PROGRAMS
Community Alternatives Program for Disabled Adults (CAP/DA)
The Community Alternatives Program for Disabled Adults (CAP/DA) is a Medicaid Home and Community–Based Services (HCBS) Waiver Program authorized under § 1915(c) of the Social Security Act.
Within Federal guidelines, States are given the freedom to develop home and community-based services waivers (HCBS Waivers) to meet the needs of people who prefer to get long-term care services and supports in their home or community, rather than in an institutional setting.
- Purpose of CAP/DA
Enable eligible beneficiaries to remain in their homes or to return to their homes from nursing facilities and live as independently as possible.
- Supplement rather than replace the formal and informal services and supports available to an individual.
- Prevent or reduce institutionalizations by providing case management and other needed waiver services.
Who is Eligible CAP/DA
- Any person 18 years of age and older who requires Nursing Facility Level of Care (NF LOC).
- Lives in a private residence and is at risk of institutionalization.
- Lives in a Nursing Facility and desires to return to a private residence. – A private residence: single family living arrangement- the beneficiary’s or relative family home with no more than three unrelated people.
- Requires long-term care support at a level typically provided in an institution directly related to a documented medical diagnosis and functional care need as assessed quarterly.
- Requires two waiver services monthly (excluding incontinence supplies, personal emergency response system, and meals preparation and delivery).
- Able to have his or her health, safety and well-being maintained at home within the CAP/DA budget limits.
- Has an emergency back-up plan with adequate formal and informal support to meet the basic needs outlined in the CAP/DA assessment and Plan of Care to maintain their health, safety and well-being.
- Does not want to be institutionalized, but desires to live in home community with the assistance of formal and informal supports.
- Qualifies for Medicaid for the Aged (MAA), for the Blind (MAB) and for the Disabled (MAD) & DSS Determination of LTC.
How to make a CAP/DA referral?
Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.
If you are a CAP/DA case management entity or a qualified home- and community-based provider, a referral can be completed in the e-CAP system.
A referral may also be made by calling 919-855-4340 or faxing the completed referral form to 919-715-0052
CAP/C
CAP/C is an NC Medicaid Home and Community-based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-based Waiver Services. The waiver program provides a cost-effective alternative to institutionalization for Medicaid beneficiaries who are medically fragile and at risk for institutionalization if the home and community-based services approved in the CAP/C waiver were not available. These services allow the beneficiary to remain in or return to a home and community-based setting. The waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Medicaid beneficiary.
Who is eligible for CAP/C?
- Medically fragile and medically complex children who are age 0 through 20 years of age
- Is determined to require a level of institutional care under the North Carolina Medicaid State Plan
- Need at least one or more CAP/C home-and community-based services based on a reasonable indication of need assessment that must be coordinated by a CAP/C case manager
How to Make a CAP/C Referral
Contact a local CAP/C case management entity in the county of residence to request a CAP/C referral. If you are a CAP/C case management entity or a qualified home and community-based provider, a referral can be completed in the e-CAP system.
A referral may also be made by calling 919-855-4340 or faxing the referral form to 919-715-0052.