What is CAP/C


This is a Community Alternatives Program for Children (CAP/C)


that seeks to allow recipients who need long-term institutional


care to return to or remain in the community. CAP/C is designed


to serve a limited number of medically fragile children who would


be institutionalized in a nursing facility or hospital if payment for


home care services were not available through this Medicaid


CAP/C waiver.




CAP/C exists to supplement rather than replace the formal and


informal services and support already available to a child.


Funding is requested not entitlements.




CAP/C is available to any child from birth through 20 years of age


who meets both the Medicaid eligibility criteria and the


CAP/C criteria.  The Medicaid criteria for CAP/C programs


are not the same as the regular Medicaid criteria.  Other


criteria include that the child must live in a private residence,


must be able to be cared for safely at home and meet minimum


nursing facility level of care. The child’s needs must be able to


be met within a monthly budget determined by the amount of


care the child requires. The family must be willing to participate


in the care and in the care planning for their child.




The recipient must meet all of the criteria below


a. Be medically fragile;


b. Reside in a primary residence used as a home

    (for the purposes of this policy, primary residence

    is defined as a residence other than a hospital or nursing

    facility (unless planning to transition to a primary residence

    once CAP/C is approved).


c. Require nursing facility LOC as determined by DMA’s fiscal agent;


d. Be under the age of 20 years;


e. During each quarter of CAP/C participation, require case

    management and at least one other waiver service (excluding respite),

    which is directly related to a documented medical diagnosis(es) and

    identified medical care needs;


f. Desire CAP/C services instead of institutional care, as evidenced

   by the written statement of the recipient’s parent(s) on the               Letter of Understanding and Freedom of Choice form; and


g. Be able to have his or her health, safety, and well-being maintained at home.