The Community Alternatives 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 member.
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.
This program also offers the added benefit of consumer direction, which means participants can choose who is hired to provide their personal assistance services, including adult children.
CAP/DA is available to North Carolina residents who are:
This waiver is 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.
Individual applicants must have a monthly income that is no greater than $1,215 (effective April 2023 – March 2024). For married applicants with both spouses applying, that limit is $1,644 per month. These figures are equal to 100% of the Federal Poverty Level (FPL), which changes every year.
However, when only one spouse is applying, the income of the non-applicant spouse is not counted. In addition, some of the applicant’s income can be transferred to the non-applicant spouse. This is called the Monthly Maintenance Needs Allowance and is intended to prevent spousal impoverishment. As of 2023, as much as $3,715.50 a month can be transferred to the non-applicant spouse to bring his or her monthly income up to this level.
Individual applicants are allowed up to $2,000 in countable resources, while married couples with both spouses as applicants can keep up to $3,000.
Married couples with only one spouse applying have different rules regarding assets. In order to prevent the non-applicant spouse from becoming impoverished, that spouse may retain up to $148,620 in assets. This is referred to as a Community Spouse Resource Allowance. In addition, the applicant spouse is still able to retain $2,000 in assets.
When determining “countable resources,” there are several considerations. One’s home is not a countable resource provided the applicant, or his or her spouse, lives there or intends on returning to live there. The equity value of their home must be less than $688,000. There are other resources that are not counted, including a vehicle, burial plot, and final-expense insurance policies.
North Carolina residents who exceed the income and asset limits but still cannot afford their care costs still might qualify for this program by working with a Medicaid planning professional. They are trained to assist applicants who find themselves in this very situation and are well versed in reallocating income and assets so that it isn’t counted toward the limits. For instance, extra income can be deposited into a Miller Trust, also referred to as a Qualified Income Trust, and an Irrevocable Funeral Trust can be used to lower one’s countable assets.
Services available to CAP/DA 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.
To apply for services through this waiver or have one’s name added to a wait list, a few options are available:
The CAP/DA waiver is available statewide and is administered by North Carolina’s Department of Health and Human Services, Division of Health Benefits. This waiver program limits the number of participants, and waiting lists to receive services are the norm. However, the waiting list is county-specific, which means there may be a waiting list in one county but not another.
More information about the CAP/DA waiver is available on the NC Health and Human Services website.