Waiver Description
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.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
General Requirements
CAP/DA is available to North Carolina residents who are:
- 65 years of age or older and at risk of nursing-home placement OR
- At least 18 and have a physical or mental disability that results in the need of care typically found in a nursing home.
Financial Requirements
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.
Income Limits
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.
Asset Limits
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.
Over the Financial Limits?
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.
WarningMedicaid has a 60-month look-back period in which all transfers within this time frame are scrutinized. Assets are not allowed to be gifted in order to meet financial requirements, otherwise the individual will be penalized with a period of Medicaid ineligibility.
Benefits and Services
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.
- Adult Day Care
- Assistive Technology
- Case Management
- Community Integration Services (to assist one who is danger of losing their home in the community due to tenancy issues)
- Financial Management Services (for the consumer-directed option)
- Homemaker and Chore Services
- Home Medical Equipment
- Home Care Supplies
- In-Home Aide Services
- Meal Delivery
- Minor Home Adaptations
- Non-Medical Transportation
- Pest Eradication
- Personal Care
- Personal Emergency Response Service (PERS)
- Respite Care (both in-home and out-of-home to relieve the primary caregiver)
- Training / Education
- Transition Services (to assist one in moving from a nursing home back into the community)
How to Apply / Learn More
To apply for services through this waiver or have one’s name added to a wait list, a few options are available:
- Contact the CAP/DA case management entity in your county. A list of case management providers by county can be found here. OR
- Fax a completed referral form to 919-715-0052. A referral form can be found here. OR
- Contact North Carolina’s Medicaid Contact Center at 888-245-0179. OR
- Contact your nursing home’s social worker if you are currently residing at a nursing facility.
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.
North Carolina Medicaid also offers personal care under its State Plan.
