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Assessing Eligibility for the North Carolina Medicaid Personal Care Services

Applying For
Personal Care Services

Nurse assessor interviewing Medicaid PCS benifiary

What To Expect When You Apply For Services

You've talked your doctor* and he or she has filled out your Request For Services form for Medicaid's Personal Care Services (PCS). So, what happens now that your doctor has sent the form to Liberty Healthcare of North Carolina?

The Next Step Is To Determine Your Eligibility

Liberty Healthcare of North Carolina has been chosen by your State Medicaid agency, NC Medicaid, as their partner in administering the Independent Assessment program for Medicaid beneficiaries who may be eligible for Personal Care Services (PCS). Our job, simply put, is to evaluate your eligibility for this program.

First: Processing The Request

Our first step will be to evaluate the Request of Services form for completeness. We will also ensure that you are eligible for Medicaid and that you qualify for consideration for the PCS program. If for any reason the request cannot be processed or you are not eligible for services, you and your doctor will be notified.

Once we've reviewed your form, one of our customer service representatives will call you to schedule an appointment at a convenient time for you. If you wish to have family members or caregivers present during your assessment, you'll want to schedule a time that is convenient for them as well.

Second: A Visit From Liberty Healthcare's Nurse Assessor

Your independent assessment will be performed by a registered nurse who is experienced in home care services.

What should you expect when the nurse assessor visits? A respectful,
professional and matter-of-fact evaluation of your in-home living arrangements and how well you can take care of your daily needs.*

Your visit with your nurse assessor will start with an interview. He or she will be asking you questions about your health and personal care needs. Don't be surprised if our nurse assessor pulls out a tablet computer to record your answers! We use the latest technology and a standardized Independent Assessment for PCS screening tool to make sure that we can process your application as quickly and as accurately as possible.

Your nurse assessor will talk with you about the details of the Request for Services referral form that your doctor filled out. Your nurse will also talk with you about your general medical condition and any concerns that you or your caregivers may have about your ability to care for yourself at home. If you have any additional records, documents or information that you think would be helpful to your assessor, please provide them at the assessment appointment.

The reason that your nurse assessor visits you in your home or in the adult care home or other approved location where you're living is so that he or she can assess your ability to perform the activities of daily living in that environment.

Here's what will be discussed during your nurse assessor's visit:

  • Your Medical Review
  • Your Doctor's Diagnosis
  • Your Current Medications
  • Your Medical Stability
  • Your Medical Status
  • Caretaker and Family Support
  • Environmental Assessment
  • Safety Check

What You'll Be Asked To Do
As part of the in-home visit, your nurse assessor will ask you to demonstrate your ability to bathe, dress, walk or otherwise move around your home. Getting in and out of the tub or shower, on and off the toilet, fixing a light meal and eating, getting dressed or undressed, putting on and taking off shoes are all examples of activities of daily living.* Be assured! You'll only be asked to simulate these activities. Your assessor will never ask you to undress or actually use the toilet during the assessment.

Your family members or other caregivers are welcome to be present during this home visit.

The Role Of Your Family
Your nurse assessor will ask you about any family members -- or alternate caregivers -- who would be available to assist in your home care.

Choosing A Personal Care Services Provider
During your visit, the nurse assessor will provide you with a printout of a randomized list of eligible PCS providers. The reason that we ask you to choose now, while your nurse assessor is with you, is so we will be able to get services to you as quickly as possible should your eligibility be approved.

You'll be able to choose up to three care providers from this list. Don't worry. If you need more time or more guidance in choosing three care providers, then your nurse assessor will leave the list with you. You may contact Liberty Healthcare as soon as you make your decision. Your nurse assessor will follow up with you within 24 hours to ensure that your selection is received so your application can be processed.

Third: Evaluating Your Information

After your visit, your nurse assessor will organize and review the information he or she has gathered from your interview. He or she will create the initial eligibility assessment report.

Your assessment goes through a Quality Assurance check to ensure that your case has been evaluated correctly and that all of Medicaid's Personal Care Services (PCS) eligibility criteria have been met. Once the assessment has been quality verified, the assessment results are used to determine both your eligibility for the program and the number of hours of service that can be authorized in accordance with North Carolina's Medicaid policy.

Fourth: Notifying You Of The Decision

Once a determination has been made, you will receive written notification of the results of your assessment.

What happens if your application isn't approved? If your application for Medicaid's Personal Care Services (PCS) has not been approved, you will receive a letter stating the reason why the application was not approved. You may have a right to appeal this decision if you disagree with this determination.

Fifth: When Your Care Services Will Begin

Once your assessment is approved and the number of personal care hours are authorized, the first Personal Care Services (PCS) provider on your list will receive notification that they have a new client. If that care provider chooses not to take on your case or does not respond in a timely fashion, your case will roll over to the second choice.

If you are already residing in a facility, you will continue to do so and will receive the services that have been authorized.

If you are living at home, your PCS provider will contact you to make arrangements for services. They will develop a plan of care to ensure that you have the support needed to take care of yourself, based on your abilities to perform the activities of daily living as demonstrated during your assessment.

Additional Assessments

Medicaid's Personal Care Services (PCS) Program requires annual assessments of beneficiaries to review ongoing eligibility. You will be reassessed annually.

Also, if your health condition changes or if you move to a new residential setting, you or your provider may request a new assessment at any time based on a change in your status.

The goal of the PCS program is to ensure that Medicaid beneficiaries receive the appropriate services needed to maintain their quality of life in the least restrictive setting possible.

Terms Used

  • *Doctor:
    Your Health Care Provider.
    Your physician, nurse practitioner or physician's assistant can all complete and send in the DHB 3051 Request For Services Form.

  • *Daily Needs: Activities of Daily Living (ADLs)
    • Bathing
    • Dressing
    • Mobility
    • Toileting
    • Eating

  • See also our Glossary of Terms