North Carolina IDD Medicaid Rates and ICF/IID Reimbursement (2026)

IDD Medicaid rates in North Carolina are anchored by one published facility rate. North Carolina pays $423.18 a day for an intermediate care facility for individuals with intellectual disabilities (ICF/IID), effective April 1, 2026. That ranks 9th of 12 ranked states and sits 9% below the national median of $464.88 a day.

The rest of North Carolina's IDD system runs largely through managed care, where plans negotiate their own rates. That makes the ICF/IID rate, plus the CAP-MR/DD waiver schedules and their 2025 rate swing, the clearest public reference points for providers in the state.

The ICF/IID daily rate pays for a day of facility-based care. Nationally, 25 states publish an ICF/IID rate and the median is $464.88 a day.

North Carolina sits in the lower-middle of the ranking: below the median, but well clear of the bottom of the range. South Dakota and Rhode Island ($734.52) show how much higher the top of the range runs, while Louisiana ($232.14), Wisconsin and Oklahoma are at the bottom.

An ICF/IID is an institutional setting that provides active treatment, nursing and around-the-clock support for people with intellectual and developmental disabilities. The daily rate funds everything that happens in the facility in a day: direct care staff on every shift, nursing and clinical oversight, food, housing costs, transportation, activities and administration.

For a North Carolina facility, a rate 9% below the median means each bed generates less revenue than a typical ICF/IID bed elsewhere, while staffing costs for nurses are close to national levels. The margin is therefore thin unless occupancy stays high.

Why occupancy decides ICF/IID margins

Facility costs are mostly fixed. Staffing patterns, licensing requirements and building costs do not fall when a bed is empty, but revenue does. At a below-median daily rate, the difference between a full facility and one with a few vacancies can be the difference between covering costs and running a deficit. Admissions planning, discharge coordination and the time it takes to fill a vacancy are as important to an ICF/IID budget as the rate itself.

North Carolina's managed care rules treat IDD services differently from most medical service lines. For physician services, hospital care, therapy and nursing facilities, plans must pay at least the published rate. For behavioral health, the same floor applies. For intellectual and developmental disability services, plans negotiate their own rates, and the published rate applies only out of network.

Home and community-based services follow a third rule: they are paid directly by the state, outside managed care. That covers the Community Alternatives Program waivers, including CAP/C for children, CAP/DA for disabled adults and the CAP consumer-directed option.

North Carolina's managed care landscape includes 15 plan listings in our IDD data. Among them are Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health, alongside AmeriHealth Caritas North Carolina, Healthy Blue and UnitedHealthcare Community Plan of North Carolina. The Children and Families Specialty Plan, Healthy Blue Care Together, serves children in foster care and related populations.

For an IDD provider, the plan that covers a person determines who authorizes and pays for services. A day program or residential provider in North Carolina is paid what its contract with a plan says, not a state-mandated floor. The North Carolina managed care page lists each plan and the rule for every service line.

Working with several plans adds administrative steps that a single state payer does not require. Each plan runs its own credentialing, authorization and claims processes, and each contract can define units, documentation and payment timelines differently. Providers serving members across several plans should keep a contract summary for each one, covering rates by service, authorization rules and filing deadlines, so intake and billing staff can check the right terms before a service starts rather than after a claim is denied.

Because plans negotiate IDD rates, the published schedule becomes a benchmark in negotiation and the default when a provider serves a member out of network. Several practical points follow:

• Know the out-of-network rate. It is the fallback if contract talks fail, so it sets a floor on what a provider should accept.
• Bring cost data. Plans respond to documented cost per hour or per day, including wages, supervision, training and travel.
• Compare across plans. Different plans can pay different rates for the same service, and a provider contracted with several plans should track which ones pay how much.
• Use national benchmarks carefully. National medians show what other states pay, but plans will weigh North Carolina's lower wage levels.

The national IDD comparison ranks North Carolina only on ICF/IID, because its community services are priced through plan contracts. For North Carolina providers negotiating with plans, three national medians are the most useful reference points: in-home and community living supports at $34.92 an hour, day habilitation at $23.14 an hour and residential habilitation at $280.27 a day. The IDD rates by state hub carries the full national picture, including codes such as T2017 and T2016 that most states use.

South Carolina, North Carolina's neighbor, leads the country on community living supports at $85.96 an hour, which gives providers working near the border a sense of how far rates can diverge across a state line. The South Carolina IDD page has the details, and the Virginia IDD page shows another neighbor with high community integration rates.

North Carolina's legacy CAP-MR/DD and TBI waiver schedule, which predates the Innovations waiver, went through an unusual sequence in late 2025:

1. October 1, 2025: new rates took effect for the CAP-MR/DD (DD) and (TBI) schedules, reflecting a 3% reduction.
2. November 3, 2025: a further posting confirmed the October 1 rate reduction.
3. January 5, 2026: the reduction was reversed and rates were restored, a 3.09% change applied back to the October 1, 2025 effective date.

For providers, the practical effect was three months of claims paid at reduced rates followed by restored rates retroactive to October 1. Billing teams in North Carolina should confirm that claims from that window were reprocessed at the restored amounts, and follow up on any that were not.

Lessons from the reversal

The episode shows why providers should keep claim-level records of rates paid. When a rate changes retroactively, the only way to confirm that every affected claim was corrected is to compare paid amounts against the restored rate for each date of service. Agencies that tracked this closely recovered the difference quickly; those that did not had to reconstruct it later.

Federal occupational wage data for May 2025 shows North Carolina below the national median on every IDD role tracked:

• Direct support professional: $20.60 an hour, versus $22.08 nationally (based on the closest comparable occupation)
• Residential advisor: $18.81, versus $20.31
• Home health and personal care aide: $15.02, versus $17.21
• Licensed practical nurse: $30.42, versus $30.96

The pattern is notable for ICF/IID operators. Direct care wages in North Carolina are clearly below national levels, which helps offset a below-median daily rate. Licensed practical nurse wages, however, are almost at the national median, and ICF/IID facilities depend on nursing coverage. Facilities therefore get less wage relief on their clinical staff than on their direct care staff.

For community providers negotiating plan contracts, the lower direct support wage cuts both ways: it lowers cost per hour, but it also gives plans less reason to move rates toward national medians.

North Carolina SPA 22-0006 gave public notice of an ICF-IDD rate increase effective February 1, 2022. The current rate of $423.18 took effect April 1, 2026. Between those dates, the ICF/IID rate has been reviewed periodically, and North Carolina's wider Medicaid rate history in our data reaches back to 1991.

For facilities, the rate history is the best guide to budgeting. Watch for public notices on ICF-IDD rates, which give the earliest signal of a change, and plan staffing and capital spending around the April effective date of the current rate.

• ICF/IID operators: budget on $423.18 a day and model occupancy scenarios, since vacancies cut revenue without cutting costs.
• Community providers: treat the published rate as the out-of-network floor and negotiate plan contracts from documented costs.
• Billing teams: reconcile rates paid against published rates after every change, including retroactive ones.
• Expansion planning: compare North Carolina with its neighbors service by service, since plan-negotiated rates here can differ sharply from the fixed waiver rates across the border.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. National ranks compare daily ICF/IID rates across the states that publish one. Our methodology explains how daily and hourly rates are compared.

The North Carolina Medicaid rates hub brings together the state's fee-for-service schedule under North Carolina Medicaid Direct, drawn from all 143,093 current North Carolina Medicaid rates. The full dataset, including the CAP-MR/DD and TBI legacy fee schedule and the CAP consumer-directed option, is described on our pricing page.