PCA (Personal Care Assistance) services provide assistance to an individual with a disability who needs help with activities of daily living (ADLs). In general, activities of daily living are those activities which need to be performed in order for a person to take care of oneself. This guide will provide general information on requirements for Medical Assistance (MA, Medicaid) to pay for PCA services.
Eligibility – Based on an assessment, the person is determined to be dependent in at least one ADL or demonstrate a Level 1 behavior.
Assessment – An assessment must be completed by the county public health nurse or a certified public health nurse under contract with the county. The initial assessment is a review of the need for PCA services completed in person with the intended recipient. The assessment includes:
- Documentation of the person’s health status
- Determination of the need for PCA services
- Evaluation of the effectiveness of PCA services
- Identification of appropriate services
- Development of a service plan
- Coordination of services, referrals to others and follow-up to appropriate payers and community resources
- Completion of required reports
- Recommendations for service authorization
- Consumer education
Additional information related to assessment – limitations
In order for a person to be determined as dependent in an ADL, the person must need:
- Cuing and constant supervision to complete the task, OR
- Hands-on assistance to complete the task
A child cannot be determined to be dependent in an ADL if an adult would typically perform the activity or assist the child due to the child’s age. A copy of the assessment is available at: http://bit.ly/RocSZO.
Activities of daily living include:
- Dressing, including assistance with choosing, applying and changing clothing and application of special appliances, wraps and/or clothing
- Grooming, including assistance with basic hair care, oral care, shaving, applying cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included except for recipients who are diabetic or have poor circulation.
- Bathing, including assistance with basic personal hygiene and skin care
- Eating, including assistance with hand washing and application of orthotics required for eating, transfers and feeding
- Transfers, including assistance with transferring the recipient from one seating or reclining area to another
- Mobility, including assistance with ambulation, including use of a wheelchair. Mobility does not include providing transportation
- Positioning, including assistance with positioning or turning a recipient for necessary care and comfort
- Toileting, including assistance with helping recipient with bowel and bladder elimination and care including transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the area, inspection of the skin and adjusting clothing
Level 1 behaviors – Defined as physical aggression towards self, others, or destruction of property that requires an immediate response from another. More information on PCA services, including information on health-related tasks and procedures, is available
For further information or advocacy services, contact The Arc Minnesota at 952-920-0855 or toll-free at 833.450.1494 or visit www.arcminnesota.org. (Please note: This document is not legal advice, and should not be construed as such. Thus, no information herein should replace the sound advice of an attorney.)
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