Family & Children's Medicaid Change Notices
A. Ma-3260 I.A., General, subsection 2.b. is revised to clarify the level of care of CAP/C. Institutional care for CAP/C is defined as Nursing Facility (NF) and Hospital level.
B. MA-3260 I.B., Available CAP Programs, subsection 1.a. is revised to reflect age limit of 21 for the CAP/C waiver.
C. MA-3260 I.A., Available CAP Programs, subsection 1.c. is revised to reflect current policy. CAP/C services are available statewide.
C. MA-3260 I.B., Available CAP Programs, subsection 2.c. (2) is revised to reflect current policy. A reference to MA-2280, Community Alternatives Programs for county transfer instructions is added.
C. MA-3260 II., Policy Rules-Applicable to all Programs, subsection B is revised to include current policy. When a CAP recipient moves to another county, it does not affect his eligibility for CAP services. A reference to MA-2280, Community Alternative Programs for county transfer instructions is added.
D. MA-3340 V.E., Effective Date of County Transfer, The phrase “HMO coverage” is removed from subsection 4 as there is no Medicaid HMO.
D. MA-3340 V.E., Effective Date of County Transfer, subsection 5 is removed. CAP coverage is no longer automatically terminated by EIS when a county transfer is initiated by the county caseworker. A county change initiated by the Social Security Administration will continue to terminate the CAP coverage until a modification can be made in EIS, sometime later in August. Continue to re-enter the CAP coverage until you are notified via a listserv message that the modification for SSI individuals has been made in EIS.
A. Remove: MA-3260 Pages 1- 6
B. Insert: MA-3260 Pages 1- 6 dated 08/01/10
A. Remove: MA-3340 pages 9- 10
B. Insert: MA-3340 pages 9- 10 dated 08/01/10
CHANGE NOTICE FOR MANUAL NO. 09-10, COMMUNITY ALTERNATIVE PROGRAM (CAP)
DATE: JULY 26, 2010
Manual: Family and Children’s Medicaid
Change No: 09-10
To: County Directors of Social Services
Effective: 08/01/2010
I. BACKGROUND
The CAP Programs provide home and community based services to Medicaid recipients who require institutional care (placement in a nursing facility), but for whom care can be provided cost-effectively and safely in the community. North Carolina has four CAP waivers that provide these services to a limited number of persons in specific groups within the state.
Effective 08/01/2010, DMA is implementing new policy and procedures regarding the CAP/C waiver program. The changes include a new age limit for CAP/C, changes in level of care and new services added to the CAP/C waiver.
DMA Administrative Letter 04-10 was issued 07/01/2010, stating new policy and procedures regarding county transfers for all CAP waiver programs. Effective 08/01/2010, the policy on CAP county transfers is being incorporated into the manual. When a CAP recipient moves to another county, it does not affect his eligibility for CAP services. This includes CAP/Choice recipients moving to a non-Choice county and recipients participating in the Piedmont Innovations Waiver and moving to a non-Piedmont county.
II. Content of Change
A. Ma-3260 I.A., General, subsection 2.b. is revised to clarify the level of care of CAP/C. Institutional care for CAP/C is defined as Nursing Facility (NF) and Hospital level.
B. MA-3260 I.B., Available CAP Programs, subsection 1.a. is revised to reflect age limit of 21 for the CAP/C waiver.
C. MA-3260 I.A., Available CAP Programs, subsection 1.c. is revised to reflect current policy. CAP/C services are available statewide.
C. MA-3260 I.B., Available CAP Programs, subsection 2.c. (2) is revised to reflect current policy. A reference to MA-2280, Community Alternatives Programs for county transfer instructions is added.
C. MA-3260 II., Policy Rules-Applicable to all Programs, subsection B is revised to include current policy. When a CAP recipient moves to another county, it does not affect his eligibility for CAP services. A reference to MA-2280, Community Alternative Programs for county transfer instructions is added.
D. MA-3340 V.E., Effective Date of County Transfer, The phrase “HMO coverage” is removed from subsection 4 as there is no Medicaid HMO.
D. MA-3340 V.E., Effective Date of County Transfer, subsection 5 is removed. CAP coverage is no longer automatically terminated by EIS when a county transfer is initiated by the county caseworker. A county change initiated by the Social Security Administration will continue to terminate the CAP coverage until a modification can be made in EIS, sometime later in August. Continue to re-enter the CAP coverage until you are notified via a listserv message that the modification for SSI individuals has been made in EIS.
III. Effective date and Implementation
If you have any questions, please contact your Medicaid Program Representative.
Craigan L. Gray, MD, MBA, JD, Director
This material was research and written by Ena Lightbourne, Policy Consultant, Medicaid Eligibility Unit.
