North Carolina - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The North Carolina Division of Health Service Regulation (DHSR) requires agencies providing non-medical supervision and socialization to obtain a Home Care Agency license under G.S. 131E-135 before delivering services. North Carolina does not maintain a standalone "Adult Companion" service definition; instead, these supports are absorbed and billed as Community Living and Supports under the NC Innovations Waiver or as In-Home Aide services under the CAP/DA waiver.

To receive Medicaid reimbursement for these waiver services, an agency must secure national accreditation and win a network contract from a regional Local Management Entity/Managed Care Organization (LME/MCO). Because LME/MCOs operate closed provider networks based on regional need, securing this contract is a mandatory structural precondition before an agency can bill for waiver-funded companion-style care.

1. Service Definition and Scope

North Carolina does not license or cover a distinct "Adult Companion Services" category. Instead, non-medical supervision, socialization, and assistance that allow an adult to remain safely in the community are provided under broader service definitions.

For individuals with intellectual or developmental disabilities, these tasks fall under Community Living and Supports (CLS) within the NC Innovations Waiver. For aging adults or those with physical disabilities, similar supports are delivered as In-Home Aide services under the Community Alternatives Program for Disabled Adults (CAP/DA).

• Service Name (I/DD): Community Living and Supports under the NC Innovations Waiver.
• Service Name (Aging/Physical): In-Home Aide services under the CAP/DA waiver.
• Scope: Non-medical supervision, socialization, and assistance with activities of daily living.
• Setting: Delivered in the beneficiary's private home or integrated community settings.
• Exclusions: Cannot duplicate continuous nursing care or services provided in a residential facility.

2. Regulatory and Oversight Agencies

Facility licensure is managed by the state's health regulation division, while Medicaid policy and waiver administration are handled by the Division of Health Benefits. Regional managed care entities control the actual provider networks.

Providers must interact with all three tiers to become fully operational and billable in North Carolina.

• Licensing Agency: NC Division of Health Service Regulation (DHSR) Acute and Home Care Licensure and Certification Section (https://info.ncdhhs.gov/dhsr/ahc/)
• Medicaid Authority: NC Medicaid Division of Health Benefits (https://medicaid.ncdhhs.gov)
• Enrollment Portal: NCTracks (https://www.nctracks.nc.gov)
• Regional Network Managers: LME/MCOs such as Partners Health Management (https://www.partnersbhm.org)

3. Gatekeeping Prerequisites: Who Can Even Apply

North Carolina imposes strict structural preconditions before an agency can operate or bill for waiver services. The state lifted its moratorium on new In-Home Aide licenses on July 1, 2019, but other significant gates remain.

For the Innovations Waiver, providers face a hard mandate for national accreditation and must navigate closed network procurement by regional managed care entities.

• Licensure Prerequisite: Proof of previously owning a home care agency or completion of approved home care provider training is required before DHSR will accept a license application.
• Accreditation Mandate: National accreditation (e.g., CQL, CARF, ACHC, Joint Commission) is required to enroll as a provider of Innovations Waiver services in NC Medicaid.
• Network Access: Closed network contracting controlled by regional LME/MCOs; providers cannot bill without an active contract, which is subject to regional need reviews.
• Moratorium Status: The state moratorium on new In-Home Aide licenses was officially lifted July 1, 2019.

4. Licensure and Certification Requirements

Agencies must apply directly to the DHSR Acute and Home Care Licensure and Certification Section. Each site providing home care services must be separately licensed.

The initial survey is typically conducted as a desk review of the agency's policies, procedures, and personnel documents to ensure compliance with state administrative codes.

• Statutory Authority: North Carolina General Statutes 131E-135 through 142.
• Administrative Code: Title 10A of the North Carolina Administrative Code (10A NCAC 13J).
• Application Form: DHSR Home Care License Application.
• Licensure Fee: $510.00 initial fee, payable to the N.C. Division of Health Service Regulation.
• Timeframe: Applicants must complete all necessary requirements within one year (12 months) from receipt of the initial application.

5. Medicaid Provider Enrollment

Once licensed by DHSR, providers must enroll in the state's Medicaid system. Behavioral health and I/DD provider credentialing is centralized through the state's vendor.

