Long Term - Personal Care Services

Who is eligible?

Medicaid recipients who are either 65 years of age or older, OR 21 years of age or older with disabilities (Disabled is defined as meeting the eligibility criteria established by the Social Security Administration for disability benefits.)

These individuals must also:

    • · Meet the requirements for nursing facility level of care, AND
    • · Be able to direct his/her care independently or through a responsible representative, AND
    • · Meet one of the following criteria:
    • · Be in a nursing facility and be able to be discharged if community-based services were available; OR
    • · Be likely to require nursing facility admission within the next 120 days; OR
    • · Have a primary care-giver who has a disability or is over the age of 70; OR
    • · Face a substantial possibility of deterioration in mental or physical condition or functioning if either home and community-based services or nursing facility services are not provided in less than 120 days.

What are personal care services?

Personal care services are those services that provide assistance with activities of daily living and instrumental activities of daily living. They may be either the actual performance of the personal care task for the individual or supervision and prompting so the individual performs the task by him/herself. They include tasks such as:

    • · eating;· bathing;· dressing;· grooming;
    • · transferring (getting in/out of the tub, from a bed to a chair);
    • · reminding the recipient to take medication;
    • · ambulation;
    • · toileting;
    • · light housekeeping;
    • · food preparation and storage;
    • · grocery shopping;
    • · laundry;
    • · assisting with scheduling medical appointments when necessary;
    • · accompanying the recipient to medical appointments when necessary due to the recipient’s frail condition;
    • · assisting the recipient to access transportation.

What is not covered under personal care services?

Personal care services ARE NOT to be used for:

    • · specialized nursing procedures (i.e., insertion of feeding tube, indwelling catheter, tracheostomy care, injections)
    • · skilled nursing services
    • · medication administration
    • · rehabilitative services
    • · specialized aide procedures (i.e., measuring/recording vital signs, specimen collection, special skin care, etc.)
    • · cleaning areas of home not occupied by recipien
    • · food preparation or laundry for anyone other than the recipient
    • · companionship
    • · supervision
    • · respite of the primary care giver