SPEED REFERRAL

Community Alternatives Program for Disabled Adults (CAP/DA)

📞 To fill out this form over the phone, call 919-713-1556.

👉 Have all of your information ready before you call.

 

What This Form Is For

This form starts the referral process for the CAP/DA program.

This is NOT the official application. Medicaid will send you the application via physical mail once the referral is submitted.

To submit a referral through RFS, you must:

• Live in Wake County
• Be 18 years or older
• Require a higher level of care, like what’s offered in a nursing home or skilled nursing facility.
• Be eligible for Medicaid
  • If you are not eligible, a monthly deductible will be calculated by Medicaid. Estimates are NOT provided.

Important Rules

• Incomplete forms will not be accepted
• All questions with an asterisk (*) are required
• You must provide your full Social Security number
• The person filling out the form is responsible for giving all required information
• You can fill out the form yourself, OR call 919-713-1556 to have an Intake Specialist fill it out with you over the phone

Who Runs CAP/DA vs. RFS

• CAP/DA: Run by Medicaid (a GOVERNMENT program)
• Resources for Seniors (RFS):  LOCAL non-profit organization specific only to Wake County.

RFS Role in CAP/DA

RFS only does two things in CAP/DA:

1. Submit the referral (not the official application)
2. Serve as Case Managers if the client chooses RFS
   • Clients can pick from several case management agencies
   • Case Managers only work with assigned clients who are actively enrolled in CAP/DA

Questions About Your Application

If you want to know the status of your application or have specific program questions, call CAP/DA directly at: 📞 (833) 522-5429

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⚠️ Read the information above before starting ⚠️

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