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Home  •  Waiver & Medicaid Services  •  CAP/C  •  What Happens When my Child Turns 20?

Cap/C Waiver

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What Happens When my Child Turns 20?

When your child turns 20, there should be a formal plan in place for aging out of CAP/C and making a transition to Community Alternatives Program for Disabled Adults (CAP/DA) or NC Innovations Waiver.

In order to transition to the Innovations waiver, you must already be on the registry of unmet needs/waiting list. Check with your local LME/MCO (located on your child’s Medicaid card) to verify your child’s Innovations status and/or start the application process to be placed on the waitlist.

When transitioning out of CAP/C, your child is guaranteed an evaluation and placement into CAP/DA, if they are deemed eligible, and will bypass any waitlist. There are CAP/C-to-Innovations transition slots, but the slots are limited to a certain number each year. You should contact your LME/MCO in July of the fiscal year (July to June) that your child will be turning 21 to reserve a slot for them.

Unlike CAP/C, both CAP/DA and Innovations have slots assigned by county and not state-wide, so you must coordinate any moves within the state ahead of time to ensure a smooth transition.

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.