Speed ReferralsPlease use these forms only if you are familiar with these programs and their eligibility criteria. If you are not sure about this, please call our Information Department at 713-1556 to discuss your needs.
Complete referral forms online and submit electronically for:
- Community Alternatives Program for Disabled Adults: This is a Medicaid-funded program offering in-home care for those clients who might otherwise require nursing home care.
- Cost-Shared In-Home Care: This is a general term for several programs providing limited in-home services on a sliding-scale basis for Wake County residents who need help with personal care. Lengthy wait list.
- Housing and Home Improvement: Minor home repairs such as fixing roof leaks, minor plumbing problems. Also adaptations such as grab-bars, and equipment such as tub seats and handheld showers.
- Housing and Home Improvement: Wheelchair ramps and hot water heaters ONLY
- Weatherization: Home energy audits and upgrades, including insulation, weatherstripping, HVAC tune-ups, and other energy-efficiency measures.
- Medicaid At-Risk Case Management: Case management program for clients who already have Medicaid.
- Wake Independence at Home Adult Day Funds: Funding to help clients pay for the cost of adult day care.
Please be sure to complete all of the boxes on the form -- We cannot accept referrals with missing information.
Please note: If you experience difficulty using these forms, including getting an error message instead of a confirmation that your referral was sent, please call us at 919-872-7933 and ask for Chris.