North Carolina’s Personal Care Services (PCS) is a Medicaid program intended for residents who need assistance with their Activities of Daily Living, such as feeding oneself, using the bathroom, and putting on clothes. Other assistance may also be provided, such as light housecleaning.
Services are administered in an individual’s home or in a group residential care setting (such as adult foster care or certain assisted living residences). Services are not available to those residing in a nursing home, as the program is intended to prevent or delay nursing home placement.
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 North Carolina called the Community Alternative Program/Disabled Adults (CAP/DA) Waiver.
CAP/DA is very popular but is subject to enrollment caps. Waiting lists may exist for the CAP/DA waiver, while qualified participants in the PCS program will never have to wait for personal care services. However, the CAP/DA 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 Health Benefits within the Department of Health and Human Services. Eligible applicants receive services through providers who have been approved by the state. Applicants can choose the PCS agency of their liking to provide services.
An individual must be disabled, have a medical issue, or be impaired cognitively, In addition, the applicant must need help with their activities of daily living (ADLs). The degree to which they need help is split into the following two categories:
- The individual must need some assistance with three of the five ADLs. OR
- The individual must need assistance with two ADLs, one of which requires considerable assistance.
The five ADLs that are considered are:
An assessment via an independent assessment entity (currently, Liberty Healthcare 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 first be referred by a health care provider.
The applicant must also be financially eligible.
Individual seniors cannot exceed $1,215 a month in income (April 2023 – March 2024). For a married couple, the income limit is $1,644 a month, until March 2024.
In addition, there are asset (or resource) limits. For single applicants, the asset limit is set at $2,000. For married couples, the asset limit is $3,000. While this asset limit may seem relatively low, there are some higher valued assets that are considered 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 $688,000 — is exempt. Intent to return to one’s home to live also qualifies it for exemption.
Over the Financial Limits?
Applicants with finances over these limits should consider working with a Medicaid planning professional. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their income and resources appropriately.
Learn more about Medicaid planning here.
A Word of Caution
It is vital that persons do not give away assets or sell them for less than fair market value within 60 months of one’s Medicaid application date. This is because doing so is a violation of the Medicaid look-back period and can result in Medicaid denial. A Medicaid planning professional is highly recommended in this circumstance.
Benefits and Services
Through the PCS program, participants receive help with their activities of daily living. This may include assistance with:
- Transferring: moving from one location to another
- Light housecleaning, in some cases
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.
How to Apply / Learn More
Seniors must first be enrolled in Medicaid. Once enrolled, the senior’s physician will need to fill out and submit the Request for Independent Assessment and Attestation of Medical Need Form for Personal Care Services (PCS).
- The form and instructions can be found here.
- Completed forms should be faxed to Liberty Healthcare at 919-307-8307.
More information about the PCS program can be found here. Additionally, one can call Liberty at 855-740-1400.