North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA)
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
CAP/DA Waiver Overview
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.
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. 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.
Waiver 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 2013 Medicaid Income Guidelines
Applicants will qualify automatically if their monthly income is less than approximately $950. For married applicants with both spouses applying, that limit is approximately $1,300 / 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. Persons interested in this option will want to speak with a Medicaid planning professional.NC 2013 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 $115,920. 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 $536,000. 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
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
-In-Home Aide Services
-Personal Emergency Response Service (PERS)
-Respite Care (to relieve the primary caregiver)
How to Apply / Program Availability
Both the CAP/DA and the CAP/Choice programs are now available Statewide. Both waiver programs limit the number of participants so it is possible that waiting lists could exist.
To apply for these programs, one should contact the lead agency in their county. A list with contact information is available for download here
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Page Reviewed / Updated - Jan 2013