AFL provides individualized services and supports to enable a person to live successfully in a setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the person’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination and ensure the person’s opportunity to have full membership in his/her community.

Residential Supports includes learning new skills, practice and/or improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the individual is dependent on others to ensure health and safety.

Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.

Residential Supports are provided to individuals who live in a community residential setting that meets the home and community based characteristics as outlined in the Waiver in Appendix C. Residential Supports may additionally be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. These sites are licensed or unlicensed in accordance with state rule. All unlicensed AFL sites will be reviewed using the PIHP AFL checklist for health and safety related issues. NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports.

Respite services provide periodic or scheduled support and relief to the primary caregiver(s) from the responsibility and stress of caring for the individual. NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports.

This service enables the primary caregiver to meet or participate in planned or emergency events, and to have planned time for him/her and/or family members. This service also enables the individual to receive periodic support and relief from the primary caregiver(s) at his/her choice. Respite may be utilized during school hours for sickness or injury.

Respite may include in and out-of-home services, inclusive of overnight, weekend care, or emergency care (family emergency based, not to include out of home crisis). The primary caregiver(s) is the person principally responsible for the care and supervision of the beneficiary and must maintain his/her primary residence at the same address as the beneficiary.

Supported Living provides a flexible partnership that enables a person/s to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the person/s. The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the individual/s, budget management, attending appointments, and interpersonal and social skills building to enable the individual to live in a home in the community. Training activities, supervision, and assistance may be provided to allow the person to participate in home life or community activities. Other activities include assistance with monitoring health status and physical condition, and assistance with transferring, ambulation and use of special mobility devices. Transportation is an inclusive component of Supported Living to achieve goals and objectives related to these activities with the exception of transportation to and from medical services covered through the Medicaid State Plan.

This service is distinct from Residential Supports in that it provides for a variety of living arrangements for individuals who choose to live in their own home versus the home of a provider. A person’s own home is defined as the place the person lives and in which the person has all of the ownership or tenancy rights afforded under the law. This home must have a separate address from any other residence located on the same property. Persons living in a Supported Living arrangement shall choose who lives with him/her, are involved in the selection of direct care staff, and participate in the development of roles and responsibilities of staff. Persons receiving Supported Living have the right to manage personal funds as specified in the Individual Support Plan. A formal roommate agreement, separate from the landlord lease agreement, is established and signed by individuals whose name is on the lease.

The provider of Supported Living services shall not:

a. Own the person/s’ home or have any authority to require the person/s to move if the person/s changes service providers.

b. Own, be owned by, or be affiliated with any entity that leases or rents a place of residence to a person if such entity requires, as a condition of renting or leasing, the person to move if the Supported Living provider changes.

The Supported Living provider shall be responsible for providing an individualized level of supports determined during the assessment process, including risk assessment, and identified and approved in the Individual Support Plan (ISP) and have 24 hour per day availability, including back-up and relief staff and in the case of emergency or crisis. Some persons receiving Supported Living services may be able to have unsupervised periods of time based on the assessment process. In these situations a specific plan for addressing health and safety needs must be included in the ISP and the Supported Living provider must have staffing available in the case of emergency or crisis. Requirements for the person/s safety in the absence of a staff person shall be addressed and may include use of tele care options. When assessed to be appropriate Assistive Technology elements may be utilized in lieu of direct care staff.

To ensure the intent of the definition to support persons to live in a home of their own and achieve independence, Supported Living shall not be provided in a home where a person lives with family members unless such family members are a person receiving Supported Living, a spouse, or a minor child. Family member is defined as a parent, grandparents, siblings, grandchildren, and other extended family members. In addition, it also includes step-parents, non-minor step-children and step-siblings and non-minor adoptive relationships. All persons receiving Supported Living services who live in the same household must be on the lease unless the person is a live-in caregiver.

Community Living and Support is an individualized service that enables the waiver beneficiary to live successfully in his/her own home, the home of his/her family or natural supports and be an active member of his/her community. A paraprofessional assists the person to learn new skills and/or supports the person in activities that are individualized and aligned with the person’s preferences. The intended outcome of the service is to increase or maintain the person’s life skills or provide the supervision needed to empower the person to live in the home of his/her family or natural supports, maximize his or her self-sufficiency, increase self- determination and enhance the person’s opportunity to have full membership in his/her community.

Community Living and Support enables the person to learn new skills, practice and/or improve existing skills. Areas of skill acquisition are: interpersonal, independent living, community living, self-care, and self-determination.

Community Living and Support provides supervision and assistance for the person to complete an activity to his/her level of independence. Areas of support consist of assistance in monitoring a health condition, nutrition or physical condition, incidental supervision, daily living skills, community participation, and interpersonal skills.

Community Living and Support provides technical assistance to unpaid supports who live in the home of the individual to assist the individual to maintain the skills they have learned. This assistance can be requested by the unpaid support or suggested by the Individual Support Planning team and must be a collaborative decision. The technical assistance is incidental to the provision of Community Living and Supports.


Your first step is to call your local LME/MCO to see what service options might be available to you. If you are unsure of which LME/MCO serves your area give us a call and we'll help you find out.

There are a few options for member's who do not have the Innovations waiver. These include State funded services, private pay services and B(3) services. Call your local LME/MCO to discover which option is right for you.

There is no standard time-frame for getting a placement. This is because our agency focuses on matching the right member with the right home - ensuring a successful placement. That said, we receive several calls a week regarding placement, which increases the likely hood of an early placement.

AFL stands for Alternative Family Living. Whenever someone refers to an AFL they are usually referring to a staffed home that provides medicaid funded residential services. Services like these allow the member to reside in a staff's home and receive habilitative care - not unlike Foster Care.

You cannot be classified as an "AFL" for your child. However, you may be able to provide residential services for your child by starting a conversation with your local LME/MCO

Call your local LME/MCO. If you already have established services, start a conversation with your Qualified Professional or the Care Coordinator for your member's case.


If you have further questions regarding this service, or any other questions at all, please do not hesitate to

Contact Us!