Innovations Waiver Tiers.

2025-2026 Session Introduced by Jim Burgin and 2 co-sponsors

Creates a three-tier Innovations Waiver plan (tiers $25k, $75k, full waiver) to aid NC Innovations waitlist individuals.

Passed 1st Reading

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Overview

Bill Title: Innovations Waiver Tiers

Sponsor: Senator Burgin (primary)

Purpose: Establish a plan to create a tiered Innovations Waiver program to address the needs of individuals on the NC Innovations waiver waitlist.

Effective Date: Upon becoming law

Fiscal Note/Appropriation: $100,000 in nonrecurring General Fund money for the 2025-2026 fiscal year to implement the act (Section 3).

Key Provisions

Section 1 — Plan for a Tiered Innovations Waiver

The Department of Health and Human Services (DHHS), specifically the Division of Health Benefits (DHB), must:

Consult with Local Management Entities/Managed Care Organizations (LME/MCOs) and other stakeholders to develop a plan.
Create a three-tier tiered Innovations Waiver program intended to address individuals on the NC Innovations waiver waitlist.
The proposed tiers include:
Tier 1: Benefit capped at $25,000.
Tier 2: Benefit capped at $75,000.
Tier 3: Full waiver benefit (no explicit cap stated beyond the full waiver).

Section 2 — Reporting Timeline

DHB must submit a report detailing the plan required by Section 1 on or before December 1, 2026.

The report should be delivered to:

House of Representatives Committee on Health
Senate Committee on Health Care
Joint Legislative Oversight Committee on Medicaid
Fiscal Research Division

Section 3 — Appropriation

An initial, nonrecurring appropriation of $100,000 from the General Fund to DHB for the 2025-2026 fiscal year to implement this act (Section 3).

Section 4 — Effective Date

The act becomes effective when it becomes law (i.e., not retroactive to a past date).

Who Would Be Affected

Primary stakeholders:

Individuals on the NC Innovations waiver waitlist (potential access to alternate funding pathways or phased support via the tiered program).
DHHS/DHB as the implementing state agency.
Local Management Entities/Managed Care Organizations (LME/MCOs) involved in care coordination and service delivery.

Other affected groups:

Legislators and oversight bodies (for reporting and monitoring of the plan’s implementation).
General Fund finances, due to the stated appropriation for implementation.

Potential Impact and Implications

Access to Services: The tiered structure introduces a potential pathway for individuals currently on the waitlist to receive varying levels of support, potentially reducing wait times or providing interim assistance.

Flexibility and Resource Allocation: The tiered caps ($25k, $75k, full waiver) allow for staged resource allocation based on individual needs and program design outcomes.

Planning and Oversight: The plan requires stakeholder engagement and a formal report to multiple legislative committees, enabling review, adjustments, and accountability.

Budget Considerations: A modest initial appropriation ($100k nonrecurring) is provided to develop and implement the plan, with no details on ongoing funding beyond this appropriation.

Notes

The bill does not specify the exact criteria for tier assignment, eligibility details beyond the existence of the three tiers, or how individuals would transition between tiers.

The timeline centers on a plan development with a final reporting deadline of December 1, 2026. The act’s longer-term funding and operational mechanics would depend on the legislative process and subsequent appropriation decisions.

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