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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

CAP/DA

DMA Clinical Policy and Programs
919-855-4260
Fax 919-715-0052

The Community Alternatives Program for Disabled Adults (CAP/DA) is a special Medicaid program under the Community Care Section of the Division of Medical Assistance. The program makes care at home a real possibility for many people who face nursing home placement. When the program began in 1982, four counties participated.  It is now available in all 100 counties.

The CAP/DA program waives certain NC Medicaid requirements to furnish an array of home and community based services to adults with disabilities 18 years of age and older who are at risk of institutionalization. The services are designed to provide an alternative to institutionalization for beneficiaries in this target population who prefer to remain in their primary private residences, and would be at risk of institutionalization without these services.

CAP/DA or CAP/Choice supplement, rather than replace, the formal and informal services and supports already available to a beneficiary. CAP/DA or CAP/Choice services are intended for situations where no household member, relative, caregiver, landlord, community, agency, volunteer agency, or third party payer is able or willing to meet all medical, psychosocial, and functional needs of the beneficiary.

The two options under the CAP/DA Program are:

  1. CAP/DA, the traditional option; and
  2. CAP/Choice, the consumer-directed option.

  3. CAP/Choice, an option under the CAP/DA program, is consumer-directed care for disabled adults who wish to remain at their primary private residence and have increased control over their own services and supports. Beneficiaries and their caregivers direct their own services and supports which are provided in their own primary private residence and community. It offers beneficiaries the choice, flexibility and control over the types of services they receive, when and where the services are provided, and by whom the services are delivered.

CAP/DA waiver services are specified below:

  • Adult day health
  • Personal care aide
  • Home accessibility and adaptation
  • Meal preparation and delivery
  • Institutional respite services
  • Non-institutional respite services
  • Personal Emergency Response Services
  • Specialized medical equipment and supplies
  • Participant goods and services
  • Community transition services
  • Training, education and consultative services
  • Assistive technology
  • Case management
  • Care advisor (CAP/Choice only)
  • Personal assistant (CAP/Choice only)
  • Financial management services (CAP/Choice only)

For service requirements, coverage criteria and limitations, refer to Clinical Coverage Policy 3K-2, Community Alternatives Program for Disabled Adults and Choice Option (CAP/DA-Choice) (PDF, 150 KB)

CAP/DA Contacts

CAP/DA Policies & Manuals

  • CAP/DA Waiver (PDF, 2MB)
  • CAP/DA Instructional Manual – Under Development

Medicaid Bulletins

The 1915 (c) Home and Community-Based Services (HCBS) waiver for CAP/DA was renewed by the Centers for Medicare and Medicaid Services (CMS) on October 1, 2013. This waiver is in effect for a time period of 5 years (October 1, 2013-September 30, 2018). See the May 2013 Special Bulletin for more information.

The renewed CAP/DA waiver proposes a number of changes in the areas of eligibility, level of care determination, administrative authority and case management practices.

The proposed changes in the renewed CAP/DA waiver will take a phase-in approach. The first date of the phase-in approach began November 1, 2013.

SFY 2010 and 2011, DMA was directed by the N.C. General Assembly to freeze slots in the Community Alternatives Program for Disabled Adults (CAP/DA) in order to meet the budget reduction goals. As a result of this initiative, the CAP/DA program is approved to service a total of 11, 214 Medicaid beneficiaries statewide per fiscal year.

Additional information is available in the Medicaid Bulletin:

CAP/DA Trainings

CAP/DA Fee Schedules

CAP/DA Forms

CAP/DA Memorandums

CAP/DA Frequently Asked Questions

  • Questions about Consumer Direction - Under Development
  • Comments about the CAP/DA Waiver – Under Development

 

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