Page Reviewed / Updated - Mar. 2016
The Community Alternative Program for Disabled Adults (CAP/DA) is North Carolina Medicaid's home and community based services waiver program. In this program, low-income, disabled state residents have an alternative to nursing home placement. Program participants remain in their private residences or receive care in the home of a friend or family. By offering medical and personal care services, North Carolina aims to increase the disabled and seniors' autonomy. The program also covers the cost of minor home adaptations that increase the independence or safety of the program participant.
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 that they can be paid is tightly regulated and is likely between 50% - 70% of the state hourly average for home care. In CAP/Choice, personal caregivers are estimated to receive a wage of between $10 and $14 per hour.
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 2016 Medicaid Income Guidelines
Applicants will qualify automatically if their monthly income is less than approximately $990. For married applicants with both spouses applying, that limit is approximately $1,335 per 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 2016 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 $119,220.
When determining "countable resources," there are several considerations. Significant financial gifts, or asset transfers, as far back as 60 months, are audited and potentially subject to penalties. On the other hand, 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 $552,000. There are other resources that 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.
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.
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 early 2016, state wide demand for these positions exceeded the existing capacity for services. A waiting list is used to keep track of those needing 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.