North Carolina Medicaid Resources:

• State Medicaid Website: North Carolina
• North Carolina Council on Developmental Disabilities Website
• The Arc of North Carolina

North Carolina Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 286,600 people with disabilities covered by Medicaid in North Carolina. North Carolina spent $14,935 on each Medicaid recipient with a disability in 2007.

17% of all people covered by Medicaid in North Carolina have a disability, while the national percentage of people covered by Medicaid who have a disability is 15%.

The state spends 46% of all the money it spends on Medicaid on services for people with disabilities, while the national percentage of Medicaid spending on these services is 42%.

Carolina ACCESS, and ACCESS II/III:

These programs provide coverage to adults with disabilities and children with special needs as defined by the BBA. They include those also eligible for Medicare. Although these programs are closely related, they may have different payment requirements based on the kind of services provided.

• Health: chiropractic, disease management, dialysis, durable medical equipment, early and periodic screening, diagnosis, and treatment, immunization, hospital care, laboratory, midwife services, physician services, private-duty nursing facilities, speech therapy, x-ray
• Home: home health care, personal care

Mental Health/Developmental Disabilities/Substance Abuse Services Plan and Innovations Waiver:

This plan is a joint effort between the state’s medical assistance, mental health, developmental disability, and substance abuse agencies and local health care providers. This program will cover some people who are also eligible for Medicare.

Restrictions: This plan is restricted to Cabarrus, Union, Davidson, Rowan, and Stanley counties.

• Community: community transitions support
• Health: assistive communication devices, habilitation services, nursing or intermediate care facilities, substance abuse and mental health services, specialized consultation services, equipment and supplies
• Home: caregiver training, home modifications, personal assistance, respite care, vehicle adaptations
• Social Services: case management, financial management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to an approved PACE center to be eligible.

• Community: day health care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home care, and home and environmental modifications
• Social Services: social services

Community Alternatives Program (CAP) Developmental Disabilities waiver:

This waiver allows people with developmental disabilities to receive needed services at home or in the community.

Ages: 18 and older

Level of Care: intermediate

Options for Self-Direction: This waiver does allow people to control and direct some of their own services.

• Home: personal care services
• Social Services: case management

Elderly and Disabled waiver:

This waiver allows older adults and people with disabilities to receive services in their homes or in a community setting.

Ages: 18 and older

Level of Care: nursing

• Health: telephone alerts, and medical supplies
• Home: in-home aide
• Social Services: case management

CAP Choice waiver:

This program helps people with disabilities pay for services so they can be delivered in the home or community, and patients can avoid moving into a residential facility.

Ages: 21 and older

Level of Care: nursing

• Health: medical equipment and supplies
• Home: personal care services
• Social Services: case management

Children’s waiver:

This waiver applies to children who need long-term care due to a condition that makes them ‘medically fragile.’

Ages: 18 and older

Level of Care: nursing

• Health: hourly nursing care, medical supplies
• Home: personal care, home respite
• Social Services: case management

Comprehensive waiver:

This waiver is designed to support people with developmental disabilities of all ages and diagnoses. It provides a wide array of home and community-based services.

• Community: adult day care, day supports, transportation
• Health: communication devices, behavioral consultation, crisis respite and other crisis services, personal emergency response systems, specialized medical equipment and supplies
• Home: personal care, residential supports, respite care, caregiver support and training, home modifications, vehicle adaptations
• Work: supported employment, long-term vocational support

Supports waiver:

This waiver is designed to complement the Comprehensive waiver by providing many of the same services, but for individuals who need a less intensive level of care (these correspond roughly to nursing versus intermediate levels of support). It also applies to people with disabilities of all ages. The services provided by the supports waiver are designed to support community living.

Option for Self-Directed Care: this waiver offers people with disabilities a role in directing their own care.

• Community: adult day care, day supports, community supports, transportation
• Health: communication devices, behavioral consultation, crisis services, specialized consultation, personal emergency response systems, specialized medical equipment and supplies
• Home: home supports, personal care, respite, home modifications, individual and caregiver training, vehicle modifications
• Work: supported employment, long-term vocational supports