1915(b)(3) to 1915(i) Transition Update: 1915(i) Presumptive Eligibility and Individuals above 150% Federal Poverty Level (FPL)

What if the individual receiving 1915(b)(3) services is Medicaid Direct, not Tailored Plan?

CMS requires the phase out of all 1915(b)(3) services by December 31, 2024. To meet this timeline , all Medicaid Direct members receiving 1915(b)(3) services must be assessed for 1915(i) services, have a Person-centered Care Plan/Individual Support Plan (“ISP”) developed, and complete the transition from 1915(b)(3) to 1915(i) by no later than November 30, 2024.

1915(b)(3) services for Medicaid Direct members will not be authorized after 12/31/2024.

For services to continue past 12/31/2024, the following must occur:

1. The requesting provider and the member need to be notified that services can’t be authorized past 12/31/2024.
2. The member must be assessed for 1915(i) services ASAP.
3. The TCM must develop the care plan/ISP that reflects the 1915(i) services the member is requesting.
4. If the requesting provider and/or the member does not work with the TCM on the development of the care plan/ISP by 11/30/2024, services will end on 12/31/2024.

For additional information:

1915(i) Waiver: Medicaid Home and Community-Based Services | NC Medicaid (ncdhhs.gov)

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