North Carolina Medicaid Innovations Waiver Provider Update
NC Medicaid has issued an important update for providers delivering services under the NC Innovations Waiver. If your organization is enrolled under taxonomy 251S00000X (Community/Behavioral Health), action is required, and the clock is ticking.
What’s Changing
Starting April 20, 2026, NC Medicaid is overhauling how Innovations Waiver services are reported in the Provider Permission Matrix (PPM). Here’s the short version:
- 39 distinct Innovations Waiver service options will replace the single “Community/Behavioral Health” service currently used for these providers.
- National accreditation will now be required for select services and must be reported at the time of service selection.
- The old Community/Behavioral Health service will be end-dated on April 20, 2027. Providers who haven’t made the switch by then will no longer be eligible for reimbursement.
Why This Matters
This update is designed to improve service-level reporting accuracy for Medicaid beneficiaries with intellectual and developmental disabilities (I/DD). Rather than all providers billing under a single broad taxonomy service, NC Medicaid is requiring providers to identify the specific Innovations Waiver service they deliver, and to back that up with the appropriate national accreditation credential.
For providers who’ve been coasting on a legacy enrollment setup, this is a meaningful compliance shift.
Who Is Affected
This applies to providers who:
- Currently have an active 251S00000X taxonomy and bill for Innovations Waiver services
- Are newly enrolling with the 251S00000X taxonomy
- Are adding this taxonomy to an existing provider record
- Are adding a new Innovations Waiver service to an existing 251S00000X record
Accepted Accreditations
For most Innovations Waiver services, one of the following national accreditations is required:
- COA (Council on Accreditation)
- CQL (Council on Quality and Leadership)
- JCAHO (Joint Commission)
- CARF (Commission on Accreditation of Rehabilitation Facilities)
Nursing Respite providers have two additional accepted accrediting bodies: ACHC and CHAP.
Services Covered Under the New Requirements
The updated PPM includes 13 service categories under taxonomy 251S00000X, including:
- Benefits Counseling
- Community Living and Support
- Community Navigator
- Community Networking
- Community Transition (Agency w/Choice Provider)
- Crisis Services
- Day Supports
- Individual Goods & Services (Agency with Choice Providers Only)
- Natural Supports Education (Agency with Choice Providers Only)
- Residential Supports
- Respite (Provider Agencies and Facilities Only)
- Supported Employment
- Supported Living
What You Need to Do, And When
Effective April 20, 2026: The PPM is updated with the new service options. Providers currently enrolled with 251S00000X who are already nationally accredited are strongly encouraged to submit an NCTracks Manage Change Request (MCR) to select a new Innovations Waiver service and report their accreditation. Getting this done early protects your reimbursement eligibility.
Deadline — April 20, 2027: The legacy Community/Behavioral Health service is removed from the PPM. Any provider who hasn’t selected a new Innovations Waiver service and reported national accreditation will lose eligibility to bill for Innovations Waiver services.
Important reminder: National accreditation expiration dates are not automatically updated in NCTracks. Providers are responsible for updating their accreditation before it expires to avoid adverse action.
How to Update Your NCTracks Record
Use the NCTracks Manage Change Request (MCR) process to add your new Innovations Waiver service and national accreditation. NC Medicaid has a Job Aid available for step-by-step guidance: How to Add or Update Licensing and Accreditation on the Provider Profile in NCTracks.