North Carolina Supported Decision-Making Agreement for Disabled Adults

What Supported Decision-Making Does

Supported Decision-Making (SDM) lets a young adult with a disability keep their full legal rights while designating trusted people — parents, siblings, mentors — to help them understand and make decisions about healthcare, finances, housing, and daily life. The individual remains the decision-maker. The supporters provide information, explain options, and help communicate choices to third parties.

This matters because full guardianship can strip substantial legal autonomy. A full or general guardianship order can transfer authority over medical consent, finances, and contracts; a limited order can preserve rights outside the domains covered. For many young adults with intellectual disabilities — people who can express preferences and participate in decisions with the right support — guardianship goes far beyond what the situation requires.

North Carolina's Legal Framework

North Carolina formally incorporated SDM into its guardianship statute through Senate Bill 615 (Session Law 2023-124), effective January 1, 2024. The law amended Chapter 35A of the General Statutes to require that any person petitioning for guardianship must first consider and document less restrictive alternatives — including SDM.

Under the current law, anyone filing Form AOC-SP-200 (Petition for Adjudication of Incompetence) must certify:

• Which less restrictive alternatives were considered (SDM plans, Powers of Attorney, Representative Payee designation)
• A factual explanation of why those alternatives are insufficient for the respondent's needs

The court must also distribute Form AOC-SP-197 (Notice of Rights) to ensure the individual understands their right to counsel, a multidisciplinary evaluation, and the possibility of limited rather than full guardianship.

This means SDM is not just a family preference — it is part of the legal framework courts are required to evaluate before granting a guardianship petition.

Writing the Agreement

North Carolina does not mandate a specific statutory form for SDM agreements. There is no state-issued template, no required format, and no court filing requirement. This gives families flexibility to build an agreement tailored to their child's specific capabilities and support needs.

A functional SDM agreement typically covers these domains:

Healthcare decisions. The individual authorizes supporters to attend medical appointments, receive health information (with a HIPAA authorization), explain treatment options, and help communicate preferences to providers. The individual retains the right to consent to or refuse treatment.

Financial management. The individual names supporters who can help review bank statements, explain financial documents, assist with bill payments, and accompany them to meetings about benefits or financial planning. The individual remains the account holder and signer.

Daily living. Supporters help with decisions about housing, transportation, social activities, and community participation. The agreement can specify which supporters handle which domains.

Employment. Supporters assist with understanding job offers, workplace expectations, and accommodation requests. The individual makes the final decision about whether to accept, stay in, or leave a position.

Each domain should specify:

• Who the designated supporter(s) are
• What kind of help they provide (explaining, accompanying, communicating on behalf of)
• What decisions remain solely with the individual
• How to add or remove supporters
• How disagreements between supporters are resolved

SDM vs. Other Options

SDM occupies a specific lane. Understanding where it fits — and where it does not — prevents families from choosing the wrong tool.

SDM vs. Power of Attorney: A Power of Attorney can give another person legal authority to act on the individual's behalf — sign documents and manage accounts; a Health Care Power of Attorney addresses healthcare decisions. The individual delegates authority. In SDM, the individual keeps all authority and receives decision-making support. SDM is less restrictive, but some institutions (banks, hospitals) may not recognize it as readily as a notarized POA.

SDM vs. Guardianship: Guardianship transfers legal rights by court order. The guardian makes decisions for the ward. SDM preserves all rights and provides structured support. Under Senate Bill 615, courts must consider SDM before granting guardianship.

SDM vs. Representative Payee: An SSA Representative Payee manages federal benefits on behalf of a beneficiary. This is a federal designation, independent of any state agreement. An individual can have both an SDM agreement for general life decisions and a Representative Payee specifically for SSI/SSDI management.

Practical Considerations

SDM agreements are not legally enforceable in the way a court order or notarized Power of Attorney is. A hospital, bank, or landlord is not legally obligated to recognize the agreement, though many will honor it once they understand the arrangement. To improve acceptance:

• Have the agreement notarized
• Include a HIPAA authorization as a separate attachment (healthcare providers are familiar with this form and will accept it)
• Carry a copy to every appointment, meeting, and interaction with service providers
• Pair the SDM agreement with a Health Care Power of Attorney for medical settings that insist on a recognized legal instrument

For young adults enrolled in Medicaid Tailored Plans through an LME/MCO, the Tailored Care Manager can help coordinate the SDM arrangement with service providers. The care manager already maintains a care plan that tracks the individual's service authorizations and supports — adding the SDM agreement to that file ensures that everyone involved in the individual's care knows the decision-making framework.

Getting Started

Families should begin the SDM conversation well before the eighteenth birthday. Observe where your child already makes decisions independently, where they need information translated into accessible language, and where they rely on others entirely. Those observations become the backbone of the agreement.

The North Carolina SSI at 18 & Adult Disability Benefits Guide includes a decision-making framework evaluator that helps families map their child's capabilities across healthcare, financial, daily living, and employment domains — producing a clear picture of where SDM fits and where stronger legal instruments may be necessary.

See more North Carolina guides →