NC Community Alternative Program for Children

The Community Alternative Program for Children (CAP/C) is a significant Medicaid Home and Community-based Services (HCBS) program in North Carolina. The CAP/C waiver aims to provide a cost-effective alternative to institutionalization for medically fragile children at risk of institutionalization without the home and community-based services it offers. This vital program supports family caregivers in providing quality care for their children in the comfort of their homes.

Overview of Community Alternative Program for Children

The specific goals and objectives of the CAP/C program are multi-faceted:

1. Preventing Institutionalization: The primary aim of the CAP/C waiver is to prevent the unnecessary institutionalization of medically fragile children. By providing home and community-based services, the program ensures that care recipients can receive adequate care in familiar and supportive environments, thus enhancing their overall well-being.
2. Cost-Effective Care: CAP/C seeks to offer cost-effective care solutions by providing essential services that supplement existing formal and informal support systems. By delivering tailored services to each beneficiary, the program aims to optimize the allocation of resources and minimize healthcare costs.
3. Family Empowerment: The program recognizes the vital role of family caregivers in the healthcare system. CAP/C is designed to support and empower these caregivers, acknowledging their dedication and compassion in caring for their children. It includes offering caregiver-directed services that allow family members to act as employers of record for personal care services.
4. Community Integration: CAP/C strives to ensure that medically fragile children can remain integrated within their communities and avoid isolation caused by institutionalization. The program provides services that enhance community participation and social engagement, fostering a sense of belonging and quality of life.
5. Personalized Care Plans: Each beneficiary enrolled in CAP/C receives a customized care plan developed through care coordination and assessment. These individualized plans aim to address each child's unique needs and challenges, promoting optimal health outcomes and well-being.

Eligibility Requirements for CAP/C

To be eligible for CAP/C, individuals must meet the following criteria:

1. Be medically fragile and medically complex children aged 0 through 20 years.
2. Be determined to require institutional care under the North Carolina Medicaid State Plan.
3. Require at least one or more CAP/C home-and community-based services, as assessed by a CAP/C case manager.

Comprehensive Services Offered under CAP/C

The CAP/C waiver program provides various services supporting caregivers in caregiving responsibilities. Some of the services include:

1. Assistive Technology: Adaptive or therapeutic equipment to enhance the beneficiary's mobility, safety, and integration into the community.
2. Attendant Nurse Care: Skilled nurse care for beneficiaries with substantial, complex, and continuous nursing needs, offered through consumer-directed services.
3. CAP/C In-Home Aide (IHA) Services: Hands-on assistance with instrumental activities of daily living (ADLs and IADLs) tasks.
4. Care Coordination: Case management and care advising, linking beneficiaries to community resources, and ensuring continuous community integration.
5. Community Integration Services: Support for active beneficiaries facing community placement challenges.
6. Community Transition Services: Assistance for prospective beneficiaries transitioning from institutions to the community.
7. Coordinated Caregiving: Supportive services for live-in caregivers to improve their community living skills.
8. Financial Management Services: Assistance for beneficiaries directing their care to manage and distribute consumer-directed funds effectively.
9. Home Accessibility and Adaptation: Equipment and modifications to enhance the beneficiary's mobility, safety, and independence at home.
10. Goods and Services: Provision of necessary health, safety, and well-being supplies not covered by other waiver programs or the Medicaid State Plan.
11. Nutritional Services: Coverage for essential health supplements and nutritional products related to primary medical conditions.
12. Non-Medical Transportation: Transport services to access medication, food, and community resources.
13. Pediatric Nurse Aide Services: Extensive hands-on assistance with ADLs and IADLs.
14. Pest Eradication: One-time pest eradication treatment in the beneficiary's home.
15. Respite Care: Temporary relief for primary unpaid caregivers in an institutional or in-home setting.
16. Specialized Medical Equipment and Supplies: Support for safe transport through adaptive car seats or vehicular vests.
17. Training, Education, and Consultative Services: Supportive services to enhance the decision-making ability of beneficiaries or primary caregivers.
18. Vehicle Modification: Services to increase independence and physical safety during transportation.

How to Make a CAP/C Referral

To request a CAP/C referral, individuals can contact their local CAP/C case management entity in their county of residence. Qualified home and community-based providers can also complete referrals through the e-CAP system.

Compensation for Family Caregivers

CAP/C offers consumer direction, a service delivery model that allows Medicaid beneficiaries or their designated representatives to act as employers of record for personal care services. This empowers beneficiaries to choose their caregivers, set pay rates, and assign work tasks based on medical and functional needs.

A note from Givers

Family caregivers are the backbone of healthcare, providing unwavering support to their loved ones. It's time to recognize their invaluable role. If you're a caregiver in North Carolina, find out if you may be eligible for compensation by completing this form.