What is CAP/DA?
CAP/DA is a Medicaid Home- and Community-Based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-Based Waiver Services.
The waiver program provides a cost-effective alternative to institutionalization for a Medicaid beneficiary who is medically fragile and at risk for institutionalization if home and community-bases services approved in the CAP/DA waiver were not available. CAP/DA services allow the beneficiary to remain in or return to a home and community-based setting by supplementing, rather than replacing, the formal and informal services and supports already available to an approved Medicaid beneficiary.
Who is eligible for CAP/DA?
- A disabled adult 18 years old and older.
- An individual who is determined to require a level of institutional care under the State Medicaid Plan.
- An individual who needs at least one or more CAP/DA home and community-based service based on a reasonable indication of need assessment that must be coordinated by a CAP/DA case manager.
What Home-and Community-Based services are approved in the CAP/DA waiver?
- Adult day health
- CAP In-home aide
- Equipment, modification and technology
- Meal preparation and delivery
- Respite services – Institutional respite and In-Home Aide respite
- Personal Emergency Response Services (PERS)
- Specialized medical supplies
- Goods and services – Participant, individual-directed, pest eradication, nutritional services, non-medical transportation and Chore services-declutter and garbage disposal
- Community transition
- Community integration
- Training, education and consultative
- Coordinated caregiving
- Case management – case management and care advisement
- Personal assistance
- Financial management
- Consumer directed services
What is Consumer Directed Services?
Consumer-direction is a service delivery model that allows a CAP/DA Medicaid beneficiary or designated representative to act in the role of employer of record to direct their personal care services by:
- Freely choosing who will provide care to meet medical and functional needs
- Independently recruiting, hiring, supervising, and firing (when necessary) an employee (personal assistant)
- Independently setting a pay rate for an employee (personal assistant)
- Assigning work tasks for the employee (personal assistant) based on medical and functional needs
How to make a CAP/DA referral?
Contact a local CAP/DA case management entity in the county of residence of the applicant to request a CAP/DA referral.