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Community Alternative Care (CAC) Waiver

Page posted: 10/1/03

Page reviewed: 4/25/13

Page updated: 10/1/18

Legal authority

Federally approved CAC Waiver Plan, Minn. Stat. §256B.49


Community Alternative Care (CAC) Waiver: Home and community-based services necessary as an alternative to institutionalization that promote the optimal health, independence, safety and integration of a person who is chronically ill or medically fragile and who would otherwise require the level of care provided in a hospital.


To be eligible for the CAC Waiver, a person must choose the CAC Waiver and meet all of the following criteria:

1. Eligible for Medical Assistance (MA)
2. Certified disabled by Social Security or through the State Medical Review Team (SMRT) process
3. Under age 65 at the time of opening to the waiver
4. Determined by the case manager/service coordinator to meet the hospital level of care criteria
5. Certified by the primary physician to meet the level of care provided in a hospital
6. Has an assessed need for supports and services over and above those available through the MA State Plan.

Hospital level of care criteria

To meet the requirements for a hospital level of care, a person must meet all of the following:

1. Need skilled assessment and intervention multiple times during a 24-hour period to maintain health and prevent deterioration of health status
2. Have both predictable health needs and the potential for changes in condition that could lead to rapid deterioration or life-threatening episodes
3. Require a 24-hour plan of care, including a back-up plan, to reasonably ensure health and safety in the community
4. Be expected to require frequent or continuous care in a hospital without the provision of CAC waiver services.

Covered services

The following services are covered under the CAC Waiver. For a service-specific policy page, select a service from the list:

  • 24-hour emergency assistance
  • Adult companion services
  • Behavioral support
  • Caregiver living expenses
  • Case management/service coordination
  • Case management aide
  • Chore services
  • Consumer directed community supports (CDCS)
  • Crisis respite
  • Employment development services
  • Employment exploration services
  • Employment support services
  • Environmental accessibility adaptations
  • Extended home care services
  • Family adult day services
  • Family training and counseling
  • Foster care
  • Home-delivered meals
  • Homemaker
  • Housing access coordination
  • Independent living skills (ILS) training
  • Individualized home supports
  • In-home family supports
  • Night supervision
  • Personal support
  • Remote support – Individualized home supports and supported living services for adults in own home
  • Respite
  • Specialist services
  • Specialized equipment and supplies (includes personal emergency response systems [PERS])
  • Supported employment services
  • Transitional services
  • Transportation.
  • Local waiver program administration

    Local county or tribal administration acting as agents for the state Medicaid agency and DHS have many responsibilities. See the state and county/tribal responsibilities for waiver management section on CBSM – Waiver programs overview.

    Waiver forms

    For a comparison grid of forms applicable across and/or specific to waiver programs, see CBSM – Required waiver forms.

    Process and procedure

    Additional resources

    CBSM – Waiver/AC provider enrollment and standards
    CBSM – Waiver general process and procedures (BI, CAC, CADI, DD)

    CBSM – Waiver programs overview

    CBSM – Waiver rates and billing
    Community Alternative Care (CAC) Waiver Program brochure, DHS-2827 (PDF)

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