North Carolina TBI Waiver, 1915(i), Medicaid, and Appeal Help: Official Starting Points

Use this page if you live in North Carolina and need brain injury services, Medicaid home and community support, or help responding to a service decision.

ABI Resources provides care services in Connecticut. This North Carolina page is public educational information and does not mean ABI Resources provides services in North Carolina. North Carolina agencies and health plans make eligibility and service decisions.

Start here

1. Save the notice, envelope, care plan, assessments, and messages.

2. Write the deadline at the top of the notice.

3. Call the number on your Medicaid card and ask which plan or program made the decision.

4. Ask whether you must complete a health-plan appeal before requesting a state hearing.

5. Ask for plain-language instructions and a reasonable accommodation if a brain injury makes the process difficult.

6. Keep proof of everything submitted.

Official TBI and 1915(i) service information

NC Medicaid explains that certain 1915(i) services are available to some people with Medicaid, including people with traumatic brain injury. The page describes community living and support and lists official plan contacts.

• NC Medicaid 1915(i) services for traumatic brain injury

The official page says the NC Medicaid Ombudsman may help when a health plan has not solved a problem or when a person needs help understanding NC Medicaid.

TBI Waiver and Tailored Plans

NC Medicaid states that Tailored Plans are the health plans that offer the NC Innovations Waiver or Traumatic Brain Injury Waiver. The official page explains who may qualify, services that may be available, and how to identify the plan serving an area.

• NC Medicaid Tailored Plans

• NC Medicaid health plans and programs

Ask the plan or care manager:

• Which TBI pathway applies to me?

• Is the requested service covered under the TBI Waiver, 1915(i), Medicaid Direct, or another program?

• What assessment or level-of-care decision is required?

• Is there a wait list or service limit?

• What written notice will I receive if the answer is no?

If a service is denied, reduced, delayed, or stopped

Use the instructions on the notice and contact the plan promptly. NC Medicaid publishes state-hearing and appeal information and beneficiary due-process materials.

• NC Medicaid state hearing and appeal process

• NC Medicaid program-specific policies and due-process resources

Ask these exact questions:

• “What is the appeal deadline?”

• “Must I complete a plan appeal first?”

• “How do I ask for an expedited review?”

• “Can current services continue while the appeal is pending?”

• “Where do I send records, and how will you confirm receipt?”

What to document

• The service requested and why it is needed.

• Current services and the proposed change.

• Safety risks if the service is missing.

• Names of clinicians or care-team members with supporting information.

• Every call date, name, reference number, and promised next step.

• Any communication or cognitive accommodation requested.

More help from ABI Resources

• National Brain Injury and Disability Resource Navigator

• Medicaid Service Problems, Appeals, Complaints, and Federal Oversight

• Medicaid Service Problem Documentation Worksheet

Reviewed September 19, 2026. Verify current instructions on the linked government pages and your own notice. This page is general information, not legal or medical advice. Call 911 for an emergency or 988 for suicide or crisis support.