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Library of Consumer Publications
Medicaid and Health Choice Applications
When you receive services from your LME-MCO, you and your legal representative (if you have one) are involved in deciding what services you will use. A lot takes place to prepare for your service planning meeting. This page explains the preparation steps and what happens at a service planning meeting. The more you know about the service system, the better you can advocate for yourself.
Service plans are not one size fits all. Each service plan should be different from someone else's. This is called "person centered."
Read more about Person Centered Planning for Consumers.
Service planning usually occurs once a year. It may happen more often than once a year if a big change happens in your life that changes the support you need. The example below shows one person's goals, his capacities and support needs related to his goal, and the action steps. It also includes how the plan will be checked to make sure your services are working for you. Here is a made up example of a service plan:
John's goal: Hike to the top of Mt. Adams with my family.
Support strengths: John is very motivated and has family who want to help him.
Support needs: He needs help gaining strength and attempting increasingly more difficult hikes with rocky and uneven terrain.
Action steps: Purchase gym membership. Attend exercise classes to build strength and flexibility 3 times a week. Plan a day hike once a month, increasing number of hours outdoors and altitude. Get hiking permit for June 2013.
Monitor: Care Coordinator will check with John and his staff monthly.
Your service planning team is made up of YOU, your legal representative, your Care Coordinator and other people important to helping you get what you need. Using assessment information (including your SIS assessment information), and what you want in your life, your service planning team will talk about options and choices you can make. Together, decisions will be made about your the goals for the year and who is responsible for doing what.
To get ready for a service plan meeting, the Care Coordinator plays a key role. Care Coordinators will ask you or your legal representative how well things are going. Your Care Coordinator will also ask your family, direct care staff, and professionals involved in providing your services how well things are going. If some things are going well, this is a time to acknowledge the success. But if something is not going well, this is a chance to let others know and make changes.
Read more about Care Coordinator's role under the Innovations waiver (PDF, 23k) 
.
An important quality improvement underway in North Carolina is for people to choose their own services. Starting in 2013, people who have participated in a SIS assessment will also have an Individualized Budget Amount to get services for the year.
Read more about Individualized Budget Amounts.
You will know your Individualized Budget Amount at your service planning meeting. With this funding budget, you can choose your services from a service menu. Individualized Budgets are made up of two types of paid services: base budget services and add on services.
Base budget services are created from your SIS assessment and level. Everyone eligible for Innovation Waiver services will receive a base budget to use for their services.
Add on services – These services are often one-time only services based on need for additional help, such as to prevent a crisis. Some Add on services only apply to the self-directed option.
The table below shows the service choices under the Base and Add On Services. Click here for a more brief description of these services. For a comprehensive overview of the services, reference pages 105 to 185 of the Final NC Innovations Manual
| Base budget services are below: | Add on services are below: |
|---|---|
| Community Networking Services | Assistive Technology Equipment and Supplies |
| Supported Employment | Community Guide Services |
| Day Supports | Community Transition Services |
| In-Home Skill Building | Crisis Services |
| In-Home Intensive Supports | Financial Support Services |
| Personal Care | Individual Goods and Services |
| Residential Supports | Natural Supports Education |
| Respite | Specialized Consultation Services |
| Vehicle Modifications | |
| Home Modifications |
If you think that your budget is not sufficient to get the services you need, you can request a modification (change) to your budget at your service planning meeting. Your Care Coordinator will take it from there.
Your Care Coordinator must periodically check on you and that services are delivered as agreed to in your service plan. How often this checking takes place will be noted in your service plan. Your Care Coordinator is also checking on your health and safety, how your budget is being spent, and on your Medicaid eligibility and benefits.
If you are not satisfied with anything, letting your Care Coordinator know is usually a first step.
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