Winston-Salem 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 nursing facility level of care but want to stay at home; it pays for services that make staying home safe.
- Personal care aide hours at home
- Adult day health
- Respite for family caregivers
- Home modifications such as ramps and grab bars
- Meal preparation or home-delivered meals
- A personal emergency response button
- Certain medical supplies
- Case management
- A consumer-directed option to hire your own aide
It does not pay rent, food or the room-and-board cost of an adult care home. The program is run by NC Medicaid, with a local lead agency in each county doing assessments and case management.
Who qualifies for CAP/DA in North Carolina?
An adult who is eligible for NC Medicaid, who meets nursing facility level of care on the state assessment, whose needs can be met safely at home within the program's cost limits, and who lives in a home setting rather than a facility.
Medicaid financial eligibility for people 65 and over still runs through the aged, blind and disabled rules, with a resource limit of $2,000 for one person; Medicaid expansion does not change that for older adults. Someone who is not yet on Medicaid applies at the county department of social services and requests a CAP/DA referral at the same time.
Is there a waiting list for CAP/DA in Forsyth County?
Often, yes: each county has a limited number of CAP/DA slots, and when they are full, new applicants wait until one opens, so apply as soon as a parent's needs look likely to reach nursing home level.
Ask the county DSS or the local CAP/DA lead agency how long the current wait is and how priority is set. People leaving a hospital or nursing home, or at risk of entering one, are sometimes prioritized. While you wait, consider adult day care, Senior Services Inc.'s home care program in Forsyth County, or a few hours of private-pay help to bridge the gap.
Can a family member be paid through CAP/DA?
Through the consumer-directed option, a CAP/DA participant or their representative can hire, train and supervise their own aide, which can include certain relatives, with a financial management agency handling payroll.
The rules on which relatives can be paid and how many hours have changed over time, so confirm the current policy with the case manager before planning around it. Consumer direction suits families who want control and continuity; the agency-directed model suits those who would rather the agency handle hiring, scheduling and backup when an aide is out.
How does CAP/DA differ from PACE around Winston-Salem?
CAP/DA brings services to the home through separate providers, while PACE, available here only in Davidson and Davie counties through Carolina SeniorCare in Lexington, provides all medical and long-term care through one organization and its day center.
Someone enrolled in PACE cannot also use CAP/DA. In Forsyth and Stokes counties, where PACE of the Triad West is listed as coming soon but not yet enrolling, CAP/DA is the main Medicaid route for help at home. See PACE and county programs for details.
What it is, and what it is not
| CAP/DA is | CAP/DA is not | |
|---|---|---|
| Purpose | Medicaid help so a person can stay at home | Payment for an adult care home's rent |
| Who | Adults needing nursing facility level of care | Anyone who would like a little help |
| Access | Limited county slots, sometimes a waiting list | Immediate on approval |
| Control | Agency-directed or consumer-directed | Only one model of care |
Based on N.C.G.S. Chapter 131D, 10A NCAC 13F and 13G, DHSR and NCDHHS documents, NC Medicaid, CMS, the VA, CareScout and the local agencies named above; see our editorial standards for how each is checked.
