CAP/C Case Management

CAP/C Case Management

CAP/C Waiver Services Offered:

What does CAP/C do?

Who is eligible for CAP/C Case Management Services?


- Case Management
- In‑Home Aide & Pediatric Nurse Aide Services
- Respite Care
- Consumer Direction
- Coordinated Caregiving 
- Home Accessibility & Adaptation
- Vehicle Modification
- Assistive Technology
- Training / Education / Consultative Services
- Participant Goods & Services
- Adaptive Car Seats and Tricycles 
- Community Transition 


CAP/C is an NC Medicaid Home and Community-based Services (HCBS) program authorized under section1915(c) of the Social Security Act and complies with 42 CFR § 440.180, Home and Community-based Waiver Services. The waiver program provides a cost-effective alternative to institutionalization for Medicaid beneficiaries who are medically fragile and at risk for institutionalization if the home and community-based services approved in the CAP/C waiver were not available. These services allow the beneficiary to remain in or return to a home and community-based setting. The waiver supplements, rather than replaces, the formal and informal services and supports already available to an approved Medicaid beneficiary.

- Medically fragile and medically complex children who are age 0 through 20 years of age
- Determined to require a level of institutional care under the North Carolina Medicaid State Plan
- Need at least one or more CAP/C home-and community-based services based on a reasonable indication of need assessment that must be coordinated by a CAP/C case manager

Compassionate Quality Healthcare Services
Serving the Charlotte Area Since 1994
Compassionate Quality Healthcare Services
Serving the Charlotte Area Since 1994

CAP/C Clinical Coverage Policy

According to the CAP/C Clinical Coverage Policy: 3K-1, your child could qualify for CAP/C if he or she is under the age of 21 and meets all of the following medically complex conditions:

Has a primary medical (physical rather than psychological, behavioral, cognitive, or developmental) diagnosis(es) to include chronic diseases or conditions such as chronic cardiovascular disease, chronic pulmonary disease, congenital anomalies, chronic disease of the alimentary system, chronic endocrine and metabolic disorders, chronic infectious disease, chronic musculoskeletal conditions, chronic neurological disorders, chronic integumentary disease, chronic renal disease, genetic disorders, oncologic and hematologic disorders; and

Has a serious, ongoing illness or chronic condition requiring prolonged hospitalization (more than 10 calendar-days, or three (3) hospital admissions) with in 12 months, ongoing medical treatments, nursing interventions, or any combination of these that must be provided by a registered nurse or medical doctor; and

Has a need for life-sustaining devices such as endotracheal tube, ventilator, suction machines, dialysis machine, jejunostomy tube and gastrostomy tube, oxygen therapy, cough assist device, and chest PT vest; or care to compensate for the loss of bodily function.