Answer
NC Medicaid may cover authorized services such as:
- Staff supervision
- Assistance with activities of daily living
- Personal care support
- Life skills development
- Health and safety supervision
- Support with community participation
- Transportation connected to approved residential services
- Implementation of individualized support goals
However, Medicaid Residential Supports do not cover:
- Rent
- Room and board
- Food as an ordinary household expense
- Routine facility maintenance
- General property upkeep
- Personal spending money
- Certain expenses not included in the approved service plan
The current NC Medicaid Innovations policy specifically states that payments for Residential Supports do not include room and board or the cost of maintaining and operating the residence.
What Part of Group Home Care Can Medicaid Cover?
The NC Innovations Waiver includes access to group homes for qualifying people with intellectual or developmental disabilities. It is a home and community-based program designed to help eligible individuals receive support in community settings rather than institutional facilities.
In a group home, the Medicaid-funded service is generally called Residential Supports.
Residential Supports may help a person:
- Live safely in a community-based residence
- Receive necessary supervision
- Complete bathing, dressing, eating, grooming, and other daily activities
- Develop or maintain cooking, cleaning, budgeting, and communication skills
- Participate in community activities
- Increase independence and self-determination
- Receive transportation when it is part of the authorized residential service and is not paid by another source
The exact type and amount of support must be based on the person’s assessed needs and approved service plan. Residential Supports are not simply a payment for occupying a bedroom in a group home. They pay for the eligible care, training, supervision, and support the individual receives.
Does Medicaid Pay for Room and Board?
No. NC Innovations Residential Supports do not normally pay for room and board.
Room and board may include:
- Rent or housing charges
- Meals and groceries
- Utilities
- Household supplies
- Routine building maintenance
- Property repairs
- General operating expenses for the residence
The resident may need to use income, disability benefits, personal funds, a housing program, State and County Special Assistance, or another approved source to cover these costs.
Before accepting a placement, request a written breakdown showing:
| Expense | Possible Payment Source |
|---|---|
| Residential support staff | Authorized Medicaid Residential Supports |
| Supervision and daily assistance | Authorized Medicaid Residential Supports |
| Rent or housing charge | Resident income or another housing benefit |
| Meals and groceries | Resident funds or an approved assistance program |
| Personal clothing and spending | Resident’s personal funds |
| Routine household expenses | Room-and-board payment |
| Medical care | Medicaid or another health insurance plan |
| Transportation to medical appointments | Medicaid transportation when eligible |
| Community transportation | Residential Supports when authorized and not covered elsewhere |
Funding arrangements vary. Confirm all charges with the provider, care manager, LME/MCO, and local Department of Social Services.
What Is the NC Innovations Waiver?
The NC Innovations Waiver is a Medicaid home and community-based services program for eligible children and adults with intellectual or developmental disabilities.
Potentially qualifying conditions may include:
- Intellectual disability
- Autism
- Down syndrome
- Cerebral palsy
- Fetal alcohol spectrum disorder
- Certain developmental disabilities
- Traumatic brain injury that occurred before age 22
- Other related conditions that meet the program’s criteria
Anyone may apply regardless of age, current insurance, or income. However, applying does not guarantee eligibility, immediate enrollment, a waiver slot, or group home placement. The individual must meet the program’s clinical and functional requirements.
The waiver may provide services such as:
- Residential Supports
- Help with daily activities
- Community participation
- Supported employment
- Crisis services
- Assistive technology
- Home and vehicle modifications
- Caregiver support
- Transportation to medical appointments through Medicaid
The services a person receives depend on assessed needs, eligibility, authorization, and the approved individual support plan.
Who May Qualify for Medicaid-Funded Residential Supports?
An adult may be considered for Residential Supports when the person:
- Has a qualifying intellectual or developmental disability
- Meets NC Innovations Waiver eligibility requirements
- Requires an institutional level of care but can safely receive services in the community
- Needs regular supervision or assistance
- Has Residential Supports included in an approved person-centered plan
- Has an available Innovations Waiver slot
- Selects a qualified provider in the appropriate network
- Is matched with a residence capable of safely meeting the person’s needs
Having Medicaid alone does not mean the person automatically qualifies for a Medicaid-funded group home.
