North Carolina does not run a Medicaid waiver dedicated to assisted living. Its one Medicaid HCBS waiver relevant to seniors, CAP/DA, pays for in-home services only. Room and board inside an adult care home is instead covered through State/County Special Assistance, a state- and county-funded cash program -- not a Medicaid waiver.
CAP/DA: in-home only
Community Alternatives Program for Disabled Adults (CAP/DA) is NC's Medicaid HCBS waiver (1915(c)) for adults 18+ who need a nursing-facility level of care but wish to remain in their own home/community. It covers 18 in-home and community-based services including adult day health, in-home aide services, home modifications/equipment, meal preparation, respite care, personal emergency response systems, specialized medical supplies, case management, and consumer-directed care allowing beneficiaries to hire/supervise their own caregivers.
Special Assistance: room and board, not a waiver
North Carolina does NOT have a Medicaid HCBS waiver specifically covering room-and-board or services in assisted living/adult care homes. There is no 'CAP/AL' or equivalent ALF waiver in NC's Medicaid waiver portfolio. Room and board in adult care homes for low-income residents is instead covered through the State/County Special Assistance (SA) program, which is explicitly a state- and county-funded cash supplement program, NOT a Medicaid waiver (see nf_medicaid/merp-adjacent note below). SA recipients are also automatically eligible for Medicaid, which then covers medical/personal care costs, but SA itself pays the room-and-board portion.
Personal Care Services, layered on top
Medicaid State Plan Personal Care Services (PCS) can pay for hands-on personal care within a licensed adult care home for Medicaid-eligible residents, layered on top of Special Assistance's room-and-board payment.
Source: NC Special Assistance program
Source: CAP/DA program
