NORTH CAROLINA · PROGRAM GUIDE
North Carolina:
Community Alternatives Program for Disabled Adults (CAP/DA) — Consumer Direction
North Carolina's CAP/DA waiver helps qualifying adults remain in a community setting when they would otherwise need institutional care. Consumer direction is one service-delivery option within that waiver. It gives the participant or representative employer responsibilities for personal assistance, with case-management and financial-management support. The first practical contact is the CAP/DA case-management entity serving the applicant's county. Selecting a relative is only one part of the service decision.
Official sources checked: 2026-11-15. View references
Program at a glance
- Program
- Community Alternatives Program for Disabled Adults (CAP/DA) — Consumer Direction
- State agency
- NC Medicaid, working with local CAP/DA case-management entities and NC LIFTSS
- Payroll or employer arrangement
- An approved financial-management provider coordinated through the CAP/DA consumer-direction arrangement
- Payment arrangement
- Consumer-directed personal assistance within the authorized plan; coordinated caregiving is a separate service
- Spouses
- Policy 3K-2 permits a qualified spouse or other adult relative for adult CAP/DA personal assistance. Guardian or power-of-attorney roles require separate exception review.
- Parents of minors
- CAP/DA serves adults aged 18 or older. CAP/C has different children's and legally responsible caregiver rules.
Consumer direction, CAP/C and coordinated caregiving
CAP/DA is for adults aged eighteen or older. CAP/C is a separate children's program, so a paid-parent rule quoted from CAP/C should not be transferred without checking. CAP/DA also lists coordinated caregiving among its services; that is not simply another name for hourly personal assistance. Ask the case manager to identify the exact service and delivery model. The employee-hiring process, payment method and permitted tasks follow that choice, not a generic online description of North Carolina family-caregiver pay.
Explain why community supports are needed
CAP/DA requires the relevant institutional level of care and a need for at least one waiver service, alongside applicable Medicaid requirements. The assessment considers the person's needs and existing support rather than simply the family's preferred schedule. Describe hands-on help, risks and tasks that other available services do not meet. A spouse or adult relative may qualify as a personal assistant, but legal guardianship or power of attorney creates additional issues under policy 3K-2. Tell the case manager about all roles held by the proposed worker.
CAP/DA can have a statewide waitlist
NC Medicaid published a statewide waitlist notice when waiver slots reached capacity. That notice is a reason to ask about current availability, not a reliable forecast of today's waiting time. The county case-management entity and NC LIFTSS can explain referral status and the applicable entry process. If placed on a list, keep the notification and ask how to report a significant change in need. Also request information about other Medicaid or community services that may be available while the waiver request is pending.
Taking on the employer role
Consumer direction means recruiting, hiring, supervising and, when needed, replacing a personal assistant. It also involves agreeing a pay rate and tasks within program rules and the authorized plan. Work through the case manager's orientation and financial-management arrangements before promising a wage to a relative. Ask who approves employment paperwork, verifies qualifications and confirms the start date. If the worker also has another job, discuss scheduling honestly: the CAP/DA service must meet the beneficiary's assessed needs and cannot be displaced by other obligations.
Get service-specific recording instructions
Keep the approved plan, employee agreement and service records together. Ask the case manager and financial-management provider which electronic visit verification method applies to personal assistance, and whether a documented live-in arrangement changes that process. Do not infer an exemption from a policy for another state or another CAP service. The worker should record actual delivered care and flag missed shifts, hospital stays or changes in the service plan promptly. A caregiver's availability for an entire day is not the same as a full day of authorized billable work.
Your next steps
- Request a referral through the CAP/DA case-management entity for the applicant's county.
- Complete the needs and Medicaid eligibility reviews; ask whether a waiver slot or waitlist applies.
- Discuss consumer direction, worker relationships and any guardian or power-of-attorney exception.
- Complete employer orientation and financial-management enrollment, then confirm tasks, rate, records and start date.
Explore a pay scenario
The table uses a hypothetical amount of $18.00 per hour. This is not a rate verified for this state. Approved units depend on the assessment and written plan; the table does not establish a maximum or entitlement.
| Hours/week | Weekly | Monthly average |
|---|---|---|
| 20 | $360.00 | $1,560.00 |
| 30 | $540.00 | $2,340.00 |
| 40 | $720.00 | $3,120.00 |
Monthly average = weekly × 52 ÷ 12. Overtime and taxes are not calculated.
Edit this example in the calculator →Does caregiver pay qualify for IRS Notice 2014-7?
IRS Notice 2014-7 can exclude certain qualifying Medicaid waiver payments from federal gross income when the care recipient lives in the provider’s home. Sharing a home alone is not enough: the payment and program must qualify. This is not an exemption for all caregiver wages, all taxes or all state programs. Ask payroll which payments are covered and check the IRS guidance or a qualified tax adviser. Our calculator does not apply a tax exemption.
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Questions families ask
Can my spouse provide paid CAP/DA personal assistance?
Policy 3K-2 permits qualified spouses and other adult relatives for adult beneficiaries. A legal guardian or power-of-attorney role needs separate review; disclose it before hiring.
Can CAP/DA pay me for caring for a child under eighteen?
CAP/DA serves adults. Ask about CAP/C and its separate eligibility and legally responsible caregiver rules for a child.
Does applying reserve an immediate waiver slot?
No. CAP/DA can have a waitlist. Confirm the current entry status with the case-management entity or NC LIFTSS rather than relying on an estimated date online.
Can I keep another job while providing paid care?
The care arrangement must still meet assessed needs. Policy 3K-2 says outside employment must not interfere with the services; discuss a feasible schedule before approval.
Official sources and review notes
- NC Medicaid: CAP/DA program and referrals
- NC Medicaid: CAP/DA beneficiary overview
- NC Medicaid: Clinical Coverage Policy 3K-2, September 2025
- NC Medicaid: CAP/DA waitlist notice, March 2024
- NC Medicaid: CAP/C legally responsible caregiver requirements
- NC Medicaid: CAP/DA approved waiver application
Sources describe the named programs; they do not endorse this website. Rules and provider arrangements can change. Check the linked agency before making a financial decision.
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