CAP-MR/DD

 

 

CAP-MR/DD operates under a Medicaid home and community-based services waiver granted by the Health Care Financing Administration (HCFA). HCFA approves the services, the number of individuals that may participate, and other aspects of the program. The participants must be at risk of institutionalization. The Medicaid cost for community care must be cost effective in comparison to the cost of ICF/MR care.

 

The CAP-MR/DD program is administered by the Best Practice and Community Innovations Team in the Community Policy Management Section of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. The Local Management Entities are responsible for operation at the local level. The Division of Medical Assistance, as the State Medicaid Agency, provides oversight in relation to Medicaid and waiver issues.” This information is quoted from the Division website and may be found online at:

http://www.dhhs.state.nc.us/mhddsas/cap-mrdd/cap-discription.pdf

 

This is a limited funding stream allocated through the State to local LMEs as funds become available through the N.C. Legislature’s budget for each fiscal year. The budget is impacted by the overall economy and availability of funds.

 

Unlike regular Medicaid, CAP-MR/DD waiver funding is not an entitlement. Therefore, there is a waiting list for services. The waiting list is prioritized by severity of needs. Using a State-approved prioritization tool, individuals who seek CAP-MR/DD Waiver services are evaluated by the LME for their potential eligibility and then are prioritized according to needs. North Carolina’s procedure in which this process is completed is outlined online at: http://www.dhhs.state.nc.us/mhddsas/cap-mrdd/cap-prioritizationform10-10-08.pdf

 

The first step in applying for CAP-MR/DD funding in Cumberland County is to go through a case manager. If the individual does not have a case manager they should contact the LME’s Screening, Triage and Referral unit at (910) 424-HOPE to inquire about screening for the CAP-MR/DD waiting list and other related services for which they may be eligible.

 

If an individual qualifies for CAP-MR/DD services and is placed on the waiting list there may be other resources available to assist them while they wait for CAP-MR/DD funding. Your case manager can help you to explore these options. The LME can also assist individuals in locating resources. If you are new to the area or the Mental Health system, contact the LME’s Screening Triage and Referral Program at (910) 424-HOPE. Advocacy groups such as the ARC may also assist at this time.

CAP Referral form:

http://www.ccmentalhealth.org/provider_information/cap_mrdd/waiting_list_info/CAPReferral.pdf