NCTracks
A Message from NCTracks on Behalf of NC Medicaid NC Medicaid: Personal Care Services Alignment Demonstration - Section 1115 Demonstration Application Submission (2026)
The North Carolina Department of Health and Human Services intends to submit its NC Personal Care Services Alignment Demonstration application to the Centers for Medicare & Medicaid Services (CMS) in late November. As directed by Session Law 2025-64 (House Bill 546), this new Section 1115 demonstration is designed to expand Medicaid coverage of personal care services for eligible Medicare beneficiaries residing in licensed adult care homes and special care units whose income exceeds current Special Assistance limits. The demonstration would operate statewide for a five-year period and provide only a limited, service-specific PCS benefit - not full Medicaid coverage.
To be eligible, an individual would need to:
- Be enrolled in Medicare and reside in, or be seeking admission to, a licensed adult care home or special care unit;
- Have an assessed clinical need for personal care services under North Carolina's Medicaid criteria (Clinical Coverage Policy 3L-1);
- Have income above the State-County Special Assistance limit but within the demonstration ceilings:
- Up to 180% of the federal poverty level for adult care home residents; and
- Up to 200% for special care unit residents; and
- Meet all other Special Assistance program requirements (such as resource limits)
- Meet Medicaid non-financial eligibility rules (such as North Carolina residency).
The demonstration would cover PCS as already defined in the North Carolina Medicaid State Plan - the same service, providers, clinical criteria and payment rates used today. It does not add or change any other benefit.
North Carolina will hold a public comment period from Sept. 10, 2026 through Nov. 9, 2026, including four public hearings to gather input from residents, providers, advocates, and other stakeholders. The hearings include both in person and virtual options:
Public Hearings (2026)
First Public Hearing
Sept. 16, 2026 from 5:30 - 7 p.m.
Virtual via Microsoft Teams (Join on your computer, mobile app or room device)
Click here to join the meeting
Call in (audio only)
+1 984-204-1487, 438242315# (United States)
Phone conference ID: 438 242 315#
Second Public Hearing (in person)
Sept. 29, 2026 from 2:30-4:00 p.m.
Greenville Convention Center
303 SW Greenville Blvd
Greenville NC 27834
Third Public Hearing (in person)
Oct. 12, 2026 from 2:30-4:00 p.m.
Mountain Area Health Education Center (MAHEC)
Blue Ridge A & B in the Education Building
121 Hendersonville Road, Asheville NC 28803
Fourth Public Hearing
Oct. 22, 2026 from 11:30 a.m. - 12:30 p.m. -NC Medicaid Advisory Committee (MAC) Meeting
Virtual via Microsoft Teams (Join on your computer, mobile app or room device)
Click here to join the meeting
Call in (audio only)
+1 984-204-1487, 352166225# United States
Phone conference ID: 352 166 225#
To ask questions about accessibility or request accommodations, please email Medicaid.NCEngagement@dhhs.nc.gov.
Written comments are also accepted by email and U.S. mail through Nov. 9, 2026 at:
Email: Medicaid.NCEngagement@dhhs.nc.gov
U.S. Mail:
North Carolina Department of Health and Human Services
NC Medicaid Section 1115 Waiver Team
1950 Mail Service Center
Raleigh, NC 27699-1950
More information about the demonstration - including the full application, public comments, and hearing materials - is available at: