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Assessing Eligibility for the North Carolina Medicaid Personal Care Services

About Medicaid
PCS & Eligibility Assessment

nurse assessing individual's eligibility for PCS services.

About Medicaid's Personal Care Services Program

Medicaid's Personal Care Services (PCS) is a North Carolina health assistance program for qualified active Medicaid beneficiaries, who, because of a physical disability, cognitive impairment, or chronic medical condition, are unable to accomplish tasks that they would ordinarily do for themselves if they were not disabled.

Personal care services do not include skilled medical or skilled nursing care. The individual requesting services must be referred by a primary care or attending physician or by the physician who is providing treatment for the medical condition causing the person's need for PCS.

Covered services under this program include hands-on assistance by a paraprofessional aide with Activities of Daily Living (ADLs). The State of North Carolina recognizes the following five (5) ADLs:

(1) Bathing, (2) Dressing, (3) Mobility, (4) Toileting, (5) Eating.

Medicaid's Personal Care Service is available for qualified beneficiaries in private residences and licensed adult care homes (ACH), family care homes, 5600a and 5600c supervised living homes, and combination homes with ACH beds. These services are provided under a consolidated Clinical Coverage Policy 3L, PCS benefit.

About Eligibility Assessment

The Independent Assessment Program was instituted by North Carolina's State Medicaid agency, the Division of Medical Assistance (DMA) as a method for providing an independent, non-biased eligibility assessment to determine the type and quantity of services needed.

Liberty Healthcare Corporation of North Carolina is the DMA's partner in administering the Independent Assessment program for Medicaid beneficiaries who may be eligible for Personal Care Services (PCS).

As the Independent Assessment Entity (IAE), we'll be conducting the eligibility assessment to determine if the individual meets specific Medicaid criteria for personal care services. The actual PCS services will be provided by state-approved personal health care providers.