It's time to raise the limits for Medicaid's CAP-DA Program! Not institutionalize my GF!!!

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RE: Community Alternatives Program for Disabled Adults (CAP-DA) funded by Medicaid through the Home and Community-Based Service Waiver, 42 CFR § 440.180, authorized under section1915(c) of the Social Security Act.

Just so everyone is on the same page, the above NC general statute is the one we're addressing and the one that needs to change, so please share this with everyone you know.

My significant other, Melissa, is 47 years old and has been a quadriplegic since a tragic car accident when she was 19. She lives independently only because she has in home care givers through the Community Alternatives Program for Disabled Adults (CAP-DA). The CAP-DA waiver assists her by providing a nursing aid a few hours/day to help with basic activities of daily living as well as providing the funds needed for additional medical supplies. She also has a strong family support system nearby that helps to provide any additional necessary attention. Without the Medicaid/CAP-DA waiver she would be forced to live in a nursing facility and not in her own home. This would pose a much greater cost to the state and her health both physically and mentally.

The CAP waiver is a different category then the disabled only Medicaid. The CAP Program is designed to reduce costs by providing participants with care in their home instead of a Nursing Home. The FPL change would only apply to a limited amount of people since the program has a limited amount of openings available. It would only change for those that the state of NC has already qualified for the waiver! This would reduce cost in the end because the deductible is forcing nursing home placement which is very expensive. Each state sets that program qualifier with Medicaid for that state.

We are asking the North Carolina legislators for an increase of the income percentage of the Federal Poverty Level(FPL) allowed for disabled adults in the Community Alternative Program for Disabled Adults(CAP-DA) and/or allow a payment in the amount of excess income by disabled adults to continue to qualify for Medicaid and the CAP-DA waiver. Forcing well-adjusted disabled individuals that have been and wish to continue living on their own to be institutionalized, separating them from their families, from their friends, and their from their communities which is both cruel and counter productive from a financial standpoint.

If someone is even $1 over the income limit that has been set by North Carolina, they must pay a deductible each MONTH in order to keep their Medicaid/CAP-DA benefits which are extremely difficult to gain access to anyway. In other words, all income over $262/month must be paid out as Melissa's deductible wiping out most of her total income that she has to use to pay her other expenses such as rent, electricity, food, etc. No one can live on $262 a month. This deductible has not been revised or even revisited since the 1980's.

The current income limits for the CAP-DA program for North Carolina recipients needs to be changed. It is 100% of the Federal Poverty Level (FPL) which sounds sufficient at first glance, but this number is well below the percentages set by other comparable states. It is also, outdated due to the fact that it was set in the 1980’s. This is requesting a legislative determination to increase these income limits to a more appropriate level. In 42 other states, this limit has already been changed and is much higher like in Tennessee where the income eligibility is set at 300% of the FPL.

Melissa’s only income is the social security(SS) benefits extended to her from her father’s eligibility since she was disabled at such a young age. She is unable to work nor get a raise or promotion. Unfortunately, her father passed away recently. His death did allow her to get the largest raise she can ever hope to get. However, it bumped her SS benefit/income up to a few dollars over NC Medicaid's CAP-DA income limit of $1012/mo. The relief of getting an increase in income to help pay for her food, rent, utilities, etc. was soon doused when she found out she could lose her CAP-DA benefits even though her disability needs have not changed.

Melissa has been a CAP-DA beneficiary for eight years and has not been hospitalized nor had any major health problems outside of her disability while living in the community. Statistics show that living in a nursing home away from family and friends often leads to depression and an overall decline in physical and mental health which inevitably will cost more for NC Medicaid and, ultimately for the NC taxpayers.

I fully appreciate the need to identify qualifying benefit income maximums. My comments are for the impact on the unemployable disabled who have already proven to be eligible for CAP-DA when earning any income from working is not possible. The impact to Federal and NC state funding that is needed for the Medicaid program wouldn't increase at all. In fact, the program is designed to save Medicaid money by keeping the participants out of very costly nursing facilities and in their own homes. The impact to the participants, however, would be astronomical because I don't know anyone who would choose to live in an institution over living at home.

On behalf of Melissa and people like Melissa who strive to normalize life in the face of a disability most can't even imagine having or living with. Please consider my/our request to sign this petition for the people who often get overlooked and are well under represented. Thank you so much for taking the time to read this and thank you even more if you can help us make a much needed change to this.



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