North Carolina received approval in September 2022 to add medical respite care to its 1115 waiver as part of the state’s Healthy Opportunities Pilot Program (more details in our 2022 State of the States report).
The state uses a universal coordination system for HOP services, allowing providers to gain care referrals, enroll potential Medicaid eligible clients in benefits, and bill for reimbursement among other things. This has lifted some of the administrative burden for medical respite programs, especially those who may not have had experience with Medicaid billing prior to the approval of the 1115 waiver.
Note: North Carolina expanded Medicaid eligibility, to include the single adult population, almost a year after the benefit was approved. Since Dec. 1, 2023, the number of individuals who can qualify and use medical respite care has increased significantly.
Next Steps: The North Carolina state legislature is currently working on a budget resolution, and future funding needed to secure these services for the next two years is uncertain.
