Personal Care Services under NC Medicaid State Plan

Program Description

North Carolina Personal Care Services (PCS) program is a Medicaid program intended for residents who need assistance with activities of daily living, such as feeding oneself, using the bathroom, and dressing. This program aids participants, based on a program of care, in an eligible individual’s home or in a group residential care setting (such as adult foster care or certain assisted living residences). Other assistance may also be provided, such as light housecleaning. Eligible applicants choose the PCS agency of their liking to provide services.

The PCS program is a Medicaid State Plan program and, therefore, it is considered an entitlement. This is an important distinction because there is a similar program covering many of the same services in NC called Community Alternative Program/Disabled Adults (CAP/DA) Waiver. The CAP/DA Program is very popular and is subject enrollment caps. Waiting lists exist for the CAP/DA waiver, while qualified participants will never have to wait for personal care services under the PCS Program. CAP/DA is also only for those that live in their own home. However, the program does offer some services that PCS does not, such as skilled nursing, equipment to help with mobility and respite care.

Both programs are under the direction of the North Carolina Division of Medical Assistance (DMA). Assessments for eligibility for the PCS program are completed by Liberty Healthcare Corporation of North Carolina. Eligible applicants receive services through providers who have been approved by the state.

 

Eligibility Guidelines

Eligibility for NC PCS is comprised of two components; a functional need for assistance and a financial need.

Functional Criteria
An individual must be disabled, have a medical issue, or be impaired cognitively, and must have a physician referral. The individual must need some assistance with at least three of five activities of daily living (ADLs), which include eating, bathing, toileting, mobility, and dressing OR need considerable assistance with two of the five ADLs.

An assessment via the Liberty Healthcare Corporation of North Carolina must be completed to determine if these limitations exist and to what extent. For the assessment to be conducted, an individual must have a physician’s referral.

Financial Criteria
The applicant must also be financially eligible for Medicaid. The eligibility requirements differ based on the age of the applicant. For those considered "aged, blind or disabled" income eligibility limits for NC (State Plan) Medicaid, as of 2017, are $1005 per month for an individual and are $1353 for a married couple.

Those persons who are ensure if they qualify for NC Medicaid, should read about Medicaid planning

 

Benefits and Services

Through the PCS program, participants receive help with activities of daily functioning in which they need assistance. This may include helping the individual to bathe, use the toilet, move from one location to another, eat meals, or dress oneself. Light housecleaning may also be a provided service. Adults may receive up to 80 hours of care per month. However, the actual care budget will depend on the diagnosis and clinic needs of the recipient.

 

How to Apply / Learn More

For more information about the PCS program, click here. Download the request for a personal needs assessment here. Fax the completed form, filled out by a doctor, to Liberty Healthcare Corporation-NC at 866-728-8039 or call 855-740-1400 for additional information.

Click here for information on providers of services.