Medicaid Waivers in North Carolina – An Overview

Find Medicaid Waivers in the Tar Heel State

Regina Woodard

By Regina Woodard for Assisted Living Directory

Way down south, the Tar Heel state enjoys a long history, thanks to being one of the original 13 colonies. Along with a rich history, there are numerous fascinating aspects of the state, including its music history – with such names like John Coltrane, Thelonious Monk, Nina Simone, Roberta Flack, and Randy Travis – and of course, its delicious Southern cooking.

An overview of North Carolina's Medicaid Waivers

Return to, or visit our North Carolina assisted living section.

North Carolina is a popular state, with over 9 million people living in its various counties and cities. Of those, over 1 million are 65 years of age and older, with that number expected to double by 2030. Due to the growth of their elderly population, North Carolina has developed several different programs that can help seniors and their families get the best options in terms of waivers that are offered with Medicaid.

Community Alternatives Program (CAP)

The CAP is a program for those individuals that need long term care, but want to stay in their own homes, while avoiding a nursing facility. There are four of these programs under this list, however only a few are geared towards the elderly.

  • CAP for Disabled Adults (CAP/DA) – CAP/DA provides home and community based services to those adults with disabilities who are at risk for being institutionalized and want to stay within their own home or their community. This section of the CAP is directed towards individuals who do not have a relative, caregiver, community, house member, or third party individual that is able or willing to meet all of the medical, psychosocial, and functional needs of the disabled party.
    • Individuals have the option to choose this program or that of the CAP/Choice, which is a consumer directed care that gives the individual more increased control over their own services and supports. Individuals and their caregivers are then able to direct their own services which are provided in their own residence and community.
    • Some of the services this waiver offers included
      • adult day health
      • personal care aide
      • meal preparation and delivery
      • personal emergency response services
      • training, education, and consultative services
      • case management
    • To be eligible for the CAP, individuals must be 18 years or older and have a qualified disability.

Innovations Waiver

The Innovations waiver provides a wide variety of community based services geared to promoting choice, control, and community membership, with this particular waiver focused on alternatives for institutional care for individuals who need an intermediate care facility for individuals with intellectual disabilities.

Some of the services that are included with this waiver include assistive technology equipment, community transition, in home intensive supports, personal care services, respite service, vehicle modifications, and more. To be eligible for this waiver, individuals must have a diagnosis of an intellectual or developmental disability, need waiver services in order to remain in their home or to move out of a ICF-IDD, be eligible for Medicaid, and be able to choose a living arrangement or residential facility where waiver services and supports that can be maintained.

Innovations Waiver

Program of All-Inclusive Care for the Elderly (PACE)

PACE is a national managed care program for the frail elderly, which provides a range of integrated preventive, acute care, and long term services to manage the needs of the frail elderly. The goal of PACE is to enhance the quality of life and autonomy for frail, older adults by maximizing dignity of and respect for older adults to enable them to live in their homes and community.

Some of the services that PACE offers include all Medicaid covered services, primary care, social work services, restorative therapies, personal care, transportation, meals, lab tests, and more. To be eligible for PACE, individuals must be 55 years or older, be determined to need the required level of care required by the state Medicaid plan, be a resident of North Carolina or a PACE service area, and be able to live in a community area at the time of enrollment.

Money Follows the Person

Money Follows the Person is a state project that helps individuals who are living in hospitals, nursing facilities, or intermediate care facilities return to their homes or communities. The project aims to help these individuals have more choice on where they would like to receive their long term support care, with up to $3,000 in order to secure items and services in order to help transition from a hospital or nursing facility back into their home or community.

To be eligible for this program, individuals must have lived in a hospital, skilled nursing facility, or an intermediate care facility for developmental disabilities for at least three months, meet the requirements for the CAP, innovations waiver, or PACE, be receiving Medicaid services before transitioning and choose a qualified residence, such as a personal home/apartment, family home, or group home.

These are just some of the programs that North Carolina is providing for their elderly population, with some of these undergoing changes in order to continue providing care and services for these residents. If you’d like to learn more, please visit the NC Department of Health and Human Services site or the NC Division of Medical Assistance site.

Photo by D.L. Pardue


Resources & References

NC Waiver Factsheet

Medicaid for Long Term Care

Innovations Waiver – guide