Community Alternatives Program (CAP)

The Community Alternatives Program (CAP) provides home and community care as a cost-effective alternative to institutionalization. CAP is a program where standard Medicaid requirements are waived to allow the program to operate. Waiver programs provide services that would otherwise not be covered under Medicaid.

Community Alternatives Program for Children (CAP/C)

Community Alternatives Program – (CAP/Choice)

Community Alternatives Program for Disabled Adults (CAP/DA)

Update: Combined CAP/C and CAP/DA Waivers

In 2011, the Division of Medical Assistance (DMA) implemented a project to merge the Community Alternatives Program Waivers, Community Alternatives Program for Children CAP/C and Community Alternatives Program for Disabled Adults CAP/DA. In March 2014, The Centers for Medicare and Medicaid Services (CMS) implemented an HCBS Final Rule to encourage states to combine waivers that targets similar populations.

Between 2011 -2015 work groups met to identify waiver processes to aid in the merger of these two waivers. These work groups analyzed the six waiver assurances and case management practices to identify similarities, differences and methods for consolidation. Recommendations from these work groups were used to draft the proposal of the combined 2015 CAP waiver. This draft waiver will be submitted to CMS for review and approval in December 2015.

Prior to the waiver submission to CMS, the waiver will be posted for a second 30-day public comment period to allow review of changes made to the waiver based on comments and recommendation received. Areas updated in the proposed waiver include the following:

Proposed Waiver Document

  1. Main Module
  2. Major Changes
  3. 1-f: Level(s) of Care
  4. Brief Waiver Description
  5. Public Input
  6. Transition Plan
  7. Appendix A
  • A-1: State Line of Authority for Waiver Operation
  • A-4: Role of Local/Regional Non-State Entities
  • A-5: Responsibility for Assessment of Performance of Contracted and/or Local/Regional Non-State Entities
  • A-7: Distribution of Waiver Operational and Administrative Functions
  1. Quality Improvement: Administrative Authority: a-i
  2. Quality Improvement: Administrative Authority: a-ii
  3. Appendix B
  • B-1-a: Target Group(s)
  • B-1-b: Target Groups – Additional Criteria
  • B-3-a: Unduplicated Number of Participants
  • B-3-b: Limitations on the Number of Participants Served at Any Point in Time
  • B-3-c: Reserved Waiver Capacity
  • B-4: Eligibility Groups Served in the Waiver
  • B-6-c: Qualifications of Individuals Performing Initial Evaluation
  • B-6-d: Level of Care Criteria
  • B-6-e: Level of Care Instruments
  • Quality Improvement: Level of Care
  • B-7: Freedom of Choice
  1. Appendix C
  • Appendix C1/C3: Service Specification
  • Quality Improvement – Qualified Providers
  • Appendix C-5: Home and Community Based Settings
  1. Appendix D
  • Appendix D-1-c: Service Plan Development
  • Appendix D-1-d: Service Plan Development Process
  • Appendix D: Quality Improvement
  1. Appendix E
  • Appendix E-1-j: Participation Direction of Services: Overview (9 of 13) 
  • Appendix E-1-m: Involuntary Termination of Participant Direction
  • Appendix E-2-b-iii: Informing Participant of Budget Amount
  1. Appendix F:
  • Appendix F-1: Opportunity to Request a Fair Hearing
  1. Appendix G
  • Appendix G-2-a: Use of Restraints
  • Appendix G-2-b: Use of Restrictive Interventions
  • Appendix G-2-c: Use of Seclusion
  • Appendix G: Quality Improvement
  • Appendix G: Quality Improvement a-ii
  • Appendix G-b-i: Methods for Remediation/Fixing Individual Problems
  1. Appendix I
  • Appendix I-1: Financial Integrity
  • Appendix I-1-2: Rate Determination Methods
  • Appendix I-3-d: Payments to State or Local Government Providers
  1. Appendix J Appendix J-2-c-i: Factor D derivation

This public comment posting provides an opportunity to share additional comments or recommendations to the changes made to the proposed waiver. Any additional comments or recommendations will be carefully considered for possible inclusion in the draft waiver prior to the final submission to CMS.

The 30-day public comment period starts on Tuesday, October 20, 2015 and will end on Thursday, November 19, 2015. You can submit your comments to this email address  or you can call this voice mail number (919) 855-4210 to leave a comment.


Medical Assistance Clinical Section
Phone: 919-855-4340
Fax: 919-715-0052

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