North Carolina Medicaid will cut rates for ICF/IID facilities and personal care services by 8% and pay Innovations waiver, 1915(i) and traumatic brain injury waiver services at 97% of their Sept. 30 rates, starting Oct. 1, 2025, according to a Medicaid bulletin published Sept. 25, 2025.
What the bulletin listed
The state Division of Health Benefits said the cuts were needed to keep Medicaid within the money the General Assembly provided. Many services faced 3% cuts, while hospitals and nursing facilities faced 10%. Community Alternatives Program services were cut 8% for personal-care-like services and 3% for others. For the Innovations waiver and 1915(i) services, the state planned to set the 97% level through state directed payments in its managed care contracts.
In August, the Department of Health and Human Services said the state's Medicaid rebase, the money needed to maintain current services, had a $319 million shortfall after lawmakers passed a stopgap spending plan.
Why this mattered for providers and DSPs
The Innovations waiver is the state's main program for people with I/DD. A 3% cut on top of already thin rates made it harder for provider agencies to hold onto DSPs, after a 2023 state report had priced $18 DSP wages at $78.2 million a year in state money. The bulletin said the cuts could change if lawmakers added money. In December 2025, after court rulings, North Carolina restored rates to September 2025 levels.