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Home  •  Waiver & Medicaid Services  •  CAP/C  •  Parents as paid caregivers step-by-step diagram and service definitions

Cap/C Waiver

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Parents as paid caregivers step-by-step diagram and service definitions

Jump straight into step-by-step diagrams by clicking the images below, or review more details within each paragraph.

Additional Details:

“Employed by an Agency,” also known as “Provider-led”

This is an option exclusively for a parent with one of the following qualifications: Certified Nursing Aide I (CNA), CNA I + 4, CNA II, Licensed Practical Nurse (LPN), or Registered Nurse (RN). In other words, this option requires that the parent or other legally responsible individual must hold the appropriate certification/licensure to meet the assigned level of care for their child. The level of care (LOC) of the child will be the rate of pay, and the parent must meet the qualifications of the child’s LOC at a minimum (e.g., A parent with an RN license can be paid to care for a child with a CNA LOC, but the parent will be paid at the CNA rate. However, a parent with a CNA certificate cannot utilize this option to be paid for a child with RN LOC.) This option allows the parent to be employed by a home care/in-home agency to provide care up to 40 hrs per week when at least one extraordinary circumstance applies

This option allows the family to “direct” their child’s care. For a parent or other legally responsible individual to be paid under this service, at least one extraordinary circumstance must be met. Someone, other than the paid parent/legally responsible individual, must act as the Employer of Record (EOR) to participate in financial management (FM) agency and CAP/C case management (CM) contacts, complete state and FM agency online training, manage staff training, approve and troubleshoot any issues with biweekly timesheets, and complete required CAP/C CM and FM agency paperwork. A FM agency is utilized to start the business and help with billing, taxes, payroll, etc. See our “Consumer Direction” section for more information about this service and “Resources” for contact information for the FM agencies in NC, as well as copies of all the paperwork needed to get started.

This option is consumer direction strictly for the RN/LPN level of care. For the parent or other legally responsible individual to be paid under this service, they must have an active RN or LPN license, meet the qualifying criteria, and at least one extraordinary circumstance must be met. If the parent is an LPN, they must find an RN to provide oversight. The paid parent or other legally responsible individual is responsible for completing a care plan with the child’s physician, including medication and treatment orders. Someone, other than the paid parent/legally responsible individual, must act as the Employer of Record (EOR) to participate in financial management (FM) agency and CAP/C case management (CM) contacts, complete state and FM agency online training, manage staff training, approve and troubleshoot any issues with biweekly timesheets, and complete required CAP/C CM and FM agency paperwork. A FM agency is utilized to start the business and help with billing, taxes, payroll, etc. See our “Consumer Direction” section for more information about this service and “Resources” for contact information for the FM agencies in NC, as well as copies of all the paperwork needed to get started.

This option is available for all levels of care to any parent or legally responsible individual who meets basic criteria (i.e., background check, lives with child, CPR certified). This option does not require professional certification/licensure or the need to meet an extraordinary circumstance. The paid parent/legally responsible individual would work with a provider agency that offers this service. The provider agency supports the paid parent/legally responsible individual through coaching, supervision, and financial management (i.e., payroll). See the “Resources” section for contact info for the coordinated caregiving agencies in NC.

Must meet one of the following nursing experience requirements:

  • A minimum of 1000 hours of experience in the previous two years in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous three years in an acute care hospital caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous five years, working for a licensed and certified home health agency caring for individuals with the care need(s) of individuals at the levels of care specified in this waiver.
  • A minimum of 2000 hours of experience in the previous five years in an area not listed above that, in the opinion of DHHS, would demonstrate appropriate knowledge, skill, and ability in caring for individuals at one or more of the levels of care specified in this waiver.

Extraordinary Circumstances:

  1. There are not sufficient nurse aides in the waiver participant’s county or adjunct counties through a Home Health Agency/In-home aide agency due to a lack of qualified providers, and the waiver participant needs extensive to maximal assistance with bathing, dressing, toileting, and eating daily to avoid an out-of-home placement.

  2. The waiver participant requires short-term isolation, 90 days or less, due to experiencing an acute medical condition/healthcare issue requiring extensive to maximal assistance with bathing, dressing, toileting, and eating, and the waiver participant chooses to receive care in their home instead of an institution.

  3. The waiver participant requires physician-ordered 24-hour direct observation and/or supervision specifically related to the primary medical condition(s) to assure the health and welfare of the participant and avoid institutionalization, and the legal guardian is not able to maintain full or part-time employment due to multiple absences from work to monitor and/or supervise the waiver participant; regular interruption at work to assist with the management of the waiver participant’s monitoring/supervision needs; or employment termination.

  4. The waiver participant has specialized health care needs that can be only provided by the legal guardian, as indicated by medical documentation, and these health care needs require extensive to maximal assistance with bathing, dressing, toileting, and eating to assure the health and welfare of the participant and avoid institutionalization.

  5. Other documented extraordinary circumstances not previously mentioned places the waiver participant’s health, safety, and well-being in jeopardy resulting in an institutional placement.