Introduction
You do not have to wait for the NC Innovations Waiver to start ABA therapy. That is the most important thing we want North Carolina families to hear, because it is also the misunderstanding we run into most often.
Many parents are told early on that the Innovations Waiver is "the way" to get services for an autistic child. So they join the waitlist and wait, sometimes for years, believing therapy has to wait too. It doesn't. ABA therapy for autistic children is covered through NC Medicaid on its own track, separate from the waiver and running in parallel with it.
This guide explains what each program pays for, why the two don't overlap, and how they can work side by side once a waiver slot opens. Whether you are a parent, a family member, an educator, or an ABA professional, you will come away knowing which door to knock on first.
Do You Need the NC Innovations Waiver to Start ABA Therapy?
No. ABA is not a waiver service. In North Carolina, ABA for autistic children and youth under 21 is covered through NC Medicaid's Research-Based Behavioral Health Treatment benefit, known as RB-BHT and described in Clinical Coverage Policy 8F. NC Medicaid has covered ABA through this dedicated benefit since 2019. Before that, it was covered only under Medicaid's EPSDT children's benefit.
The waiver, by contrast, is a separate program built for long-term home and community supports. It has a limited number of funded slots, which is why a waitlist exists. RB-BHT has no slot limit and no waitlist. If your child has NC Medicaid, an autism diagnosis, and a treatment plan that shows medical necessity, therapy can begin once your health plan approves it.
In our intake conversations, we regularly meet families who spent a long stretch waiting on the waiver list without realizing ABA was available the whole time. Early support matters, and every month spent waiting on a program that doesn't fund ABA is a month of skill-building your child could have had. Our early intervention ABA program exists for exactly this window.
What the NC Innovations Waiver Actually Is
The NC Innovations Waiver (Clinical Coverage Policy 8P) is a Medicaid program that funds long-term, individualized supports for people with intellectual and developmental disabilities, including autism, so they can live and participate in their own homes and communities. It is called a "waiver" because it waives certain standard Medicaid rules. For example, only the child's own income is counted for financial eligibility, not the whole family's.
Eligibility depends on diagnosis and functional needs, and anyone can apply regardless of age, income, or insurance. Being found eligible does not guarantee a slot, though, and that is where the waitlist comes in.
Services the Innovations Waiver Funds
The waiver pays for a menu of long-term supports, including:
- Community Living and Supports: help with everyday activities at home and in the community
- Community Networking: volunteering, classes, and building connections
- Respite: scheduled breaks for caregivers, including overnight and emergency care
- Day Supports and Supported Employment: skill-building and job support
- Residential Supports and Supported Living: help living in a group home, family living setting, or one's own home
- Community Transition: support moving into a home of one's own
- Assistive technology, home modifications, and vehicle modifications
Notice what is not on the list: ABA therapy. That is not an oversight. ABA sits in a different part of Medicaid.
The NC Innovations Waitlist (Formerly the Registry of Unmet Needs)
NC Medicaid now calls it the NC Innovations waitlist, though many families still know it as the Registry of Unmet Needs, or RUN. Each LME/MCO, the regional organization that manages behavioral health and I/DD services, keeps its own waitlist for the counties it serves. Names are organized by county and application date, and slots open only when someone leaves the waiver, or the General Assembly adds funding. Nobody can predict an exact wait time, and a small number of reserve slots exist for emergencies and extraordinary circumstances.
Our advice mirrors what the state recommends: join early, keep your contact information current, and tell your LME/MCO if your child's needs have changed since you applied. Joining the list is still worth doing even while your child is in ABA, because it protects your place for the future.
How ABA Therapy Is Covered Through NC Medicaid
Who Qualifies for RB-BHT
RB-BHT is available to Medicaid-enrolled children and youth under 21 with an autism spectrum disorder diagnosis from a licensed qualified provider. For children under 3, a provisional diagnosis is acceptable, but a final diagnosis must follow within six months. The benefit covers a range of evidence-based autism treatment models, with ABA being the most widely used.
What the Process Looks Like
Every plan works a little differently, but the general path is consistent:
- Diagnosis: a licensed qualified provider confirms autism using validated tools.
- Assessment: a qualified clinician, such as a BCBA, completes a behavioral or functional assessment.
- Treatment plan: the clinician writes an individualized plan with measurable goals and a timeline.
- Prior approval: the plan is submitted to NC Medicaid Direct or your Medicaid health plan for approval before therapy starts.
- Reauthorization: approvals are reviewed periodically, so progress and ongoing need must be documented.
Approval always depends on medical necessity, and no provider can promise a specific outcome. What we can promise is that our team verifies your benefits up front, so you know where things stand before anything begins. You can read more on our Medicaid coverage page.
What RB-BHT Does Not Cover
The state is clear that RB-BHT does not pay for respite, custodial or personal care, childcare, teaching academic subjects, or services that duplicate what schools provide under IDEA. Those are exactly the kinds of needs the Innovations Waiver is designed to meet, which is a big part of why the two programs fit together so well.
