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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.
Paying family members (or whoever the program participant chooses) works as follows. The participant / care recipient is the “employer”, but a third-party agency sits between NC Medicaid and the care provider. The care provider submits timesheets for the hours of care they provide. The 3rd party bills Medicaid, receives payment from Medicaid, withholds taxes, unemployment insurance and administrative fees and pays the care provider. In 2017, care providers receive between $8.50 - $10.50 per hour for their caregiving efforts.
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 2017 Medicaid Income Guidelines
Applicants will qualify automatically if their monthly income is less than approximately $1005. For married applicants with both spouses applying, that limit is approximately $1,353 per month.
Applicants with higher incomes may also qualify if their cost of care (using Medicaid's rates) significantly reduces their disposable income. For example, in 2017, an individual’s income after subtracting medical and care costs should not exceed $251. 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 effectively lowers the income to a Medicaid eligible level. Still another option, if the applicant is married, is to transfer some joint income to the non-applicant spouse. Persons interested in either of these options should speak with a professional knowledgeable in NC eligibility.
NC 2017 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 may have up to $120,900.
When determining "countable resources," there are several considerations.
Families considering having their loved one give away their money should be aware. Significant financial gifts, or asset transfers, as far back as 60 months, may be audited and potentially subject to penalties that would delay valuable benefits.
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 $560,000. 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.