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COVID-19 Response

Resources, information and assistance from across state government. Visit the Information Hub
NC DHB »
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Community Alternatives Program Forms

Community Alternatives Program Forms

Forms for CAP/C and CAP/DA

      Appendix K COVID-19 Flexibilities (April 16, 2020)

  • Standard Operating Procedure
  • COVID-19 CAP Toolkit
  • Consumer Direction Lite Fact Sheet
  • CAP Retainer Payment Fact Sheet
  • Daily COVID-19 Monitoring Log
  • CAP COVID-19 Presentation

________________________________________________

  • Self-Assessment Tool (DMA-3072)
  • Individual Risk Assessment (DMA-3073)
  • Service Request Form for CAP Services

 

Forms

  • HIEA Hardship Extension Forms
  • Provider/Stakeholder Request for Coverage Form

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Contact Information

NC Medicaid
Division of Health Benefits
2501 Mail Service Center
Raleigh, NC 27699-2501
 
NC Medicaid Contact Center
Phone: 888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays. 
 
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