Likewise, having an intellectual or developmental disability diagnosis does not automatically provide funding. The person must complete the required application, assessment, eligibility, planning, and authorization processes.
How Do You Apply for Medicaid Group Home Funding?
Step 1: Find the LME/MCO Serving Your County
North Carolina’s Local Management Entity/Managed Care Organizations manage the NC Innovations Waiver. The four current LME/MCOs are:
- Alliance Health
- Partners Health Management
- Trillium Health Resources
- Vaya Health
Each organization serves designated North Carolina counties. Applicants should contact the LME/MCO responsible for the county where the individual lives.
Step 2: Ask to Apply for the NC Innovations Waiver
Tell the LME/MCO that you want to apply for the NC Innovations Waiver. The application was previously known as the Registry of Unmet Needs application, so staff may still use that term.
The organization may request records such as:
- Psychological evaluations
- Intellectual or developmental disability diagnoses
- Medical records
- School records
- Guardianship documents
- Functional assessments
- Current support plans
- Information about daily supervision needs
- Behavioral or safety records
After reviewing the application, the LME/MCO will notify the applicant whether they have been added to the waitlist. A denial may include information about appeal rights.
Step 3: Complete Eligibility and Support Assessments
When a waiver opportunity becomes available, the applicant must complete the required eligibility and support assessments.
These assessments help determine:
- The person’s daily support needs
- Health and safety risks
- Personal care requirements
- Behavioral support needs
- Communication needs
- Mobility and accessibility needs
- Appropriate service levels
- Whether residential support is necessary
Step 4: Develop a Person-Centered Plan
Residential Supports must be connected to the person’s identified needs and goals.
The plan may address:
- Personal care
- Medication support
- Health monitoring
- Household skills
- Community participation
- Behavioral support
- Transportation
- Employment or day activities
- Communication
- Personal choice and independence
Step 5: Choose a Qualified Provider
The individual or authorized representative can review qualified providers and ask about:
- Current group home openings
- Populations served
- Staff training
- Accessibility
- Medication support
- Behavioral support
- Transportation
- Admission requirements
- Room-and-board charges
- Compatibility with current residents
- Provider network participation
A provider may have an opening but still determine that it cannot safely meet the individual’s needs. Similarly, authorization for Residential Supports does not guarantee that a suitable vacancy will be immediately available.
Is There a Waiting List for the Innovations Waiver?
Yes. North Carolina currently has a long Innovations Waiver waitlist because the number of available waiver slots is limited.
Each LME/MCO manages its own waitlists, which are organized by county and application date. People who have waited the longest are generally served first. An LME/MCO cannot predict an applicant’s exact waiting time because new slots become available when the General Assembly adds funding or when an existing participant no longer needs a slot.
A limited number of reserve slots may be available for extraordinary circumstances or emergencies. Someone experiencing a major change should contact the assigned LME/MCO and ask whether the situation may qualify for additional review.
Do not wait until a caregiver crisis or emergency occurs. NC Medicaid recommends applying as soon as a qualifying diagnosis is identified, even when residential services may not be needed immediately.
Can Someone Receive Services While Waiting?
Some people with NC Medicaid may qualify for 1915(i) services while waiting for the NC Innovations Waiver.
Available services may include:
- Community Living and Supports
- Assistance with personal care and daily activities
- Life skills development
- Respite
- Supported employment
- Community transition assistance
Receiving eligible 1915(i) services does not remove someone from the Innovations Waiver waitlist.
However, 1915(i) services are not the same as Innovations Waiver Residential Supports. They are primarily intended to help eligible people receive support in their own homes and communities. They should not be assumed to pay for permanent group home room and board.
Can State and County Special Assistance Pay for a Group Home?
Some low-income adults may qualify for State and County Special Assistance to help pay room-and-board expenses in an approved residential facility.
The program may apply to qualifying residents of:
- Adult care homes
- Family care homes
- Group homes
To qualify, a person generally must be age 65 or older or have a qualifying disability, meet the program’s financial requirements, and live in a facility approved to participate in Special Assistance. The facility must also agree to accept the state-established payment rate. Applications are handled through the person’s local Department of Social Services.