NC Innovations Waiver vs. ABA Therapy at a Glance
ABA Therapy (RB-BHT) | NC Innovations Waiver | |
What it is | Medicaid treatment benefit (Policy 8F) | Long-term supports waiver (Policy 8P) |
Main purpose | Build skills and reduce barriers linked to autism | Ongoing help to live and take part in the community |
Who it serves | Medicaid-enrolled children and youth under 21 with autism | People of any age with I/DD who meet waiver criteria |
Waitlist? | No waitlist, but prior approval is required | Yes, slots are limited |
Typical services | Assessment, treatment plan, direct therapy, BCBA supervision, caregiver involvement | Respite, Community Living and Supports, Community Networking, Day Supports, home modifications |
Who manages it | NC Medicaid Direct or your health plan | Your county's LME/MCO |
How the Two Programs Work Together Without Overlapping
Different Jobs, Different Goals
ABA teaches; the waiver sustains. Because RB-BHT excludes respite and personal care, and the waiver does not fund ABA, the two programs do not duplicate each other. In practice, a child might work with a BCBA on communication and daily routines while waiver-funded respite gives their parents a scheduled break. One builds skills while the other supports the family and the child's life in the community.
Care Coordination Across Both
People enrolled in the waiver are assigned a Tailored Care Manager, who helps them navigate services, find providers, arrange rides to appointments, and stay on top of Medicaid paperwork. NC Medicaid also expects ABA treatment intensity to take into account the other services a child receives, such as school, respite, and occupational or speech therapy, and expects caregivers to be involved in assessment, planning, and delivery.
In our sessions, this is where parent involvement pays off most. A treatment plan works best when the BCBA knows what else fills your child's week. If you'd like us to coordinate with your care manager, parent training and regular plan reviews are natural places to make that happen.
What to Do While You Wait: 1915(i) Services
There is another option some families can explore while waiting for an NC Innovations Waiver slot. NC Medicaid’s 1915(i) services provide supports similar to some Innovations Waiver services, including help with daily activities, skill-building, and, for eligible members, job coaching. There is no waitlist for 1915(i) enrollment, and using 1915(i) services does not change a person’s position on the Innovations waitlist. However, people already receiving Innovations Waiver services are not eligible for 1915(i), and 1915(i) services are not available through NC Medicaid Standard Plans; eligible members may be able to access them through a Tailored Plan, NC Medicaid Direct or the EBCI Tribal Option. Families should contact their health plan or LME/MCO to confirm eligibility and available options.
Five Steps Families Can Take Right Now
- Confirm Medicaid coverage. If your child isn't enrolled, apply through NC Medicaid first, since RB-BHT requires it.
- Get or confirm the autism diagnosis. A documented diagnosis from a licensed, qualified provider is the foundation for everything else.
- Start the ABA process. Contact a provider for a benefits check and assessment. Depending on your child's needs, that may mean in-home, center-based, or school-based ABA.
- Join the Innovations waitlist. Contact your county's LME/MCO, ask for written confirmation of your application date, and keep your contact information updated.
- Ask about 1915(i) and Tailored Care Management. These can add support while you wait.
What ABA Professionals and Educators Should Know
For ABA Professionals: Policy 8F Changes
NC Medicaid updated Policy 8F effective August 1, 2026. Key changes include a requirement that paraprofessionals hold an RBT or ABAT certification (with a 120-day grace period), the removal of telehealth for paraprofessional-delivered services, more frequent reauthorization for treatment plans above 16 hours per week, and new supervision and observation requirements for licensed providers. For families, this means therapy delivered in person by certified technicians under active clinical supervision. Always check the current policy text and your health plan's guidance, since details have changed recently and may change again.
For Educators: Working Alongside School Services
RB-BHT does not cover services that duplicate or replace what a school provides under IDEA, so ABA and school supports are meant to complement each other. Educators can help families most by pointing them to both tracks: the Medicaid ABA benefit for treatment now, and the Innovations waitlist for long-term supports later. Our school-based ABA team collaborates with teachers and school staff so skills carry across settings.
Conclusion
The NC Innovations Waiver and ABA therapy are two different tools for two different jobs. ABA is covered through NC Medicaid's RB-BHT benefit, has no waitlist, and can start as soon as diagnosis, assessment, and approval are in place. The waiver funds long-term supports like respite and community living help, and it comes with a waitlist that can take years. Because the services don't overlap, families don't have to choose. They can start ABA now, hold their place on the waitlist, use 1915(i) services if eligible, and let a care manager and BCBA keep everything coordinated once a slot opens.
If you live in Virginia, note that the waiver system there works differently from North Carolina's. Our team can walk you through how Virginia Medicaid and its waivers fit together on our Virginia locations page.
If your child is on the waitlist, or you're not sure where to begin, Connect n Care ABA can help you sort out coverage and get started. We serve families across North Carolina, including Charlotte, Raleigh, and Durham.
Contact us today to talk with our intake team about starting ABA therapy while you wait.
SOURCES:
- https://medicaid.ncdhhs.gov/beneficiaries/nc-innovations-waiver/about-nc-innovations-waiver-waitlist
- https://medicaid.ncdhhs.gov/beneficiaries/nc-innovations-waiver/nc-innovations-waiver-services
- https://medicaid.ncdhhs.gov/beneficiaries/1915i/faq
- https://medicaid.ncdhhs.gov/blog/2026/08/31/updated-reminder-requirements-research-based-behavioral-health-treatment-service-delivery-aug-31
- https://medicaid.ncdhhs.gov/policy-paper-ensuring-person-centered-care-children-autism-spectrum-disorder-nc-medicaid-program/open
- https://disabilityrightsnc.org/resources/eligible-for-an-innovations-waiver/
- https://www.autismsociety-nc.org/1915i-services-what-are-they-eligibility-and-how-to-apply/
