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 putting on clothes. 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 means that anyone who is eligible to receive services is able to do so. 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 Program is very popular and is subject to enrollment caps. Waiting lists may 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 homes. However, the program does offer some services that PCS does not, such as adult day health, equipment to help with mobility, and respite care.
Both programs are under the direction of the North Carolina Division of Medical Assistance (DMA) within the Department of Health and Human Services. Eligible applicants receive services through providers who have been approved by the state.
Eligibility for NC PCS is comprised of two components; a functional need for assistance and a financial need.
Functional CriteriaAn 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 the 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.
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 April 2019 – March 2020, are $1,041 per month for an individual. However, beginning in April of 2020, the monthly income limit will increase to $1,063. For a married couple, the income limit is $1,409 / month until March 2020, and in April 2020, it will increase to $1,437 per month. In addition, there are asset (or resource) limits. For single applicants, the asset limit is set at $2,000, and for married couples, the asset limit is $3,000. While this asset limit may seem relatively low, there are some higher end assets that are generally exempt or “non-countable”. For example, one motor vehicle, and one’s home, given the applicant or his or her spouse resides in it, and the value is at or under $595,000, is exempt. Intent to return to one’s home to live also qualifies it for exemption.
Those persons who are unsure if they qualify for NC Medicaid, should read about Medicaid planning.
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 130 hours of care per month. However, the actual care budget will depend on the diagnosis and clinical needs of the recipient.
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 855-740-1600. Persons can call Liberty Healthcare at 855-740-1400 for additional information.
Click here for information on providers of services.