How much is North Carolina raising Innovations direct care rates on Oct. 1, 2026?

NC Medicaid’s Sept. 25, 2026, bulletin sets a uniform $0.30 increase per 15-minute unit for included Innovations waiver services. That add-on comes from $21.3 million in recurring state funds, about $57.2 million total after federal match and indirect-cost adjustments.

Which Innovations services get the North Carolina DCW rate add-on?

Included services are Community Networking, Residential Supports, Supported Employment, Respite Care, Community Living and Supports, Day Supports, and Supported Living. Goods, meals, assistive technology, home/vehicle modifications, community navigator/transition, natural support education, specialized/financial consultative services, and crisis services were excluded.

What must Innovations providers do to receive the DCW rate increase?

Providers must submit a DCW Wage Increase Attestation and Acknowledgment Form to their LME/MCO, commit to using the increase for DCW wages, benefits, or payroll costs, keep payroll documentation, and support reporting. LME/MCOs aggregate data for NC Medicaid; the revised Year-End Aggregate Report deadline is Dec. 1, 2027.

North Carolina: Innovations +$0.30/15-min Oct. 1

NC Medicaid adds $0.30 per 15-minute Innovations unit for listed direct care services on October 1, 2026, retroactive to July 1. The add-on uses $21.3 million in recurring state funds ($57.2 million total with federal match after adjustments) and requires a wage-increase attestation.

policy · north-carolina · innovations · dsp-wages · rates

DiscoA340, Wikimedia Commons, CC BY-SA 4.0

Direct Support News desk · September 25, 2026 · Updated September 29, 2026 · 2 min read

North Carolina is putting a concrete number on its Innovations direct care raise: $0.30 more per 15-minute unit for listed Medicaid waiver services, effective Oct. 1, 2026, and retroactive to July 1. The NC Medicaid bulletin published Sept. 25 walks through the math behind Session Law 2026-41’s $21.3 million recurring state appropriation.

With federal match, total funds are about $59.4 million; after underwriting gain and premium-tax adjustments inside capitation, about $57.2 million is available for rate increases. Divided across a projected 189.6 million 15-minute units, that yields the uniform $0.30 add-on. Percentage increases will vary by existing code rates; the dollar add-on does not.

Services in the analysis include Community Networking, Residential Supports, Supported Employment, Respite Care, Community Living and Supports, Day Supports, and Supported living. Excluded categories include individual goods and services, home-delivered meals, assistive technology, home and vehicle modifications, community navigator and transition, natural support education, specialized and financial consultative services, and crisis services and consultation.

The statute does not fix a required pass-through percentage to hourly wages. To bill the higher rates, Innovations providers must file a DCW Wage Increase Attestation and Acknowledgment Form with their LME/MCO and use the increase for direct care worker wages, benefits, or associated payroll costs. Providers must keep payroll documentation. LME/MCOs aggregate usage data for NC Medicaid; the revised deadline for the Year-End Aggregate Report is Dec. 1, 2027. Funds not used as required may be recouped.

Why this matters for providers and DSPs

This bulletin is the operational follow-through on the $21.3 million appropriation covered earlier this summer. Billing teams need the code table and attestation on file before October claims; finance leads should model the $0.30 unit add-on against actual utilization, not assume a flat percentage raise. For DSPs on Innovations residential, day, respite, and employment services, the raise only reaches the paycheck if the provider agency honors the attestation — so workers and frontline supervisors should ask how the agency will show the wage pass-through in payroll.

Common questions

How much is North Carolina raising Innovations direct care rates on Oct. 1, 2026?: NC Medicaid’s Sept. 25, 2026, bulletin sets a uniform $0.30 increase per 15-minute unit for included Innovations waiver services. That add-on comes from $21.3 million in recurring state funds, about $57.2 million total after federal match and indirect-cost adjustments.
Which Innovations services get the North Carolina DCW rate add-on?: Included services are Community Networking, Residential Supports, Supported Employment, Respite Care, Community Living and Supports, Day Supports, and Supported Living. Goods, meals, assistive technology, home/vehicle modifications, community navigator/transition, natural support education, specialized/financial consultative services, and crisis services were excluded.
What must Innovations providers do to receive the DCW rate increase?: Providers must submit a DCW Wage Increase Attestation and Acknowledgment Form to their LME/MCO, commit to using the increase for DCW wages, benefits, or payroll costs, keep payroll documentation, and support reporting. LME/MCOs aggregate data for NC Medicaid; the revised Year-End Aggregate Report deadline is Dec. 1, 2027.

Sources

North Carolina Innovations Waiver Direct Care Worker Wage Increase · September 25, 2026 · Primary NC Medicaid bulletin with unit add-on, service list, and reporting rules