What is CAP/DA?

CAP/DA is a Medicaid Home- and Community-Based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-Based Waiver Services.

The waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home- and community-bases services approved in the CAP/DA waiver were not available. CAP/DA services allow the beneficiary to remain in or return to a home- and community-based setting by supplementing, rather than replacing, the formal and informal services and supports already available to an approved Medicaid beneficiary.

Who is eligible for CAP/DA?

-A disabled adults 18 years old and older.

-An individual who is determined to require a level of institutional care under the State Medicaid Plan.

-An individual who needs at least one or more CAP/DA home- and community-based service based on a reasonable indication of need assessment that must be coordinated by a CAP/DA case manager.

What Home- and Community-based services are approved in the CAP/DA waiver?

• Adult day health

• CAP In-home aide

• Equipment, modification and technology

• Meal preparation and delivery

• Respite services - Institutional respite and In-Home Aide respite

• Personal Emergency Response Services (PERS)

• Specialized medical supplies

• Goods and services – Participant, Individual-directed, Pest eradication, Nutritional services, Non-medical transportation and Chore services-declutter and garbage disposal

• Community transition

• Community integration

• Training, education and consultative

• Coordinated caregiving

• Case management – case management and care advisement

• Personal assistance

• Financial management

• Consumer directed services

What is Consumer Directed Services?

Consumer-direction is a service delivery model that allows a CAP/DA Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:

Freely choosing who will provide care to meet medical and functional needs

Independently recruiting, hiring, supervising, and firing (when necessary) an employee (personal assistant)

Independently setting a pay rate for an employee (personal assistant)

Assigning work tasks for the employee (personal assistant) based on medical and functional needs

How to make a CAP/DA referral?

Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.

If you are a CAP/DA case management entity or a qualified home- and community-based provider, a referral can be completed in the e-CAP system.

Quick Facts

A referral may also be made by calling 919-855-4340 or faxing the completed referral form to 919-715-0052

NC Medicaid Clinical Section

Phone: 919-855-4340

Fax: 919-715-0052

Email: medicaid.capda@dhhs.nc.gov

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