Medicaid’s Personal Care Services (PCS) can support individuals with daily tasks they can no longer manage independently due to age, illness, or disability. Ahead, we cover the types of services PCS provides, who qualifies, and how family members can be hired to offer care. Additionally, we’ll break down the differences between personal care and home health care, helping you make informed choices for in-home support.
Understanding Medicaid Personal Care Services
What are Personal Care Services (PCS)?
Personal Care Services, or PCS, help people who need assistance with daily tasks they can’t do on their own due to age, illness, or disability. These services are offered through Medicaid and aim to help people stay in their homes rather than in long-term care facilities.
Types of services covered
PCS help with disabilities and chronic conditions to enable them to accomplish basic activities of daily living (ADLs) or instrumental activities of daily living (IADLs; which require more complex thinking skills).
Basic ADLs
Ambulating: The extent of an individual’s ability to move from one position to another and walk independently.
Feeding: The ability of a person to feed oneself.
Dressing: The ability to select appropriate clothes and to put the clothes on.
Personal hygiene: The ability to bathe and groom oneself and maintain dental hygiene, nail, and hair care.
Continence: The ability to control bladder and bowel function
Toileting: The ability to get to and from the toilet, use it appropriately, and clean oneself.
Instrumental ADLs
Transportation and shopping: Help to get groceries, attend events, and manage transportation.
Managing finances: Paying bills and managing financial assets.
Shopping and meal preparation: Everything required to get a meal on the table, in addition to shopping for clothing and other items.
Housecleaning and home maintenance. Light housekeeping, living areas reasonably clean and tidy, and keeping up with home maintenance.
Managing communication with others: The ability to manage telephone and mail.
Managing medications: Ability to obtain medications and take them as directed.
These services are designed to help individuals manage day-to-day life more easily, promoting both safety and independence.
Eligibility for Personal Care Services
To receive PCS, individuals need to meet certain qualifications. Medicaid helps people with limited income, so qualifying usually depends on both financial and health factors. Here’s a basic breakdown:
Income requirements: Medicaid primarily serves individuals and families with low income. Each state has its own specific income limits to determine if someone qualifies, based on their household size and resources.
Level of need: PCS is meant for individuals who need significant help with daily activities due to physical or mental limitations. To qualify, applicants often need an assessment from a healthcare professional or Medicaid representative to verify their level of need.
State-specific guidelines: Medicaid is a federal program, but each state has its own rules about who qualifies and what services are offered. Some states may offer more extensive PCS support than others, or have unique programs and waivers that expand eligibility.
Hiring family caregivers to provide Personal Care Services
In some states, Medicaid allows family members to be hired as caregivers to provide Personal Care Services (PCS) for their loved ones who need help with daily activities. Here’s a breakdown of how it works and some key things to consider.
Who can be hired?
Family members: Relatives like adult children, siblings, or other close family members can usually be hired as caregivers. However, there are exceptions—some programs don’t allow spouses or legal guardians to be paid as caregivers.
Living arrangements: A family member caregiver can live with the person receiving care, but unrelated caregivers usually cannot.
Requirements for family caregivers
Training and documentation: Family caregivers may need to complete specific training, like CPR or first aid, or pass a background check to make sure that they are prepared and safe for their role.
Tracking hours: Under Personal Care Services, caregivers are required to track the hours they work and the tasks they complete through an Electronic Visit Verification (EVV) system.
How are family caregivers paid?
Payment structure: Caregivers are paid based on Private Home Care rates in their state.
Employment and taxes: Under Personal Care Services, caregivers become employees of an agency with taxes and W2.
Families interested in this option should reach out to their local Medicaid office for guidance on eligibility and application steps.
Differences between personal care and home health care
Personal care
Personal care is a type of home care (not to be confused with home health care) is for people who need help with personal and household tasks due to age, disability, or illness but don't require medical care. The focus is assistance with activities of daily living (bathing, dressing, meal prep, mobility, etc.) that don't require medical skills. Care is provided by a care aide who may not need medical training but must still complete training in areas like CPR or first aid.
An alternative to Personal Care Services is Structured Family Caregiving (SFC) through which family members provide personal support services. SFC offers a tax-free stipend, no set schedule, and no electronic visit verification. Check your eligibility here >>
Home Health Care
Home health care is for people who need ongoing medical care—those recovering from an illness, injury, or surgery, or for managing chronic health issues. Services are provided in a patient’s home by licensed medical professionals, like nurses, physical therapists, or occupational therapists.
If a senior’s doctor prescribes home health care, if necessary, they may also include home care services in the senior’s care. In that case, while they recover at home, they may also receive services like support with ADLs or help with housekeeping.
Structured Family Caregiving vs. Personal Care Services/Personal Support Services
A note from Givers
Medicaid’s Personal Care Services provide essential support for those needing help with everyday tasks, allowing them to remain safely at home with the assistance of trusted caregivers, including family members. Exploring options like PCS and understanding the differences in care types can empower families to make the best choices for their loved ones’ health and well-being.