Providers must use the NCTracks portal to submit their enrollment applications and undergo centralized credentialing before they can contract with an LME/MCO.

• System: NCTracks Provider Enrollment portal (https://www.nctracks.nc.gov).
• Credentialing: Centralized credentialing by the Department or its designated vendor via NCTracks.
• Prerequisite: Must possess an active DHSR Home Care Agency license prior to enrollment.
• Communication: Application receipts and requests for missing information are communicated by email from NC Medicaid or CSRA.

6. Staffing, Training and Background Checks

Direct support staff providing companion-style care must meet the qualifications outlined in 10A NCAC 13J and the specific waiver appendices.

Agencies are responsible for maintaining strict personnel files that prove compliance with background check and training mandates.

• Age Requirement: Staff must be a minimum of 18 years old.
• Background Check: State and national criminal history record checks are required for all direct care staff.
• Training: Staff must complete required modules including CPR, First Aid, and HCBS Settings Rule compliance.
• Supervision: Services must be supervised by a Qualified Professional (QP) or Registered Nurse (RN) depending on the specific service definition billed.

7. Documentation, Policies and Records

DHSR requires a comprehensive policy manual to be submitted and approved before a license is issued. These policies must align exactly with state rules.

Ongoing service documentation must tie directly to the beneficiary's approved care plan to justify Medicaid reimbursement.

• Initial Survey Checklist: Applicants must submit policies matching the DHSR Initial Home Care Survey Checklist.
• Care Plan: Services must be delivered according to an Individual Support Plan (ISP) signed by the care manager or care coordinator.
• Service Notes: Daily documentation must detail the socialization and supervision activities provided and the beneficiary's response.
• Personnel Files: Must contain verified background checks, training certificates, and proof of competency evaluations.

8. Billing, Rates and Claims

Reimbursement for these services is handled either through NCTracks for fee-for-service populations or through the respective LME/MCO portals for managed care beneficiaries.

Rates are established by the state and vary depending on whether the service is billed as In-Home Aide or Community Living and Supports.

• Billing System: NCTracks for fee-for-service; LME/MCO portals for waiver managed care.
• Unit of Service: Typically billed in 15-minute increments.
• Prior Authorization: Required via the approved Individual Support Plan (ISP) before any services are rendered.
• Rate Setting: Established by NC Medicaid Clinical Coverage Policy 8P (Innovations) or 3K-1 (CAP/DA).

9. Approval Sequence and Timeline

The pathway to becoming a billable provider in North Carolina is strictly sequential. Skipping a step will result in application rejection.

Providers must secure training, licensure, accreditation, state enrollment, and finally, a managed care contract.

• Step 1: Complete approved home care provider training or provide proof of previous agency ownership.
• Step 2: Submit DHSR application and $510 fee; expect 5-10 business days for license issuance after desk review approval.
• Step 3: Obtain national accreditation (timeline varies by accrediting body).
• Step 4: Enroll and complete centralized credentialing in NCTracks.
• Step 5: Secure a network contract with a regional LME/MCO.

10. Common Denials and Survey Findings

The state explicitly notes that the primary reason home care licensure applicants are not approved is a failure to understand or comply with the initial survey checklist.

At the Medicaid level, failure to secure an LME/MCO contract due to closed networks is a frequent barrier for newly licensed agencies.

• Policy Deficiencies: Failure to align submitted policies with 10A NCAC 13J rules during the DHSR desk review.
• Missing Training: Lack of proof of home care provider training submitted with the initial DHSR application.
• Network Closure: LME/MCO denying a contract application because the region does not have a demonstrated need for additional providers.
• Incomplete ISP: Delivering and billing for services before the Individual Support Plan is fully approved and signed.

11. Key Contacts and Resources

Providers should rely on official state portals and regional managed care websites for the most current forms, manuals, and announcements.

Maintaining accurate contact information with DHSR is required to receive critical program updates.

• DHSR Acute and Home Care Licensure: https://info.ncdhhs.gov/dhsr/ahc/
• NCTracks Provider Portal: https://www.nctracks.nc.gov
• NC Medicaid Innovations Waiver: https://medicaid.ncdhhs.gov/beneficiaries/nc-innovations-waiver
• Partners Health Management (LME/MCO): https://www.partnersbhm.org

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