50 STATES OF CARE -NORTH CAROLINA
Got it — thanks for clarifying. I’ll put together a long-form blog (under 4,000 words, aiming for a strong, structured flow). It will cover:
North Carolina Medicaid waivers and insurance payors across IDD, ABA, skilled, and non-skilled care.
Credentialing difficulty and “moat” value of payer contracts.
Labor market realities — average pay rates for PCAs, HHAs, nurses, and BCBAs in NC, and how that impacts recruiting, retention, and transaction value.
Direct Care Provider model — family members providing care, requirements for PCA/HHA certification.
Thesis: Barriers to entry and labor challenges directly affect business appeal in a sale.
Audience: Retiring NC home care owners, across verticals, who’ve spent decades building family businesses.
Tone: 10th grade grammar, conversational but professional.
Plug: jake@acquire.care (minimum 3x), with “It’s what we do” vibes.
Breaking Down the Home Care Market in North Carolina: Waivers, Payors, and Why They Matter When You Sell
If you’ve been running a home care agency in North Carolina—whether in skilled nursing, non-skilled personal care, ABA therapy, or services for individuals with intellectual and developmental disabilities (IDD)—you already know one thing: this industry is not easy to break into.
Between Medicaid waivers, payor contracts, credentialing hurdles, and the ever-changing labor market, you’ve had to fight for every inch of ground. That fight is also what makes your business valuable.
When it comes time to sell, buyers don’t just look at your revenue. They look at your moat: the waivers, the contracts, the credentials, and the staff you’ve worked so hard to build.
In this post, we’ll break down:
Medicaid waivers and insurance payors in North Carolina
Credentialing difficulty and why it creates a moat
The direct care provider model (and family caregiver rules)
Labor market realities and average pay rates
How barriers to entry directly affect transaction value
And finally, we’ll talk about how all this shapes your options if you’re considering selling your business. Because at Acquire.Care, we already have the buyers, and we know how to position your business to maximize value. It’s what we do.
Medicaid Waivers and Payors in North Carolina
IDD Services: Innovations Waiver
North Carolina’s Innovations Waiver supports people with intellectual and developmental disabilities. It’s one of the hardest services to access—slots are limited, waitlists stretch for years, and credentialing is intensive.
Barrier to Entry: Extremely high.
Moat: Agencies with Innovations Waiver contracts and active clients have a rare asset. Buyers will pay more because they can’t just start fresh and compete.
ABA Therapy: Medicaid and Commercial Insurers
ABA services in NC are covered through Medicaid’s EPSDT benefit and commercial insurers. But each insurer has its own credentialing process, and Medicaid managed care now involves entities like Healthy Blue and AmeriHealth Caritas.
Barrier to Entry: Medium to high. Credentialing takes time and persistence.
Moat: An agency with multiple insurance contracts, and especially Medicaid, is far more appealing than one still trying to get approved.
Skilled Home Health: Medicare and Medicaid
For skilled nursing, PT, OT, and speech therapy, the gold standard is Medicare certification. This process involves surveys, audits, and compliance systems that take years to achieve.
Barrier to Entry: Very high.
Moat: Medicare-certified agencies are highly valuable. Buyers know it could take 2–3 years and hundreds of thousands of dollars to achieve the same approvals.
Non-Skilled Home Care: Personal and Companion Care
For personal care services, payors include Medicaid managed care plans and private-pay clients. Getting into Medicaid managed care networks requires credentialing, audits, and sometimes years of patience.
Barrier to Entry: Medium.
Moat: An agency with established Medicaid contracts is more attractive than one relying on private pay alone.
Credentialing: The Hidden Moat
Getting approved by payors isn’t just paperwork. It’s proof of compliance, staffing, and operational history.
A Medicare license is a moat.
An Innovations Waiver slot is a moat.
Medicaid managed care contracts are a moat.
Buyers know this. They value businesses that have fought through the process and come out with approvals in hand.
Direct Care Provider Model in North Carolina
Yes—North Carolina allows certain Medicaid programs to pay family members to care for loved ones. For example, under the Community Alternatives Program (CAP/DA and CAP/C), relatives can sometimes provide care.
Do family members need PCA or HHA certification?
In most programs, yes. Family caregivers must meet basic training or certification requirements (like Personal Care Aide [PCA] training). This ensures compliance and quality standards.Why It Matters: This model affects labor supply. Agencies often rely on family caregivers to fill hard-to-staff roles, but credentialing requirements still create a barrier to entry for new providers.
Labor Markets in North Carolina: Pay Rates and Impact
The labor market is the second big factor in value. Recruiting and retaining staff has never been harder, and buyers know it. Here’s the breakdown in NC:
Personal Care Aides (PCAs): ~$13–15/hour
Home Health Aides (HHAs): ~$14–16/hour
Licensed Practical Nurses (LPNs): ~$23–28/hour
Registered Nurses (RNs): ~$32–38/hour
Board Certified Behavior Analysts (BCBAs): ~$70,000–85,000/year (or ~$45–60/hour)
Why It Matters for a Sale
If you’ve built a strong recruiting pipeline, your company looks safer to buyers.
If you have stable staff, that’s a premium.
High turnover? Buyers will discount value.
Your labor model—how you recruit, train, and retain—directly affects what buyers will pay.
How Market Entry Shapes Business Appeal
Here’s the big picture:
Low barrier entry (non-skilled, private pay only): More competition, lower multiples.
Medium barrier entry (ABA with some payors, non-skilled with Medicaid contracts): Valuable, but still reliant on staffing.
High barrier entry (IDD waiver slots, Medicare-certified skilled care): Strongest moat, highest multiples.
If you’ve spent years building contracts and workforce systems, that’s equity you’ll capture in a sale.
What Retiring Owners Should Consider
What payor contracts do I hold that are hard to replicate?
How strong is my recruiting and retention model?
Do I have a balanced mix of waiver, Medicaid, and commercial contracts?
Am I positioned as a business with a moat—or as one easily replaced?
Where We Come In
At Acquire.Care, we’ve built our reputation on helping owners like you maximize the value of what you’ve built.
We know the North Carolina market. We know Medicaid, waivers, and payors. And we know how to position your business so buyers see the full value of your moat.
When you’re ready to sell, email jake@acquire.care. It’s what we do.
We already have buyers who understand the challenges of recruiting PCAs, HHAs, nurses, and BCBAs in today’s labor market. We connect you directly with those buyers so you get full value for the contracts, credentials, and team you’ve built.
Don’t wait until staffing gets harder or payors tighten networks. If you’re thinking about retirement, the best step is a conversation. Reach out today at jake@acquire.care.
Because at the end of the day, whether you built an ABA agency, skilled home health company, or non-skilled or IDD provider, your moat is unique. And making sure you capture that value when you sell?
It’s what we do.
