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 the 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. The 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

Home and Community-based services approved under the CAP/C waiver?

  • Assistive technology – adaptive or therapeutic equipment to improve, maximize or enhance  the waiver participant’s mobility, safety, independence, and integration into the community.
  • Attendant nurse care – a service that provides skilled nurse care to a waiver participant who has substantial, complex and continuous skill nursing care needs. This service is offered through consumer-directed services.  
  • CAP/C in-home aide (IHA) services – hands-on assistance with instrumental activities of daily living (ADLs and IADLs) tasks.
  • Care coordination – case management and care advisor, assesses needs, care plans services, monitors health, safety and well-being, links to community resources and follows up with the waiver participant to ensure continuous community integration.
  • Community integration services – service for an active waiver participant in jeopardy of losing their community placement due to tenancy-related issues.
  • Community transition services – service for a prospective waiver participant to transfer from an institution or provider owned/controlled residence to the community.
  • Coordinated caregiving – supportive services to a live-in caregiver that assists with the acquisition, retention or improvement of skills related to living in the community.
  • Financial management services – a service provided to waiver participants who is directing their care to ensure that consumer-directed funds are managed and distributed as intended.
  • Home accessibility and adaptation – equipment and physical adaptations or minor modifications to enhance the waiver participant’s mobility, safety and independence in the primary private residence.
  • Goods and services (participant, individual-directed) - a service that provides services, equipment or supplies not otherwise provided through this waiver or through the Medicaid State Plan. This service helps assure health, safety and well-being of the waiver participant.
  • Nutritional services – a service that provides coverage for physician ordered health supplements, vitamins or mineral supplements, herbal preparations and nutritional supplements that directly related to a primary medical condition and are not available through Medicaid State Plan services.
  • Non-medical transportation – transportation services to allow the waiver participant to gain access to the community to obtain medication, food, and access resources.
  • Pediatric nurse aide services – a service that provides extensive hands-on assistance with ADLs and IADLs.
  • Pest eradication – a service that provides a one-time pest eradication treatment in the home of the waiver participant.
  • Respite care (institutional and in-home) – temporary relief to the primary unpaid caregiver(s) by taking over the care needs of the waiver participant for a limited time.
  • Specialized medical equipment and supplies – a service that enables safe transport through an adaptive car seat or vehicular vest.
  • Training, education and consultative services – a service that provides supportive services to the waiver participant, the waiver participant unpaid primary caregiver or unpaid support system to enhance the decision-making ability of the waiver participant or primary caregiver.
  • Vehicle modification – a service that enables increased independence and physical safety through personal transport.

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, within the qualifying limits, 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.

Fact sheet - How to make a CAP referral

A referral may also be made by calling 833-522-5429 or faxing the completed referral form to 833-470-0597.

CAP/C Waiver Renewal Application

NC Medicaid CAP/C Waiver Renewed 

The Centers for Medicare & Medicaid Services approved the Department of Health and Human Services’ request to renew the NC Medicaid 1915(c) Community Alternatives Program for Children (CAP/C) waiver for medically fragile and medically complex individuals between the ages of 0 through 20. 
CMS approved the Department’s request to increase the number of CAP/C waiver individuals by 500 each year of the waiver renewal period (i.e., year 1: 4000; year 2 - 4500; year 3 - 5000; year 4 - 5500; and year 5 -, 6000). 

CAP/C Waiver Implementation (or Transition) Timeline and Activities

Overview of the CAP/C Waiver Renewal

Provider Forums

CAP presentation from LTSS Provider Forum - June 25, 2024

Provider Training

Appendix K flexibilities remain in place through Nov. 11, 2023. Annual beneficiary re-evaluation that begin after May 11, 2023, will include a transition plan to the new personal care service options approved in the newly revised CAP/C waiver.

Trainings

Critical Incident Reporting

Willing and Qualified Providers of Hands-on Services

What I Need to Know as a Case Manager of CAP/C Services

Assisting Families to Direct their Care through Consumer-directed Services

Beneficiary/Family Training

Trainings

Becoming a Paid Caregiver of In-Home Aide (IHA) & Pediatric Nurse Aide (PDA) Services

Attendant Nurse Care (ANC) – Hiring my Own Nurse

What is Coordinated Caregiving and How Does it Work?

Blending Services

Special Announcements

Resources

COVID-19 Management

Archive

Contact

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

Documents

This page was last modified on 11/25/2024