Medicaid waiver
Community Alternatives Program for Disabled Adults (CAP/DA)
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- Who qualifies
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NC Medicaid beneficiaries who are 18 or older with severe and chronic physical disabilities that need the type of care usually found in a nursing home or hospital, or who are 65 or older and at risk of going to a nursing home.
The person must also need at least one CAP/DA service, based on an assessment coordinated by a CAP/DA case manager (NC Medicaid CAP/DA page). Under consumer direction, the beneficiary or a designated representative is the employer of record and hires a personal assistant.
Source: Fact Sheet: Community Alternatives Program for Disabled Adults (NC Medicaid, February 2025)Checked
- Can a family member be paid
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Yes. Yes. Relatives of all kinds can provide CAP In-Home Aide, coordinated caregiving and personal assistant services, employed by a home care agency, through consumer-directed services, or living in the same home as the participant. The relative must be at least 18, meet the hiring criteria set by the participant's care needs, and not have other employment that interferes with the participant's needs.
A spouse is covered by a stricter rule: see the next answer. The waiver also lists respite among the services relatives can provide, but the same section says a relative cannot provide non-institutional respite, so this record does not say whether a relative can be paid for respite.
Source: Application for 1915(c) HCBS Waiver NC.0132.R08.00, CAP/DA, effective Nov 01, 2024 (NC Medicaid)Checked
- Can a spouse be paid
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Depends. Depends. NC Medicaid's documents differ. The approved CAP/DA waiver lets a spouse be paid for in-home care only when one of three extraordinary circumstances applies: the participant has a cognitive limitation such as dementia or Alzheimer's disease or a related disorder, an unfamiliar person is more disruptive than productive, and the participant needs more help with daily activities than ordinary; the participant lives in an area with limited access to service providers and needs five or more hours a day of uninterrupted in-home care; or the participant has a secondary diagnosis of mental illness and the resulting behavior poses harm to an unfamiliar person, or past behaviors have alienated service providers. NC Medicaid's Clinical Coverage Policy 3K-2 lists a spouse among the relatives who can be hired, without those three conditions. The approved waiver is the governing document. Ask the CAP/DA case manager which rule applies to you.
Clinical Coverage Policy 3K-2 (amended September 1, 2025), sections 5.8.10 and 6.5.12, says "A spouse, parent, step-parent, child, sibling, or other relatives can be hired as the employee", while 6.5.12(d) bars a legally responsible person from consumer-directed personal assistance unless extraordinary conditions are met. Under the waiver, a spouse approved as the direct care worker can be authorized for 40 hours a week or less.
Source: Application for 1915(c) HCBS Waiver NC.0132.R08.00, CAP/DA, effective Nov 01, 2024 (NC Medicaid)Checked
- Can a legal guardian be paid
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Depends. Only in extraordinary circumstances. A legal guardian, Power of Attorney or Health Power of Attorney cannot be hired to provide personal care unless one of five conditions is met: no qualified aides are available in the county or adjoining counties and the person needs extensive to maximal daily help with bathing, dressing, toileting and eating; the person needs short-term isolation of 90 days or less for an acute condition and chooses care at home; the person needs physician-ordered 24-hour observation or supervision and the guardian cannot keep a job because of it; the person has specialized health care needs that only the guardian can provide, as medical records show, and those needs require extensive to maximal help with bathing, dressing, toileting and eating; or other documented extraordinary circumstances that would lead to an institutional placement.
An approved guardian can be paid for at most 40 hours a week of personal care, based on the assessed needs, and is not paid for household tasks alone, such as meal preparation, laundry or shopping.
Source: Clinical Coverage Policy No. 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA) (NC Medicaid, amended September 1, 2025)Checked
- Pay rate
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Under consumer direction, the beneficiary or designated representative independently sets the pay rate for the personal assistant they hire.
Source: Community Alternatives Program for Disabled Adults (CAP/DA) (NC Medicaid)Checked
- Hours limit
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A relative or guardian who lives in the same home as the participant cannot be assigned more than 40 hours a week as a direct care worker, and a legally responsible individual can be authorized for 40 hours a week or less.
The 40-hour cap applies to a relative or guardian living in the same home and to a legally responsible individual. The waiver says a relative or paid staff member who does not live there may be paid overtime for hours over 40 a week.
Source: Application for 1915(c) HCBS Waiver NC.0132.R08.00, CAP/DA, effective Nov 01, 2024 (NC Medicaid)Checked