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CAP/D FAQs

Frequently Asked Questions

What is CAP/DA?

CAP/DA is the Community Alternatives Program for Disabled Adults. It is a waiver program operated under a Medicaid Home and Community-Based Services (“HCBS”) waiver authorized under Section 1915(c) of the Social Security Act (“Waiver”) and complies with 42 CFR 441 Subpart G and 42 CFR 440.180. This Waiver provides a cost-neutral alternative to institutionalization for Beneficiaries, in specified target populations, who would be at risk for institutionalization if specialized Waiver services are not available. For more information, please see Community Alternatives Program for Disabled Adults (CAP/DA).

What services are provided under the CAP/DA program?

The Waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Beneficiary. Services are intended for situations where no household member, relative, caregiver, landlord, community agency, volunteer agency, or third-party payer is able or willing to meet the assessed and required medical, psychosocial, and functional needs of the approved CAP Beneficiary. Services provided under the Waiver are:

  • Adult day health
  • CAP In-home aide
  • Equipment, modification and technology
  • Meal preparation and delivery
  • Respite services - Institutional respite and In-Home Aide respite
  • Personal Emergency Response Services (PERS)
  • Specialized medical supplies
  • Goods and services – Participant, Individual-directed, Pest eradication, Nutritional services, Non-medical transportation and Chore services-declutter and garbage disposal
  • Community transition
  • Community integration
  • Training, education and consultative
  • Coordinated caregiving
  • Case management – case management and care advisement
  • Personal assistance
  • Financial management
  • Consumer directed services

Who is eligible for the CAP/DA program?

For Waiver participation under CAP/DA, an individual must (1) Be eighteen (18) years of age or older; (2) Require an institutional Level of Care consistent with the Medicaid State Plan; (3) Have a reasonable indication of need that places the applicant at-risk of institutionalization based on assessed needs; (4) Be assigned a Waiver slot; and (5) Agree to participate in the CAP/DA Waiver by signing a Waiver participation agreement which selects home based care versus institutional care.

What qualifies a person for ‘institutionalized level of care’?

A full list of conditions that are considered when assessing a beneficiary for nursing facility level of care can be found in Clinical Coverage Policy 3K-2 here:

https://medicaid.ncdhhs.gov/3k-2-community-alternatives-program-disabled-adults-capda/download?attachment 

How do I apply for the CAP/DA program?

  • Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.  
  • If you are a CAP/DA 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 Acentra at 833-522-5429.

What can I expect after I apply for the program?

You can expect to receive a service request packet in the mail within 2 business days from the date of referral, from Acentra. They are the independent assessing contractor for Medicaid. Three forms are included with the service request packet that must be returned to Acentra for review of eligibility for CAP services. These three forms are:

  • Service Request Consent form
  • Selection of Case Management form
  • Physician’s Worksheet.

Instructions are included in the packet on how to return the three required forms.

IMPORTANT: These forms are required to be returned within 7 days from date of receipt in order to be considered for the program.

How long does it take to get an approval determination once I apply for the program?

When the signed and dated consent form is received, the review of your medical condition begins in order to assess a defined level of care. If a defined level of care is determined, Acentra will schedule and conduct a face-to-face, comprehensive assessment. The timeline to receive CAP services, if all requirements are met, can be up to 45 days.

Is there a current waitlist for the program?

Waitlist vary from county to county. You can call Acentra at 833-522-5429 to get an update of the waitlist status in your county.