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.

Quick Facts

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

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Contact

NC Medicaid Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052
Email: Medicaid.capc@dhhs.nc.gov

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