Community Alternatives Program for Children (CAP/C)
What is CAP/C?
CAP/C is an NC 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 Medicaid beneficiaries who are medically fragile and at risk for institutionalization if home and community-based services approved in the CAP/C waiver were not available. These services allow the beneficiary to remain in or return to a home and community-based setting. This waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Medicaid beneficiary.
Who is eligible for CAP/C?
- Medically fragile and medically complex children who are age 0 through 20 years of age
- Is determined to require a level of institutional care under the North Carolina Medicaid State Plan
- Need at least one or more CAP/C home-and community-based services based on a reasonable indication of need assessment that must be coordinated by a CAP/C case manager
What Home and Community-based services are approved under the CAP/C waiver?
- Assistive technology
- CAP/C in-home aide (IHA)
- Care advisor
- Case management
- Community transition service
- Financial management services
- Home accessibility and adaptation
- Goods and services – participant, individual-directed, pest eradication, nutritional services, non-medical transportation and vehicle modification
- Participant goods and services
- Pediatric nurse aide services
- Respite care (institutional and in-home)
- Specialized medical equipment and supplies
- Training, education, and consultative services
- Consumer directed services
What are Consumer Directed Services?
Consumer direction is a service delivery model that allows a CAP/C 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
State Plan Nursing is not a directable service.
How to Make a CAP/C Referral
Contact a local CAP/C case management entity in the county of residence to request a CAP/C referral. If you are a CAP/C case management entity or a qualified home and community-based provider, a referral can be completed in the e-CAP system.
A referral may also be made by calling 919-855-4340 or faxing the referral form to 919-715-0052.
CAP/C Waiver Application and Updates
- CAP/C 1915(c) Waiver
- CAP/C Waiver Renewal 30-Day Public Comments and NC Medicaid Responses
- CAP/C Waiver Renewal Proposed Changes
- Medicaid Bulletin: CAP/C Waiver Update - Nov. 18, 2021
- Waiver Renewal Planning - April 2021
- Medicaid Bulletin: Community Alternatives Program for Children (CAP/C) Waiver Renewal Stakeholder Engagement - Feb. 16, 2021
- CAP/C Timeline and Renewal Activities
- NC Medicaid Clinical Policy Clarification on CAP/C Travel
- Community Alternatives Program for Children Waiver Renewal Stakeholder Engagement - March 31, 2021
- Interim Process for Comprehensive Independent Assessment Entity Request - March 16, 2021
- Community Alternatives Program Internal Independent Assessment
- DHHS Awards Contract for Electronic Visit Verification
- Post COVID-19 Transition Planning Engagement for the CAP Waivers - Aug. 12, 2022
- Resumption of In-Person Visits Workgroup Summary Notes - Oct. 6, 2022
- SPECIAL BULLETIN COVID-19 #55: NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community-Based Services - April 21, 2020
- SPECIAL BULLETIN COVID-19 #93: Targeted Rate Increase, Additional Hours and Associated Reporting Requirements for In-Home Personal Care Services (PCS) Providers under State Plan PCS and CAP/C and CAP/DA Programs - May 29, 2020
- SPECIAL BULLETIN COVID-19 #134: Clarification of COVID-19 Temporary Rate Increases and Clinical Policy Changes - Sept. 22, 2020
NC Medicaid Clinical Section