Medicaid and Medicare

The CAP/DA waiver in North Carolina

CAP/DA (Community Alternatives Program for Disabled Adults) is NC Medicaid's home and community-based waiver for adults 18 and older who need a nursing-home level of care but can live at home with support. You must qualify for long-term care Medicaid and be in NC Medicaid Direct, and since February 16, 2024, new applicants may be placed on a statewide waitlist.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 13, 2026

What CAP/DA is

CAP/DA is a Medicaid 1915(c) home and community-based services (HCBS) waiver. NC Medicaid describes it as a program that helps adults with serious health conditions "get care at home instead of moving to a nursing home." The services supplement, rather than replace, the help your family and other programs already give you.

Medicare doesn't pay for long-term personal care at home. It covers part-time skilled home health care when you are homebound and need skilled care, but not an aide for daily help on its own. That gap is what CAP/DA fills for North Carolinians who also qualify for Medicaid.

Who qualifies

NC Medicaid lists these requirements:

A disabled adult 18 or older.
A nursing-facility level of care, based on a medical review.
A need for at least one CAP/DA service, based on a needs assessment coordinated by a CAP/DA case manager.
Long-term care NC Medicaid in one of these groups: Medicaid for the Aged (MAA), Medicaid for the Blind (MAB), Medicaid for the Disabled (MAD) or Health Care for Workers with Disabilities (HCWD).
Enrollment in NC Medicaid Direct. State law keeps CAP/DA participants out of the managed care health plans (G.S. 108D-40(a)(11)).

Some participants pay a deductible, an out-of-pocket amount based on income. Because CAP/DA is long-term care Medicaid, the county also checks for gifts or transfers for less than market value in the 60 months before you apply (MA-2240), and Medicaid can later recover home and community-based service costs from the estate of a member who was 55 or older (G.S. 108A-70.5).

Services CAP/DA can include

Services follow your assessed needs and your plan of care. The waiver's service list includes:

CAP in-home aide and personal assistance
Adult day health
Respite for family caregivers, in the home or in a facility
Personal emergency response services (PERS)
Equipment, home or vehicle modifications and assistive technology
Meal preparation and delivery, and specialized medical supplies
Community transition and community integration services
Coordinated caregiving, training and consultation
Case management, and consumer-directed services with financial management

The statewide waitlist

NC Medicaid announced that, effective February 16, 2024, "individuals requesting to receive services may be placed on a waitlist," because assessments rose and the waiver's slots were fully used. The waiver that ran through October 31, 2024, had capacity for 11,648 slots, and NC Medicaid's renewal planning asked the General Assembly for at least 1,000 more. NC Medicaid hasn't published a current wait time. If you are placed on the list:

You get a letter explaining how the list works and what other Medicaid or community services you can use while you wait.
NCLIFTSS, which manages CAP/DA referrals and assessments for NC Medicaid, can tell you your number on the list (833-522-5429).
If you are already a Medicaid member, the look-back date for transfers is based on the date you were placed on the CAP waiting list (MA-2240).

How to apply

Get or confirm long-term care Medicaid. Apply through ePASS or your county Department of Social Services, and say you are requesting CAP/DA.
Request a referral. Contact a CAP/DA case management entity in your county, or call NCLIFTSS at 919-568-1717 or 833-522-5429. Referrals can also be faxed on the referral form to 833-470-0597.
Complete the assessments. A medical review decides your level of care, and a needs assessment decides which services you need.
Work with your case manager. Your case manager builds your plan of care and arranges services, or tells you about your place on the waitlist.
Keep your Medicare choices in mind. CAP/DA doesn't change how Medicare works. You can review Medicare coverage each fall, and you can request a call from a licensed insurance agent to look at plans from the companies they work with.

If CAP/DA isn't the right fit

PACE for people 55 and older in a PACE service area: one team handles Medicare and Medicaid care. NC Medicaid says 11 PACE organizations operate in 14 locations.
Special Assistance In-Home, a monthly cash payment from NCDHHS through your county DSS for people who need adult care home level of care but want to stay home. See What is Special Assistance?
Your area agency on aging for services under the Older Americans Act. North Carolina has 16 area agencies on aging.

More on how these fit together: NC Medicaid and Medicare and help for caregivers.

Sources

Frequently asked questions

Who qualifies for CAP/DA in North Carolina?

A disabled adult 18 or older who meets a nursing-facility level of care after a medical review, needs at least one CAP/DA service based on a needs assessment, qualifies for long-term care Medicaid as aged, blind, disabled or under Health Care for Workers with Disabilities, and is enrolled in NC Medicaid Direct.

Is there a waiting list for CAP/DA in NC?

Yes. Effective February 16, 2024, people requesting CAP/DA may be placed on a statewide waitlist because the waiver slots were fully used. People on the list get a letter explaining how it works, and NCLIFTSS (833-522-5429) can tell you your number on the list.

Can I have CAP/DA and Medicare?

Yes. CAP/DA is a Medicaid program, and Medicare still pays first for the care it covers, such as doctor visits, hospital care and home health. CAP/DA adds services Medicare doesn't cover, such as an in-home aide, adult day health and respite.

Can a family member be paid to care for me under CAP/DA?

Through consumer direction, CAP/DA lets participants direct their own care. NC Medicaid says legally responsible individuals, such as a spouse, can be paid caregivers only when extraordinary-circumstances rules are met, and for no more than 40 paid hours a week.

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