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North Carolina Department of Health and Human Services North Carolina Medicaid Division of Health Benefits AGED, BLIND AND DISABLED MEDICAID MANUAL MA-2280

COMMUNITY ALTERNATIVES PROGRAM (CAP)

REVISED 7/1/2020 – CHANGE NO. 03-20

I. INTRODUCTION TO CAP

Community Alternatives Program (CAP) is a 1915(c) home and community- based Services Waiver under the Social Security Act. The Waiver allows North Carolina Medicaid funds to be used to provide home and community-based services to Medicaid beneficiaries. These services provide both medical and non-medical home and community-based services to prevent or delay institutionalization.

II. CAP SERVICES ARE OFFERED IN THE FOLLOWING CATEGORIES:

A. CAP for Disabled Adults (CAP/DA)

A North Carolina home and community-based services waiver program providing services and supports in the home and community to disabled, blind and aged adults as an alternative to nursing home placement.

CAP/DA provides community-based services to individuals who:

1. Are age 18 years and over;

2. Are aged, (65 years and over);

3. Are determined to require an ICF (Intermediate Care Facility) or SNF (Skilled Nursing Care) level of care under the North Carolina State Medicaid Plan;

4. Are determined to need CAP services based on a reasonable indication of need and assessment as determined by the CAP case management entity;

5. Live in a private residence; and

6. Have been determined to be disabled by Disability Determination Services (DDS) or the Social Security Administration (SSA);

B. CAP Consumer Direction (CAP/CD)

A service delivery option of the Community Alternatives Program that allows a beneficiary to have choice and control over the services and supports received, by allowing the beneficiary the option to direct care. CAP/CD provides community-based services to individuals who: