Community Alternatives Program for Children (CAP/C)

What is CAP/C?

A 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. This waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home- and community-bases 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 State Medicaid Plan.
  • Need at least one or more CAPC 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 in 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 and Non-medical transportation; 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; and
  • Consumer directed services

What is 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); and
  • 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.

Special Announcements

Community Alternatives Program Internal Independent Assessment

DHHS Awards Contract for Electronic Visit Verification

COVID-19 Management

SPECIAL BULLETIN COVID-19 #55: NC Medicaid Receives Approval for Expanded Flexibilities for Home and Community-Based Services

SPECIAL BULLETIN COVID-19 #134: Clarification of COVID-19 Temporary Rate Increases and Clinical Policy Changes

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

CAP/C Waiver Application and Updates

CAP/C 1915(c) Waiver

Public Comment Period for Community Alternatives Program for Children Waiver Renewal

Resources

CAP Forms

NC Medicaid Clinical Policy Clarification on CAP/C Travel

We have heard from some beneficiaries expressing concern about the NC Medicaid CAP/C travel policy. The statement below is intended to clarify the policy.

Medicaid CAP/C staff is convening stakeholder engagement groups to review the CAP/C clinical coverage policy in specific areas to determine if the policy is clear and concise, and to determine if language leaves possible interpretation that the policy unintentionally creates barriers for the beneficiary to access the service or providers to render the service. The work groups will continue until the end of September to finalize their recommendations. No changes to current policy have been implemented since the CMS approval of the CAP/C on March 1, 2017, and the method in which respite was designed has not changed. 

We agree that CAP/C is a home- and community-based services waiver program that promotes community inclusion and integration. This person-centered approach to care planning allows for accommodation with what is important “for” the person receiving CAP/C and their family as well as what is important “to” them. Because it is a waiver, there is flexibility in structure and service delivery that may not be accommodated in regular state plan services.

Each participant in the CAP/C waiver is permitted to plan and participate in vacation time with his or her family regardless of the location of the vacation, in or outside of North Carolina (regulatory requirements must be met when a vacation is planned outside of North Carolina). Families are permitted to use their in-home care provider for up to 14 days per year for vacation time. A plan revision for approval is not required; the parent, assigned case manager and the provider agency simply coordinate and arrange for care coverage during the vacation time. So not to exhaust a family’s respite time and to correctly utilize the appropriate waiver service, respite hours are not authorized during planned and unplanned vacations; in-home aide or pediatric nurse hours are authorized and are permitted to be used. 

Children receiving CAP/C services who are also receiving state plan private duty nursing (PDN) are eligible to travel with their families and receive PDN services when a physician indicates the child is able to travel safely and nursing care is needed during this therapeutic leave time. Planning is required by the physician and private duty nursing agency to obtain the physician’s order and ensure that the nurse is licensed to deliver care in North Carolina.   

Dave Richard
Deputy Secretary, NC Medicaid

Archive

Contact

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