North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA)

Page Reviewed / Updated - Mar. 2014

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers" which are also called Home and Community Based Services (HCBS Waivers) or Waiver Funded Services.

Waiver Description

The Community Alternative Program for Disabled Adults (CAP/DA) is North Carolina Medicaid's home and community based services waiver program.   It is intended to provide alternatives to nursing home placement for low income, disabled state residents. This program allows participants to remain in their private residence as an alternative to nursing facility care by offering medical and personal care services to increase independence at home as well as covers the cost of minor home adaptations which will increase the independence or safety of the program participant.

 Under CAP/Choice, certain family members can be hired as personal caregivers.

Associated with this program is the Community Alternative Program for Choice (CAP/Choice).  This option offers participants consumer direction of some of their care services as well as expands some of the services covered by this waiver.  This model of program is based on the Medicaid concept of Cash and Counseling and is sometimes called self-directed care or participant direction.  Under CAP/Choice, participants can hire family members (or whomever they choose) to provide personal assistance services.  Phrased another way, the adult children of aging parents can be paid to be their caregivers.  The amount which they can be paid is tightly regulated and is likely between 50% - 70% of the state hourly average for home care.  It is estimated personal caregivers are paid between $10 - $14 / hr. 

Did You Know? NC seniors are eligible to receive free quotes for bath safety modifications such as the replacement of a shower with a walk-in bathtub. Learn more.

 

Eligibility Guidelines

CAP/DA and CAP/Choice are both available to North Carolina residents who are at least 18 years of age and have a physical or mental disability that results in a need for the level of care typically found in nursing homes or intermediate care facilities. 

These waivers are intended for low income families and as such, persons must meet the eligibility requirements for North Carolina Medicaid.  NC considers both the applicant's income and assets.

NC 2014 Medicaid Income Guidelines
Applicants will qualify automatically if their monthly income is less than approximately $958.  For married applicants with both spouses applying, that limit is approximately $1,293 / month.  Applicants with higher incomes may also qualify if their cost of care (using Medicaid's rates) exceeds their income.  These individuals are referred to as being Medically Needy instead of Categorically Needy.

Another option for persons whose incomes are over the limits is to allocate excess income into a pooled income trust.  This will effectively lower their considered income to a Medicaid eligible level.  Another option, should a spouse not be seeking Medicaid assistance, is to transfer some joint income to the non-applicant.  Persons interested in either of these options will want to speak with a Medicaid planning professional.

NC 2014 Medicaid Asset Guidelines
Individual applicants are allowed up to $2,000 in countable resources and married couples applying up to $3,000.  Married couples with one spouse applying are given a considerably higher limit of $117,240.   When determining "countable resources" there are several considerations.  Asset transfers as far back as 60 months are considered.  One's home is not a countable resource provided the applicant or their spouse lives there or intends on returning to live there.  The value of their home and real estate must be less than $543,000.  There are other assets which are not counted including a vehicle, burial plot and final expense insurance policies. 

As with incomes, potential Medicaid applicants that are concerned about their assets being over the limit should contact a Medicaid planner to ensure they qualify.  Read more.

 

Benefits and Services

Services available to CAP/DA and CAP/Choice beneficiaries are selected individually with the objective of enabling them to live or return to living outside of a nursing home environment.  These can include any of the following.  

  • Adult Day Care
  • Case Management
  • Homemaker Service
  • Home Medical Equipment
  • Home Care Supplies
  • In-Home Aide Services
  • Meal Delivery
  • Minor Home Adaptations
  • Personal Care
  • Personal Emergency Response Service (PERS)
  • Respite Care (to relieve the primary caregiver)

 

How to Apply / Learn More

Both the CAP/DA and the CAP/Choice programs are now available statewide.  Both waiver programs limit the number of participants and waiting lists to receive services are the norm.  As of March 2014, there were approximately 11,000 positions available and 8,000 individuals above and beyond these positions who were wait-listed for services. 

To apply for these programs or have one's name added to a wait list, one should contact the lead agency in their county.  A list with contact information is available for download here.   More information about CAP/DA and CAP/Choice is available on the NC Health and Human Services website.