How to Apply for the CAP Program in NC: Steps, Eligibility, and Denials

To apply for the CAP program in North Carolina, contact a local case management agency in the county where the applicant lives, or call NC LIFTSS (Acentra Health) at 833-522-5429 to be pointed to one. The agency starts the referral, and an independent nurse assessment decides whether you qualify. The Community Alternatives Program runs as two Medicaid waivers: CAP/DA for disabled adults 18 and older, and CAP/C for medically fragile children from birth through age 20.¹²

Step 1: Contact a Case Management Agency

The application starts with a referral, and the referral goes through a local CAP case management entity. You can find one through the NC Medicaid Lead Agency Directory or by calling NC LIFTSS (Acentra Health) at 833-522-5429.¹ The agency handles the referral paperwork for you. For CAP/C, the path is the same through local children’s case management agencies.²

Before you call, it’s worth checking the waitlist for your county. Some counties process applications quickly; others have backlogs. Acentra Health can tell you where things stand at 919-568-1717 or 833-522-5429.³

Step 2: Gather Documents Before the Referral Goes In

Missing paperwork is the single biggest cause of delay. Have these ready:

Recent medical records showing diagnoses, treatment plans, and current medications
Your primary care physician’s name and contact information (the referral requires physician verification of medical needs)
Financial documents such as bank statements, Social Security benefit letters, or pay stubs to confirm Medicaid eligibility
A clear description of what tasks you need help with day to day, and how often

Be specific about how your condition limits your independence. “Needs help around the house” gives the reviewer nothing to work with. “Requires assistance transferring from bed to wheelchair four times daily and needs blood sugar monitoring every six hours” gives them a picture. Get any required physician signatures before the referral is submitted.

Step 3: The Assessment

Once your referral reaches Acentra Health, the independent assessment entity under contract with NC Medicaid, it’s processed within two business days. Acentra reviews your medical condition to see whether you appear to meet the required level of care. If the initial review is favorable, Acentra schedules a face-to-face assessment, typically within two weeks.⁴

A registered nurse comes to your home. The nurse looks at your living environment, reviews your physical health and any medical equipment, and verifies what’s in the referral. The visit answers two questions: is your home safe for community-based care, and how much support do you actually need to stay out of a facility? The nurse documents your ability to handle routine tasks and recommends the type and intensity of services.

Acentra then communicates the outcome. If you’re approved, you’re connected to the case management entity you chose.

Who Qualifies

Medical Need

Both waivers require that you need the level of care usually provided in an institution. For CAP/DA, that means being a disabled adult 18 or older who needs nursing-facility-level care and at least one CAP/DA waiver service as determined by the case manager’s assessment.¹ For CAP/C, the child must be medically fragile and complex, ages 0 through 20, and require institutional-level care under the state Medicaid plan.²

The practical question is whether you’d realistically end up in a nursing facility or hospital without home-based services. People who need daily nursing supervision, use medical equipment at home, or depend on others for eating, bathing, or transfers tend to meet the threshold.

Medicaid Income and Assets

You have to be enrolled in or eligible for North Carolina Medicaid. CAP is a Medicaid waiver, so it extends your Medicaid coverage rather than standing on its own.⁵

Income is capped under the “special income rule” used for Medicaid long-term care: countable monthly income generally cannot exceed 300 percent of the SSI federal benefit rate. For 2026, that rate is $994 per month for an individual, putting the CAP income cap at $2,982 per month.⁶

Countable assets are limited to $2,000 for an individual or $3,000 for a couple, following SSI standards. Bank accounts and investments count. Your primary home, one vehicle, personal belongings, and certain other items are typically excluded.⁷

How Long It Takes

Official guidance breaks the process into three phases: up to 45 calendar days to complete the service request, up to 30 calendar days for the initial assessment, and up to 30 calendar days for that assessment to be reviewed and a final decision made. That’s up to 105 days from the point all required documents are received.⁸

Simple cases usually move faster. Acentra aims to process referrals within two business days and schedule assessments within two weeks.⁴ Incomplete paperwork and missing medical documentation are the usual reasons things stall. Getting everything together before the referral is submitted is the most reliable way to shorten your wait.

Getting Your Decision

You’ll receive the decision by mail. An approval letter lists the authorized services and the budget for your individual care plan. A denial letter explains the reasons and includes your appeal rights.

Approved services under CAP/DA can include in-home aide help with daily tasks, adult day health, respite care for family caregivers, home or vehicle modifications, meal preparation and delivery, personal emergency response, community transition support, case management, and consumer-directed services where you hire and manage your own workers.¹ CAP/C covers comparable services tailored for children with complex medical needs, including nursing care, specialized therapies, and technology-dependent support.²

If You’re Denied

You have 30 days from the date the denial notice was mailed to request a contested case hearing through the North Carolina Office of Administrative Hearings. Complete a Hearing Request Form, signed by the Medicaid beneficiary or legal guardian.⁹

Hearings are held by telephone by default. If you want an in-person hearing, contact the Office of Administrative Hearings after receiving your telephone hearing notice. In-person hearings are generally held in Raleigh unless you can show that traveling there is a hardship.⁹

If the denial came from a managed care organization rather than DHHS directly, the deadline is 120 days from the date the Notice of Resolution was mailed. Missing either window means starting the application over.

Things That Can Trip Up Your Application

The Five-Year Look-Back

Because CAP runs through Medicaid, the state reviews asset transfers made during the 60 months before your application. Federal law applies this look-back to both nursing home Medicaid and home and community-based waivers like CAP.¹⁰ If the state finds you transferred assets for less than fair market value in that window, it can impose a penalty period of ineligibility, calculated by dividing the value given away by the average daily cost of nursing home care.¹¹

The look-back catches ordinary generosity. Helping a grandchild with tuition, selling a car to a relative below market value, or paying off a child’s debt within the past five years can all trigger penalties. If you’re planning ahead and considering any transfer of real value, talk to an elder law attorney first.

Spousal Rules for Married Applicants

When one spouse applies and the other stays at home, federal law protects the at-home spouse from being impoverished by the eligibility process. The community spouse keeps a protected share of the couple’s combined assets, and can retain a minimum monthly income allowance for living expenses. The exact thresholds adjust each January.⁷ Check with your local Department of Social Services or an elder law attorney for current figures when you apply.

County Waitlists

Waitlists vary by county. Confirming yours before you start the referral helps you plan for interim support if the wait is long.³

1
NC Medicaid. Community Alternatives Program for Disabled Adults (CAP/DA)
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NC Medicaid. Community Alternatives Program for Children (CAP/C)
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North Carolina LIFTSS. Resources for CAP/C
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North Carolina LIFTSS. CAP/DA Beneficiaries and Families
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North Carolina LIFTSS. Community Alternatives Program for Disabled Adults
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Social Security Administration. SSI Federal Payment Amounts for 2026
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North Carolina DHHS. Basic Medicaid Eligibility
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NC Medicaid. Interim Process for Comprehensive Independent Assessment Entity Requests
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North Carolina Office of Administrative Hearings. Filing a Contested Medicaid Recipient Appeal
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Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
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North Carolina DHHS. Transfer of Assets