North Carolina pays for home health aides through its Medicaid waiver program, known as Community Alternatives Program for Disabled Adults (CAP/DA). Another waiver program, known as the Personal Care Services (PCS) program, offers some overlapping support with CAP/DA. The state Medicaid program also pays for short-term home health services on an as-needed basis.

Short-Term Home Health From Medicaid

North Carolina’s Medicaid program helps seniors cover the cost of any medically necessary treatment or service, including nursing home placement and home health services. For short durations, a Medicaid-enrolled doctor can authorize home health services from visiting health aides, durable medical equipment, consumable medical supplies and other paramedical support, such as at-home testing and wound care. This is not intended to be a long-term approach, however, and seniors with ongoing needs may eventually be required to either move into nursing home care or enroll in one of the state’s waiver programs.

North Carolina’s CAP/DA Waiver

Seniors enrolled in Medicaid who have ongoing needs for home health visits can get long-term services through the CAP/DA waiver program. CAP/DA is intended to reduce the demand on nursing home placement by paying home health agencies to visit and assist seniors who prefer to age in place in their own homes. The program disburses funds to a state-enrolled home health agency for however many hours of home health service the enrollee is authorized to receive.

To qualify for this waiver, seniors in North Carolina must be enrolled in Medicaid, have a medical or age-related disability that would normally justify placement in a nursing home and be able to get all of their needs met with home visits from a home health aide or other paramedical professional. A needs assessment is part of the intake process, and beneficiaries may be required to periodically recertify to keep their benefits. There is no time limit to how long these services can be provided, though the enrolled senior must be continuously in need of home health care throughout the period the benefits last.

Personal Care Services (PCS)

Seniors in North Carolina who are getting home health care, or other in-home care services, through CAP/DA can choose to manage their own benefits through the PCS option. This is not itself a waiver but an alternative way to receive necessary home health and caregiver benefits. Participants in PCS can act as their own case manager, with home health aides and caregivers acting as the beneficiary’s employees, rather than having funds go directly to an agency. Under PCS, seniors can designate their own caregivers, who may be family members, though a home health aide must be certified to receive payment under the plan.