Minnesota's Community Alternative Care waiver serves children and adults with chronic illnesses who require hospital-level care but prefer to live in their communities rather than remain hospitalized. For families facing serious, ongoing medical conditions, understanding the CAC waiver's unique eligibility requirements, specialized services and person-centered approach helps access critical support that makes home-based care possible.
The CAC waiver represents Minnesota's smallest disability waiver program, serving 200 to 300 people annually with some of the most intensive medical and support needs in the home and community-based services system.
What Is the CAC Waiver?
The Community Alternative Care waiver provides funding for home and community-based services for children and adults who are chronically ill and require the level of care typically provided in a hospital setting. These services offer an alternative to extended hospitalization, helping individuals receive complex medical care while living in community settings.
Services may be provided in various settings including a person's own home, biological or adoptive family home, relative's home, family foster care home or corporate foster care home. Married individuals may receive CAC waiver services while living at home with their spouse. The CAC waiver emphasizes person-centered planning, medical stability and community integration.
Understanding Hospital-Level Care Needs
The CAC waiver serves individuals whose medical conditions require intensive, ongoing intervention typically associated with hospital care. Unlike other disability waivers that focus on developmental disabilities or acquired brain injuries, the CAC waiver specifically addresses chronic illness with complex medical needs.
Hospital-level care needs include requiring skilled medical intervention several times daily to maintain health, having health status that could change quickly with potentially life-threatening consequences, needing continuous monitoring and backup plans to ensure health and safety, and requiring frequent or continuous hospital care without waiver services.
Eligibility Requirements
To qualify for CAC waiver services, individuals must meet these criteria:
Hospital Level of Care: Individuals must require the level of care provided in a hospital as determined through a comprehensive MnCHOICES assessment and certified by their primary care physician. This represents one of the most intensive level-of-care standards among Minnesota's disability waivers.
Medical Assistance Eligibility: Individuals must be eligible for Medical Assistance based on disability or other eligibility status.
Disability Certification: Individuals must be certified disabled by the Social Security Administration or the State Medical Review Team.
Age Requirement: Individuals must be under age 65 at the time of acceptance to the waiver. Those already receiving CAC waiver services may choose to remain on CAC or transition to Elderly Waiver services when they turn 65.
Informed Choice: Individuals must make an informed choice requesting home and community-based services instead of hospital care.
Support Plan Requirements: Individuals must have ongoing, intensive support needs requiring coordination and planning with backup systems to ensure health and safety.
Services Covered Under the CAC Waiver
The CAC waiver offers specialized services addressing complex medical and support needs:
24-Hour Emergency Assistance: On-call assistance providing crisis prevention, problem-solving and in-person response when needed. This service provides critical peace of mind for individuals with unstable medical conditions who may need immediate intervention.
Extended Home Health Care Services: Extended nursing services, occupational therapy, physical therapy, speech therapy and respiratory therapy beyond what Medical Assistance state plan covers, addressing intensive ongoing medical needs.
Extended Personal Care Assistance: Personal care services exceeding Medical Assistance limits, helping individuals with activities of daily living when medical conditions create extraordinary care needs.
Extended Private Duty Nursing: Skilled nursing care in the home for individuals requiring continuous or frequent nursing intervention.
Community Residential Services: Licensed residential settings provide around-the-clock staff support, personalized care and medical monitoring for individuals with extraordinary needs.
Caregiver Living Expenses: Financial support for caregivers who live with the individual, acknowledging the intensive nature of providing care for someone with hospital-level medical needs.
Case Management: Coordination of complex medical and support services, helping navigate multiple providers and ensure comprehensive care.
Additional Services: The CAC waiver also covers adult day care, homemaker services, respite care, employment services, behavioral support, consumer-directed community supports, environmental accessibility adaptations, assistive technology and crisis respite based on individual needs.
The Assessment and Enrollment Process
Accessing CAC waiver services begins with contacting your county social services agency or tribal nation to request screening. County or tribal agencies have 20 days from the request to complete the MnCHOICES assessment. A certified assessor conducts a comprehensive evaluation of medical needs, functional abilities, support requirements and living situation preferences.
The primary care physician must certify that the individual requires hospital-level care, providing medical documentation of diagnoses, treatments and ongoing care needs. If not already certified disabled, individuals work with financial workers to submit referrals for Social Security Administration or State Medical Review Team determination.
The MnCHOICES assessment and physician certification together determine whether the individual meets hospital level-of-care criteria. If eligible and waiver slots are available, individuals receive waiver allocation and work with case managers to develop person-centered support plans identifying goals, preferences and service needs.
Person-Centered Planning for Complex Medical Needs
Person-centered planning forms the foundation of CAC waiver services. This approach ensures services reflect individual goals and preferences while addressing serious medical requirements. During planning, case managers work to understand how individuals want to receive medical care, preferred living arrangements, goals for community participation within medical limitations, support networks including family and caregivers, and backup plans for medical emergencies or changes in condition.
The CAC waiver also offers consumer-directed community supports, giving individuals more choice and control over services, including hiring and managing support workers.
How CAC Waiver Services Differ From Other Waivers
While the CAC waiver shares similarities with other Minnesota disability waivers including BI, CADI and DD programs, several factors distinguish CAC waiver services:
Hospital Level of Care: The CAC waiver serves individuals requiring the most intensive medical care among all disability waivers, equivalent to hospital-level intervention rather than nursing facility care.
Medical Complexity: CAC waiver recipients typically have chronic illnesses requiring skilled nursing intervention multiple times daily, continuous monitoring and complex medication management.
Smaller Program Size: With only 200 to 300 participants annually, the CAC waiver represents Minnesota's smallest disability waiver, serving a highly specialized population.
Extended Medical Services: The CAC waiver emphasizes extended home health care, extended personal care assistance and extended private duty nursing beyond what other waivers typically provide.
Recent Policy Developments
Minnesota's disability waiver programs continue evolving through legislative changes and policy updates. The Minnesota Department of Human Services submitted waiver amendments for CAC, CADI and DD waivers to the Centers for Medicare and Medicaid Services in December 2025. Implementation of changes resulting from 2025 legislation will occur following federal approval.
Moving Forward With CAC Waiver Services
Chronic illness with hospital-level care needs creates extraordinary challenges for individuals and families, but Minnesota's CAC waiver offers a framework for accessing services that prioritize home and community living over extended hospitalization. The waiver enables individuals with serious medical conditions to receive complex care while maintaining connections to family, community and personal preferences.
If you or a family member has a chronic illness requiring hospital-level care and prefers community-based services, connecting with your county social services agency or tribal nation represents the first step toward accessing CAC waiver services.
Minnesota's Community Alternative Care waiver provides home and community-based services for children and adults with chronic illnesses who require hospital-level care. Understanding eligibility requirements, specialized medical services and the person-centered planning process helps families access support that makes home-based care possible for individuals with complex medical needs.
BrightPath is a 245D-licensed service provider offering Individualized Home Supports, 24-Hour Emergency Assistance, Community Residential Services, Crisis Respite and Intensive Support Services to individuals enrolled in Minnesota's BI, CADI, DD and CAC waiver programs. We serve individuals throughout Ramsey County, Hennepin County and across Minnesota. For more information about our services or to discuss how we can support your journey toward independence, contact our team today.