Greensboro Senior AdvisorWhat is CAP/DA?
The Community Alternatives Program for Disabled Adults (CAP/DA) is NC Medicaid's home and community-based waiver for adults 18 and older who need the level of care a nursing facility provides but want to remain at home.
It pays for services rather than housing, so it does not pay rent or room and board. Covered services include:
- In-home aide services
- Adult day health
- Respite care
- Home accessibility and adaptation
- Meal preparation and delivery
- Personal emergency response
- Specialized medical supplies
- Case management
- Consumer-directed care (hiring your own aide)
Who qualifies for CAP/DA in North Carolina?
Adults who are eligible for NC Medicaid, meet nursing facility level of care on assessment, can be served safely at home within the program's cost limits, and live where a CAP/DA case management entity has a slot.
Medicaid eligibility for people 65 and older follows the aged, blind and disabled rules, with a resource limit of $2,000 for one person. North Carolina's Medicaid expansion covers adults 19 to 64 by income but does not by itself create long-term care eligibility. The county department of social services decides Medicaid eligibility; the CAP/DA case management entity handles the waiver assessment and service plan.
What is consumer direction under CAP/DA?
An option that lets the participant, or a representative, hire, train and supervise their own aide, including some family members, with a financial management agency handling payroll.
Consumer direction suits families where a trusted person is already providing care and the participant wants more control over schedules. It also brings responsibility: someone has to manage the aide and keep records. Ask the case manager how back-up coverage works when the aide is sick.
Is there a waiting list for CAP/DA?
Often, yes: CAP/DA has a limited number of slots, and when they are full new applicants wait, so apply as soon as nursing-facility-level needs appear rather than waiting for a crisis.
While waiting, Medicaid personal care services, Special Assistance In-Home, adult day care and family caregiver support through the Piedmont Triad Regional Council (336-904-0300) can bridge the gap. For someone 55 or older who could join PACE, enrollment there can sometimes be faster.
How is CAP/DA different from Special Assistance?
CAP/DA pays for services to keep someone at home and requires nursing facility level of care, while Special Assistance is a cash supplement for adult care home residents and requires only adult-care-home level of care.
A person can qualify for one and not the other. A parent who needs hands-on help but not nursing-home-level care is usually better served by Special Assistance in a licensed adult care home, while someone who meets nursing home criteria and has family support at home may stay home longer with CAP/DA. NC Medicaid's contact center (1-888-245-0179) can point you to the CAP/DA case management entity for your county.
Side by side
| CAP/DA is | CAP/DA is not | |
|---|---|---|
| Program | An NC Medicaid home and community-based waiver | A cash payment to the family |
| Eligibility | Medicaid plus nursing facility level of care | Open to anyone over 65 |
| Housing | Services in the participant's home | Payment for rent or an adult care home |
| Access | Limited slots, often with a wait | Immediate on request |
Drawn from G.S. Chapter 131D, 10A NCAC 13F and 13G, DHSR and NCDHHS publications, NC Medicaid, CareScout, CMS, the VA and the Piedmont Triad aging agency cited in the text; our editorial standards explain how we check them.
