Medicaid Coverage of Home Health Services in North Carolina

In a recent article for the HealthKeeperz blog, we explained how our company is growing through its commitment to the Community Alternatives Program (CAP), an initiative of North Carolina’s Medicaid program. HealthKeeperz is steadily becoming the managing entity of choice for CAP in some of the state’s poorest, most rural counties, where it’s increasingly critical to help people navigate the options at their disposal for both obtaining care and paying for it, for themselves or their family members.

Let’s take a deeper look at North Carolina Medicaid’s innovative Community Alternatives Program. First, we need to understand that Medicaid-funded home health care includes skilled nursing and therapy services, as well as certain medical supplies and equipment (as long as your physician prescribes them as part of your care plan for a particular condition). It’s also a little-known fact that Medicaid may pay for services more traditionally perceived as personal in nature—bathing, cleaning, meal prep—if your doctor determines that you need this type of assistance in your daily living.

North Carolina has a pair of programs, often referred to as waiver programs, both administered through CAP, that aid in delivering comprehensive health and personal care services to seniors around the state. Let’s take a look at the Community Alternatives Program for Disabled Adults (CAP/DA) and Community Alternatives Program/Choice (CAP/Choice).

Here’s what the two CAP waiver programs have in common: to qualify, you must prove that you need nursing facility care, and that you are at risk of being institutionalized within 30 days of your application. You may also qualify due to blindness or disability.

Now, let’s explain the differences. With CAP/DA, you are eligible to receive a range of home health and personal care services like adult day health, personal care aides, home modification and mobility aids (such as wheelchair ramp installation), meal preparation and delivery, respite services, personal emergency response services, transition services, assistive technology, and case management. In CAP/DA, an agency like HealthKeeperz, through an assigned case manager (usually a social worker), arranges your services and oversees your plan of care for you.

With CAP/Choice, you are able to select and train your own providers in the above areas of service. CAP/Choice thus gives you more control to oversee your care. The program will also pay for people to advise you, such as a personal assistant, care advisor, or even a financial manager.

At HealthKeeperz, we will make every effort to assist you in working with the right programs to pay for your home health and personal care services. When you work within the CAP framework though NC Medicaid, we will have very clear budget parameters, combined with our knowledge of the best local care providers, to achieve your goals, giving you the dignity and better quality of life usually found from staying in your own home.

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