Personal Care Services (PCS) is a Medicaid benefit for the elderly, people with disabilities, and people with chronic or temporary conditions who need assistance with activities of daily living and help to remain in their homes and communities. Examples of PCS include bathing, dressing, light housework, money management, meal preparation, and transportation.

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​Eligibility

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Medicaid PCS are services provided to eligible beneficiaries according to a State’s approved plan, waiver, or demonstration in the beneficiary’s home or at other locations. PCS are optional Medicaid services, except when they are medically necessary for children eligible for early and periodic screening, diagnostic, and treatment services. PCS are categorized as a range of human assistance provided to persons with disabilities and chronic conditions to enable them to accomplish activities of daily living or instrumental activities of daily living. An independent or agency-based personal care attendant (PCA) may provide these services. Medicaid PCS are different from home health aide services provided through the Medicaid or Medicare home health benefit. However, home health aides may perform PCS in the course of their duties and may report it with a higher-paying code. PCS providers should contact their State Medicaid agency (SMA) for additional information.

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​Florida Medicaid provides services to eligible recipients under the age of 21 years, if such services are medically necessary to correct or ameliorate a defect, a condition, or a physical or mental illness. Included are diagnostic services, treatment, equipment, supplies, and other measures described in section 1905(a) of the SSA, codified in Title 42 of the United States Code 1396d(a). As such, services for recipients under the age of 21 years exceeding the coverage described within this policy or the associated fee schedule may be approved, if medically necessary

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Coinsurance and Copayments

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There is no coinsurance or copayment for this service in accordance with section 409.9081, F.S. For more information on copayment and coinsurance requirements and exemptions, please refer to Florida Medicaid’s General Policies on copayment and coinsurance.

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Parental Responsibility

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Florida Medicaid reimburses for personal care services rendered to a recipient whose parent or legal guardian is not able to provide ADL or IADL care, and to supplement care provided by parents and legal guardians. Parents and legal guardians must participate in providing care to the fullest extent possible. Providers must offer training to enable parents and legal guardians to provide care they can safely render without jeopardizing the health or safety of the recipient when needed

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Florida Medicaid reimburses for up to 24 hours of personal care services per day, per recipient, in order to provide assistance with ADLs and age-appropriate IADLs when the recipient meets the following criteria:

• Has a medical condition or disability that substantially limits their ability to perform ADLs or IADLs and do not have a parent or legal guardian able to provide the required care

• Is under the care of a physician and has a physician’s order for personal care services

• Requires more extensive and continual care than can be provided through a Home Health visit

• Requires services that can be safely provided in their home or the community

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Personal Care Services covered include:

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• Bathing

• Dressing

• Eating

• Grooming & Skin Care

• Positioning

• Transfers

• Toileting & Maintaining continence

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Reporting Fraud, Waste, and Abuse

 

All parties involved in providing, authorizing, and supervising PCS are responsible for protecting the quality and integrity of the Medicaid program. Report any acts of fraud to your State Medicaid Fraud Control Unit (MFCU) or SMA. To find any State’s contact information for the MFCU or SMA, visit https://www.cms.gov/MedicareMedicaid-Coordination/Fraud-Prevention/FraudAbuseforConsumers/Report_Fraud_ and_Suspected_Fraud.html on the Centers for Medicare & Medicaid Services (CMS) website. You may also contact the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) by email at HHSTips@oig.hhs.gov or by telephone at 1-800-HHS-TIPS (1-800-447-8477); TTY: 1-800-377-4950.

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For more information about our Personal Care Services, request a consultation today and one of our care coordinators will reach out to you as soon as possible.