What CAP/DA does
CAP/DA is a Medicaid home and community-based services waiver under section 1915(c) of the Social Security Act. It helps adults with serious health conditions get care at home instead of moving to a nursing home. Services include a CAP in-home aide, adult day health, respite for caregivers, personal emergency response, home and vehicle modifications, meals, specialized supplies, community transition, case management and consumer-directed care.
Medicare covers part-time skilled home health care if you are homebound and need skilled care, but not long-term help with bathing, dressing and meals on its own. CAP/DA fills that gap for people who also qualify for NC Medicaid.
Who qualifies
- 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.
- Long-term care Medicaid as aged (MAA), blind (MAB), disabled (MAD) or under Health Care for Workers with Disabilities (HCWD).
- Enrollment in NC Medicaid Direct. G.S. 108D-40(a)(11) keeps CAP/DA participants out of the managed care health plans.
Because CAP/DA is long-term care Medicaid, the county reviews gifts and transfers in the 60 months before you apply (MA-2240).
The waitlist
NC Medicaid announced that, effective February 16, 2024, people requesting CAP/DA "may be placed on a waitlist" because the waiver's slots were fully used. The waiver that ended October 31, 2024, had 11,648 slots. NC Medicaid hasn't published a current wait time, so ask NCLIFTSS for your place on the list and what other services you can use meanwhile.
How to apply
- Apply for Medicaid. Use ePASS or your county Department of Social Services, and say you are asking for CAP/DA.
- Request a CAP/DA referral. Contact a CAP/DA case management entity in your county, or call NCLIFTSS at 919-568-1717 or 833-522-5429.
- Complete the reviews. A medical review sets your level of care; a needs assessment sets your services.
The full guide: CAP/DA in North Carolina. To review your Medicare coverage alongside Medicaid, you can request a call from a licensed insurance agent.
Related questions
Does NC Medicaid pay for nursing home care?
The facility-based option.
What is Special Assistance in North Carolina?
Cash help for adult care homes and in-home care.
What is the Medicaid look-back period?
How transfers affect CAP/DA and nursing home Medicaid.
Sources
- NC Medicaid — Community Alternatives Program for Disabled Adults (CAP/DA)
- NC Medicaid — Waitlist for the CAP/DA Program (March 5, 2024)
- NCLIFTSS — CAP/DA eligibility and referrals
- N.C. General Statutes § 108D-40
- N.C. General Statutes § 108A-70.5, Medicaid Estate Recovery Plan
- Medicare.gov — Home health services
More questions in this guide
- Are people with Medicare and Medicaid in NC Medicaid managed care?
- Can I have NC Medicaid and Medicare at the same time?
- Did NC Medicaid expansion change anything for people on Medicare?
- Does NC Medicaid pay for nursing home care?
- Does NC Medicaid take your house after you die?
- Medicare vs. Medicaid in North Carolina
- What is a dual eligible special needs plan in North Carolina?
- What is Special Assistance in North Carolina?
- What is the Medicaid look-back period in North Carolina?
Part of the guide: NC Medicaid and Medicare together · All questions
Frequently asked questions
Does Medicare pay for CAP/DA services?
No. CAP/DA is an NC Medicaid program. Medicare still pays first for what it covers, such as doctor visits and skilled home health care, but it doesn't pay for long-term personal care at home.
Is there a CAP/DA waiting list?
Yes. Since February 16, 2024, people requesting CAP/DA may be placed on a statewide waitlist. NCLIFTSS, which handles CAP/DA referrals and assessments, can tell you your number on the list at 833-522-5429.
Do I have to pay anything for CAP/DA?
Some participants pay a deductible based on income, NC Medicaid says. Your county DSS figures it when it decides your long-term care Medicaid.
Can my estate be charged for CAP/DA later?
Possibly. North Carolina's estate recovery law, G.S. 108A-70.5, covers home and community-based services for members 55 and older, with deferrals for a surviving spouse and certain children.
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