Special Assistance is different from Medicaid Residential Supports:
| Program | Primary Purpose |
|---|---|
| NC Innovations Residential Supports | Pays for authorized supervision, care, training, and support |
| State and County Special Assistance | Helps eligible low-income residents pay room and board |
| NC Medicaid health coverage | Pays for eligible healthcare services |
| 1915(i) services | Provides certain home and community-based supports to eligible Medicaid members |
A person may qualify for one program and not another. Do not assume that every group home accepts Special Assistance or that every resident will qualify.
Questions to Ask a Group Home About Medicaid
Before submitting a referral or accepting a placement, ask the provider:
- Are you enrolled to provide NC Innovations Residential Supports?
- Which LME/MCO networks do you participate in?
- Do you have a current or expected opening?
- What diagnoses and support levels can you serve?
- What Medicaid authorization is required?
- What services are included in Residential Supports?
- How much is the monthly room-and-board charge?
- What expenses are not included?
- Do you accept State and County Special Assistance?
- What happens if Medicaid authorization is delayed?
- Is there a deposit or admission fee?
- How are transportation expenses handled?
- Are personal care and medication support included?
- What could cause the resident’s charges to change?
- What is the refund or discharge policy?
Request answers in writing whenever possible.
Common Medicaid and Group Home Mistakes
Assuming Every Group Home Accepts Medicaid
A residence may be licensed but not enrolled with the individual’s Medicaid program or LME/MCO network.
Confusing Medicaid Coverage With Free Housing
Medicaid may pay for authorized support services, but room and board usually remain separate.
Waiting for an Emergency to Apply
The Innovations Waiver waiting period may be long. Applying early creates more time to complete eligibility and planning requirements.
Choosing a Home Before Confirming Authorization
Do not assume Medicaid will approve services after the person moves into a residence.
Failing to Ask About Additional Costs
Request a complete list of room-and-board charges, transportation expenses, personal costs, deposits, and excluded services.
Assuming an Available Bed Is an Appropriate Placement
The provider must be able to meet the person’s medical, behavioral, mobility, communication, supervision, and accessibility needs.
Frequently Asked Questions
Does regular NC Medicaid automatically pay for a group home?
No. Regular Medicaid enrollment alone does not automatically pay for group home services. The person may need an approved program such as the NC Innovations Waiver, an authorized Residential Supports service, and an eligible provider.
Does the NC Innovations Waiver cover group homes?
Yes. Access to group homes is included among NC Innovations Waiver services for qualifying participants. Residential Supports must be authorized according to the individual’s assessed needs and approved plan.
Does Medicaid pay for food in a group home?
Ordinary food and room-and-board costs are generally not included in Residential Supports payments. The resident may need another source of funds or assistance for these expenses.
Can an adult apply for the Innovations Waiver without already having Medicaid?
Yes. North Carolina allows people to apply regardless of their current insurance or income. Final waiver participation still requires the applicant to meet all applicable eligibility requirements.
How long does Medicaid approval for a group home take?
There is no standard timeline. It may depend on waiver availability, eligibility assessments, service authorization, documentation, provider availability, and whether an appropriate residence has an opening.
What should someone do when there is no waiver slot available?
Ask the LME/MCO about the Innovations Waiver waitlist, 1915(i) services, state-funded support, respite, crisis services, community services, and any reserve-slot process that may apply to extraordinary circumstances.
Ask About Medicaid-Funded Group Home Services in North Carolina
Golden Care NC LLC provides person-centered group home services for individuals who benefit from a safe, structured, and supportive residential environment.
Available support may include:
- 24-hour supervision
- Personal care assistance
- Medication management
- Health and safety monitoring
- Life skills training
- Meal preparation
- Housekeeping support
- Behavioral support
- Transportation coordination
- Community participation
- Individualized care planning
Golden Care NC LLC serves Raleigh, Garner, Cary, Durham, Chapel Hill, Hillsborough, and nearby North Carolina communities.
Contact Golden Care NC LLC to discuss current openings, referral requirements, accepted funding arrangements, and whether our group home services may be appropriate for the individual’s needs.
CTA Button: Ask About Current Group Home Openings
Coverage and eligibility depend on the individual’s circumstances, current NC Medicaid policies, service authorization, provider participation, and available funding. Confirm benefits directly with the assigned LME/MCO, NC Medicaid plan, local Department of Social Services, and residential provider.
