North Carolina Medicaid home care: CAP/DA, consumer direction and coordinated caregiving

North Carolina pays for long-term care at home mainly through the Community Alternatives Program for Disabled Adults (CAP/DA), run by NC Medicaid. Members can direct their own personal assistant through consumer direction, and a coordinated caregiving service supports live-in caregivers.

How care at home is paid for here

NC Medicaid describes CAP/DA as a Medicaid home and community-based services (HCBS) program authorized under section 1915(c) of the Social Security Act. It is a cost-effective alternative to institutional care for a Medicaid beneficiary who is medically fragile and at risk of institutionalization, and its services supplement, rather than replace, the formal and informal services and supports a beneficiary already has. Medicaid.gov lists NC Medicaid as the state Medicaid agency.

Who is eligible for CAP/DA

NC Medicaid's program page lists three conditions: a disabled adult 18 or older; a person determined to require a level of institutional care under the State Medicaid Plan; and a person who needs at least one CAP/DA service based on a reasonable indication of need assessment coordinated by a CAP/DA case manager. The February 2025 fact sheet puts it this way: beneficiaries who are 18 or older with severe and chronic physical disabilities that need the type of care usually found in a nursing home or hospital, or 65 or older and at risk of going to a nursing home.

Services in CAP/DA

The program page lists adult day health, CAP in-home aide 1 and 2, equipment, modification and technology, meal preparation and delivery, institutional and in-home aide respite, personal emergency response, specialized medical supplies, goods and services, community transition, community integration, training, education and consultative services, coordinated caregiving, case management, personal assistance, financial management, and consumer directed services.

The fact sheet describes three service types:

• Provider-led: a home health or in-home aide agency is in charge of CAP in-home aide services.
• Consumer-directed: a person called an employer of record (EOR) hires and supervises workers.
• Coordinated caregiving: a live-in caregiver takes care of the beneficiary with the help of a health care agency.

Consumer direction

NC Medicaid says consumer direction lets a CAP/DA beneficiary or designated representative act as employer of record to direct personal care services. They freely choose who provides care to meet medical and functional needs, independently recruit, hire, supervise and fire a personal assistant, set the pay rate, and assign work tasks. The fact sheet says a financial management service pays workers hired through consumer direction. See paid family caregiver in North Carolina for the family rules.

Coordinated caregiving

See coordinated caregiving in North Carolina, NC Medicaid's live-in caregiver service.

The waitlist

NC Medicaid's CAP FAQs, modified August 5, 2026, say the CAP/DA waitlist was approximately 4,536 individuals as of April 2026. The same FAQs say Community Alternatives Program for Children recipients have priority status when moving to CAP/DA, and that transition planning must happen between age 18 and turning 21.

How to start

1. Medicaid. The fact sheet points to the "How to Apply" page at medicaid.ncdhhs.gov/apply.
2. Referral. NC Medicaid says to contact a local CAP/DA case management entity in the applicant's county. The fact sheet lists [email protected] and 1-833-470-0597 for how to apply for CAP/DA.
3. Assessment. A CAP/DA case manager coordinates the assessment.
4. Talk to your case manager every month. The fact sheet says beneficiaries must talk to a case manager by phone every month and meet in person every three months.

Questions to ask when you call

• Which CAP/DA case management entity serves my county, and can it accept a referral for me?
• Have I applied for Medicaid, or am I already enrolled?
• Where am I on the CAP/DA waitlist?
• If I want to direct my own personal assistant, who will be my employer of record?
• I have a live-in caregiver. Is coordinated caregiving available in my county?
• If the caregiver is a parent or other legally responsible individual, what documentation is needed for extraordinary circumstances?
• Is the paid-hour limit for a legally responsible individual 40 hours a week in my case, and who tracks it?
• How often will my case manager talk to me by phone and visit in person?

Terms you will see

• CAP/DA: Community Alternatives Program for Disabled Adults, a Medicaid home and community-based waiver.
• Case management entity (CME): the local agency that works with the beneficiary and family on a CAP plan of care.
• Employer of record (EOR): the beneficiary or designated representative who hires and supervises workers in consumer direction.
• LRI: legally responsible individual, the term NC Medicaid uses for a parent or similar person who may be a paid caregiver in limited cases.
• NCLIFTSS: the NC Medicaid contact named on the fact sheet for how to apply for CAP/DA services.
• Financial management: the CAP/DA service that pays workers hired through consumer direction.
• Coordinated caregiving: the CAP/DA service that supports a live-in caregiver, billed as a daily stipend.

What this page does not cover

North Carolina also has Medicaid personal care services, a program for children (CAP/C) and Innovations waiver services for people with intellectual and developmental disabilities. We have not read those pages, so we do not describe them. See intellectual and developmental disability services in North Carolina for providers.

Where Carevo fits

Carevo is a connection platform and directory. We do not run CAP/DA, make referrals or vouch for providers. The care-type links below show providers that serve your area.

Programs in North Carolina

• Coordinated Caregiving (CAP/DA): Coordinated caregiving is a CAP/DA service in North Carolina that helps a live-in caregiver look after a Medicaid beneficiary, with a health care agency's support and a daily stipend. It works like structured family caregiving in other states.

Find providers in North Carolina

• Home care in North Carolina
• Home health care in North Carolina
• Nursing homes in North Carolina
• Intellectual and developmental disability services in North Carolina
• Paid family caregiver in North Carolina