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In Lieu Of and Alternative Services

Federal law allows LME-MCOs operating under the 1915(b)(c) waiver to develop services that are cost-effective options to behavioral health services offered by the state. These services are called In Lieu Of or Alternative Services, depending on the funding source. Medicaid-funded services are known as In Lieu Of Services; those supported with state funds are called Alternative Services. 

Regardless of the funding source, In Lieu Of and Alternative Services are extra supports that may not be covered in the state’s approved service array. Through In Lieu Of and Alternative Services, Cardinal Innovations is able to change or create new services to better meet our members’ needs. In Lieu Of and Alternative Services must be just as effective, but no more expensive, than the Medicaid State Plan or state-funded services. For example, Family Centered Treatment must be as effective as and no more expensive than treatment in a group home. 

In Lieu Of and Alternative Services are the only services that may be developed by individual LME-MCOs, so they may be LME-MCO-specific and only offered in certain areas of the state. Even within an individual LME-MCO, services may only be offered in certain regions. To be eligible for these services, members must meet requirements specific to each service.

Two divisions of the North Carolina Department of Health and Human Services (NC DHHS) are responsible for approval and oversight of In Lieu Of/Alternative Services. The North Carolina Division of Medical Assistance (DMA) is responsible for Medicaid-funded In Lieu Of Services and the NC Division of MH/DD/SAS oversees state-funded Alternative Services.

Cardinal Innovations’ Lieu Of (Medicaid-funded) Services:
  • Assertive Community Treatment Step-Down
  • Family Centered Treatment®
  • In-Home Therapy Services
  • Rapid Care
  • Residential Services – Complex Needs
Cardinal Innovations’ Alternative (State-funded) Services:
  • IDD Afterschool and Summer Enrichment Program
  • Peer Support
  • Safety Supervision
  • Senior Day Support
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