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FAQ
What is a Medicaid Waiver?
According to information posted on the Centers for Medicare & Medicaid Services (CMS) website, Medicaid waivers are authorized by the Social Security Act to allow states flexibility in operating Medicaid programs.
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Who qualifies for a Medicaid Waiver?
Children through 18 years of age who are considered medically fragile and require long-term hospital care or nursing facility care qualify for CAP C.
Adults, 18 years of age and older, who qualify for nursing facility care to remain in their private residences, qualify for CAP DA.
Individuals of any age that require active treatment at the ICF-MR (Intermediate Care Facility for individuals with Mental Retardation) level of care qualify for CAP MR/DD waivers.
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Does North Carolina operate Medicaid waivers?
Yes. North Carolina operates several Medicaid 1915 (c) Home & Community-Based Services Waivers. There are two CAP MR/DD waivers. CAP C and CAP DA are two other NC Medicaid waivers.
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Do Medicaid waivers take into consideration family income?
The most important Medicaid criterion that can be waived by a state is the deeming of income and resources. Medicaid rules require that the income and resources of a spouse/parent be considered in determining Medicaid eligibility for a person who resides with a spouse/parent. This “deeming” of income and resources is to the Medicaid recipient and may be waived to allow Medicaid eligibility under the waiver to be considered similar to the methods used for people who reside in an institution. When an individual enters an institutional setting, the income of the individual is all that is considered regardless of the age of the individual. A parent’s income is not considered. In the same way, parent’s income is not considered when applying for any of the North Carolina 1915 (c) Waivers.
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What does CAP stand for?
CAP stands for Community Alternative Program.
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What is CAP MR/DD?
CAP MR/DD stands for Community Alternative Program for individuals with mental retardation and/or developmental disabilities. There are two CAP MR/DD Waivers: Supports Waiver and Comprehensive Waiver. Both waivers provide community services to individuals with autism, developmental disabilities or intellectual disabilities/mental retardation who live in their own home or reside with their family. The Comprehensive Waiver also serves individuals who receive residential supports in a community congregate setting in the state of NC. The Supports Waiver has a cost limit of $17,500 annually. The Comprehensive Waiver has a cost limit of $135,000 annually.
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Where can I obtain a copy of the new CAP MR/DD manual?
The Supports Waiver and the Comprehensive Waiver have a start date of November 1, 2008. Currently there is no manual available. However, information about these CAP MR/DD waivers can be found at the North Carolina Department of Mental Health, Developmental Disabilities, and Substance Abuse (DMH) website at the link below:
http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm
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Does my child have to be labeled with mental retardation in order to receive CAP MR/DD waiver services?
No. Both CAP MR/DD waivers serve individuals with autism, developmental disabilities OR mental retardation.
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What types of services are available on the CAP MR/DD waivers?
Services available under the Supports and Comprehensive Waivers can be found at the link below.
http://www.ncdhhs.gov/mhddsas/cap-mrdd/index.htm
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What is CAP C?
CAP C is a North Carolina Home & Community-Based Services Waiver that provides cost-effective home care for medically fragile children (through age 18) who would otherwise require long-term hospital care or nursing facility care.
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Is there a CAP C manual?
Yes. The CAP C manual and updates can be found at the North Carolina Division of Medical Assistance (DMA) website at the link below:
http://www.ncdhhs.gov/dma/cc/capc.htm
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What is CAP DA?
CAP DA is a North Carolina Home & Community-Based Services Waiver that provides a package of services to allow adults (age 18 and older) who qualify for nursing facility care to remain in their private residences.
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Is there a CAP DA manual?
Yes. The CAP DA manual and updates can be found at the North Carolina Division of Medical Assistance (DMA) website at the link below:
http://www.ncdhhs.gov/dma/services/capda.html
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What is EPSDT?
EPSDT stands for Early, Periodic, Screening, Diagnosis, and Treatment. The federal definition can be found in the Social Security Act – Section 1905(r) on the Social Security website at the link below:
http://www.ssa.gov/OP_Home/ssact/title19/1905.htm#act-1905-a-2
The North Carolina Department of Health & Human Services (DHHS) website also contains information on the federal program known as EPSDT at the link below:
http://www.ncdhhs.gov/dma/EPSDTconsumer.htm
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What is the co-employer relationship?
The co-employer is the recipient of services and/or family member who actively participates in service coordination. The duties of the co-employer include: selecting staff, determining wages and raises for staff, and assisting with individualized training.
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What is the ICF-MR level of care?
The ICF-MR level of care requires active treatment. This treatment, according to page 6 of the old CAP MR/DD manual, “refers to aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Active treatment does not include services to maintain generally independent clients who are able to function with little supervision or in the absence of a continuous active treatment program.”
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What are the principles of self-determination?
The principles of self-determination as outlined by the Center for Self-Determination are as follows:
FREEDOM – to choose a meaningful life in the community
AUTHORITY – over a targeted amount of dollars
SUPPORT – to organize resources in ways that are life enhancing and meaningful to the individual with a disability
RESPONSBILITY – for the wise use of public dollars and recognition of the contribution individuals with disabilities can make to their communities
CONFIRMATION – of the important leadership role that individuals with disabilities and their families must play in a newly re-designed system and support for the self-advocacy movement
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What is Home & Community Support?
This is a CAP MR/DD waiver service that provides habilitation, training and instruction coupled with elements of support, supervision and engaging participation to reflect the natural flow of training, practice of skills, and other activities as they occur during the course of the person’s day.
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What is Individual Caregiver Training & Education?
Includes training and counseling services for the individual and or family members of the individual. The purpose of this service is to enhance the decision making capacity of the family unit, provide orientation regarding the nature and impact of the developmental disability upon the individual and his/her family, provide information about community integration options and strategies, provide education and training on intervention strategies, and provide education and training on the use of specialized equipment and supplies.
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What is Personal Care Services?
Personal Care Services includes support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living.
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What is Enhanced Personal Care Services?
Enhanced Personal Care Services is intended for individuals receiving CAP MR/DD waiver funding who have intense medical or behavioral needs.
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What is Respite?
Respite provides periodic relief for the family or primary caregiver.
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What is Enhanced Respite?
Enhanced Respite is intended for individuals receiving CAP MR/DD waiver funding who have intense medical or behavioral needs.
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What is Supported Employment?
Supported Employment consists of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting.
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What is Residential Support?
The intent of this service is to meet the habilitation and personal care needs of individuals living in licensed residential settings or unlicensed alternative family living homes. This service is not available under the new CAP MR/DD Supports Waiver.
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What is Home Supports?
The intent of this service is to meet the habilitation and personal care needs of adult (18 years or older) participants who choose to live with their family and receive supports from their family and whose family wishes to provide services to the participant in the family home. Home Supports is designed to provide flexibility and reflect the natural flow of the participant's day. This service is not available under the new CAP MR/DD Supports Waiver.
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