HR built for North Carolina behavioral health
North Carolina has the second lowest direct support turnover of any state measured. It is still short 615,836 units of care in a single quarter. That is not a retention problem. It is a capacity problem, and it is the one we build for.
Three facts North Carolina published about itself
Every figure below comes from a North Carolina state document or a federal dataset the state itself cites. Follow the link and read it yourself.
of behavioral health positions in North Carolina are open, against a 13 percent average across the wider health workforce
About a third of the state’s behavioral health positions sit unfilled, and LPN churn exceeds 100 percent in behavioral health and long term services.
What your regulator actually wrote
We read the rule text, the provider manuals, and the bulletins so you do not have to. Each quote below is copied from the primary document and linked to it.
The State of North Carolina is confronting a critical shortage of Direct Support Professionals (DSPs) that significantly impacts the availability and quality of in-home and community-based services.
Read the source document →
Supervision shall be provided at the frequency and for the duration indicated in the individualized supervision plan created for each AP and Paraprofessional upon hire. Each supervision plan must be reviewed annually.
Read the source document →
For existing paraprofessionals without a qualifying certification, the 120-day grace period starts on Aug. 1, 2026. New paraprofessionals will be required to obtain a qualifying certification within 120 days of hire.
Read the source document →
What we would fix first in North Carolina
Three problems we hear from North Carolina operators, the published evidence behind each one, and the program we run against it.
North Carolina has the second lowest direct support turnover in America and still cannot deliver the care it authorized.
On the measure that compares states, North Carolina is a success story. On the measure that counts whether a person actually received their service, it is missing a federal consent order benchmark. Both of those are published by the same state, in the same year, and almost nobody has put them next to each other.
By the national measure, North Carolina is winning
The 2024 National Core Indicators workforce survey puts North Carolina direct support turnover at 23.9 percent mean and 19.4 percent median, against a national mean of 37.1 percent. That is second lowest of 27 jurisdictions.
Average North Carolina direct support wage in that survey was $15.90. So this is not a state buying retention with money it does not have.
And by the measure that counts service, it is failing
NCDHHS reported that in January to March 2026 alone, 615,836 units of Community Living and Supports went undelivered specifically because no provider or staff member was available.
Statewide, 84.4 percent of authorized hours were actually billed, against a consent order benchmark of 85 percent that was due in June 2025. And NCDHHS notes the figure captures only formally reported staffing disruptions, so the real number is likely higher.
This is the most important distinction in the state. Almost every dollar of workforce funding in this sector is aimed at retention. North Carolina shows what happens when retention is already excellent and the vacancy is upstream of it.
On turnover, North Carolina is second lowest in the country
Same survey, same method, same year. This is the chart North Carolina should be proud of, and it is also the chart that explains why more retention spending will not move the needle much further.
National Core Indicators, State of the Workforce in IDD, 2024 Survey Report, NASDDDS and HSRI, published December 2025. Read the source. This is a point in time ratio: separations during the year divided by headcount on a single day. North Carolina reported 126 of 440 agencies responding, covering 11,460 direct support professionals, with an average wage of $15.90 against a national median starting wage of $18.00.
Fifteen North Carolina metros, and the wage behind the undelivered hours
If retention is already strong, the question is why the post was empty to begin with. Start with what it pays against what else is available in the same town.
Direct care wage is the employment weighted median for front line direct care roles. The local wage floor is what the same worker can earn in retail and warehouse work in the same metro. Rent is the HUD Fair Market Rent for a one bedroom, FY2026. Full method and open data at the Direct Care Staffing Index.
North Carolina is continuing to face a critical shortage of direct support professionals, which is significantly affecting the availability and quality of home and community-based services for people with intellectual and developmental disabilities.
NCDHHS, Inclusion Connects Quarterly Report, published July 15, 2026, data through March 31, 2026, Direct Service Professionals Workforce section, page 27. Read the source.
The North Carolina clock
A three plan market, a new chief executive, and the first dataset that will finally publish regional vacancy rates.
Trillium changes chief executive
Senitria Goodman moves from Chief Legal Counsel and Chief Compliance Officer into the chief executive seat, with Joy Futrell retiring at the end of the year. The compliance seat becomes an open recruit.
The first regional vacancy data lands
The NC Center on the Workforce for Health and Guidehouse deliver the draft Direct Care Worker Wage and Rate Analysis to NCDHHS. It is designed to produce benchmarked wages plus workforce capacity and vacancy rates by region and population. It will be the first North Carolina instrument to do so.
Four LME/MCOs become three
Vaya Health and Partners Health Management combine into Vaya Partners, a 47 county footprint with roughly 100,000 Tailored Plan members. Providers in the former Partners network were to receive new contracts by July 31, 2026. A provider compliant under one manual is not automatically documented the way the other one reviews for.
Three things a North Carolina provider should do before October
Stop spending retention money on a sourcing problem
Your turnover is probably fine. If units are going undelivered, the fix is at the front of the funnel: time to fill, sourcing channels and offer competitiveness. Diagnose which one you actually have before you fund the wrong one.
Make one file standard that survives the merger
10A NCAC 27G .0202 requires a written job description for every position, signed by both the staff member and the supervisor and retained in that person’s file, plus verification of licensure and documented continuing education. N.C.G.S. 122C-80 gives you five business days from a conditional offer to get fingerprints to the SBI. Compliance Confidence™ builds one standard that satisfies whichever manual governs you after October 1.
Have your numbers ready for September 30
When the first regional vacancy benchmark publishes, every provider in the state will be measured against it. The ones who already know their own figure will be able to explain it. The ones who do not will be explained to.
Start with the Workup
A full diagnostic of your workforce across eight dimensions, scored and mapped, with the gaps ranked. It credits toward any TWF Signature Program.
Built for the organizations others find too complex
Straight answers
Do you know NCTracks and the Clinical Coverage Policies?
Yes. We build to CCP 8A supervision and personnel requirements, the CCP 8F paraprofessional certification rule that started its grace period August 1, 2026, and the NCTracks service enrollment and national accreditation deadlines that follow.
We are based in eastern North Carolina. Do you travel?
We are headquartered in Greenville, North Carolina and Atlanta, Georgia. Eastern North Carolina is home.
How fast do you respond?
We respond to new inquiries within 2 hours.
What does the first step cost?
The Workup™ diagnostic starts at $1,750 and credits toward any TWF Signature Program.
Metro pages: Atlanta · Charlotte · Raleigh · Durham · Greenville NC · Nashville · Richmond · Jacksonville · Birmingham. Open workforce data for 90 metros lives at our public dataset.
The North Carolina advisory brief
Every rule on this page, quoted in full, dated, and linked to the state document it came from.
Read the North Carolina brief →Talk to an HR partner
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