What Personal Care Services Does Medicaid Provide?

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

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.

What Is Covered

Covered services under this program include hands-on supplemental assistance by a paraprofessional aide with activities of daily living (ADLs). When appropriate, personal care services may also include assistance with homemaking IADLs (such as cleaning up after a bath, washing towels, etc. after an aide has assisted with bathing) when these services are directly related to the beneficiary's qualifying ADLs and IADLs.

Beneficiaries requiring personal assistance resulting from a cognitive-related impairment may also receive PCS that include cueing, prompting, guiding, coaching, and setups for IADL services that may be required for the individual to complete the ADL task.

Excluded Services

Personal Care Services, as defined in the revised State Medicaid Plan, do not include the following services:

1. Skilled nursing services provided by a LPN or RN;
2. Services provided by other licensed health care professionals;
3. Care of non-service-related pets and animals;
4. Yard or home maintenance work;
5. Medical and non-medical transportation;
6. Money management;
7. Companion sitting or leisure activities;
8. Ongoing supervision and continuous monitoring of adults 21 years and older;
9. Personal care or home management tasks for other non-eligible residents of the household; and
10. Other tasks and services not specified in the recipient's approved plan of care.