North Carolina Medicaid pays for in-home personal care and related services through the Community Alternatives Program for Disabled Adults (CAP/DA). North Carolina uses a multi-aggregator open EVV model. CAP/DA is the primary HCBS waiver for adults with disabilities; the state also operates CAP/C (children) and innovations waivers for IDD populations. NC Medicaid transitioned to managed care via Standard Plans, LME/MCOs, and Tailored Plans.
Which North Carolina waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Community Alternatives Program for Disabled Adults (CAP/DA)
Population
Adults 18 and older with disabilities who meet nursing facility level of care
Services covered
personal care
in-home aide
respite
adult day health
home modifications
case management
Billing format
Fee-for-service via NC Medicaid Direct or managed care; EVV via Sandata, HHAeXchange, or CareBridge depending on plan
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.