Family and Children's Medicaid MA-3260 COMMUNITY ALTERNATIVES PROGRAM (CAP)

II. POLICY rULES - APPLICABLE TO ALL PROGRAMS

A. Aid Program/Categories

To receive CAP, the a/r must be eligible in the Aged, Blind, and Disabled aid program/categories, EXCEPT:

REVISED 08/01/10- CHANGE NO. 09-10

(II.A.)

1. Children in CAP/C may also be in I-AS or H-SF,

2. Children in CAP-MR/DD may also be in I-AS or H-SF,

3. Adults in CAP-MR/DD may also be in S-AAD.

4. Adults (anyone 18 years or older) may participate in CAP/Choice.

5. Recipients with living arrangement codes of 16 (incarcerated) or 17 (Institution for Mental Disease) who are in suspension status for Medicaid are not eligible for CAP.

B. County transfers

When a CAP recipient moves to another county, it does not affect his eligibility for CAP services. Refer to MA-2280, Community Alternatives Program Medicaid Eligibility of the Aged, Blind, and Disabled Medicaid Manual for county transfer procedures.

C. CAP hearings

Appeal requirements apply to CAP cases just as with any other Medicaid case.

1. For appeals (FL-2/MR-2 issues) on level of care, the client first appeals to the DMA Hearing Office at 2501 Mail Service Center (MSC), Raleigh, North Carolina 27699-2501. Further appeal will go to the Office of Administrative Hearings (OAH).

2. For appeals regarding denial of CAP services, termination of CAP services, or reduction in CAP services, hold a local hearing at the county dss. If further appeal is required, hold a state appeal through the Division of Social Services Hearing and Appeals. See MA-3430, Notice and Hearings Process.

D. See MA-2280, Community Alternatives Program Medicaid Eligibility of the Aged, Blind, and Disabled Medicaid Manual for further details.