Understanding Medicaid Personal Care Services
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» BY RONALD A. FATOULLAH, ESQ.
AND STACEY MESHNICK, ESQ.
The New York State Medicaid
program provides coverage for
a category of home care services
called Personal Care Services (PCS).
Under the Medicaid rules and regulations,
personal care services are defi ned
as the assistance of a personal care aide/
home attendant with nutritional, environmental
support, and personal care
functions. According to the regulations,
such services must be essential to the
maintenance of the patient’s health and
safety in his or her own home, ordered
by the attending physician, and based
on an assessment of the patient’s needs
and based upon the appropriateness and
cost-eff ectiveness of services.
Th e two “levels” of PCS in New York
State are Housekeeping, which is considered
“Level 1” and Personal Care,
which is “Level 2”. Housekeeping services
are limited to eight hours per week
and entail housekeeping, cleaning, meal
preparation, grocery shopping, and
laundry.
Level 2 personal care consists of
housekeeping tasks as well as assistance
with personal needs such as bathing,
dressing, toileting, walking, turning and
positioning, feeding, and routine skin
care. PCS must be medically necessary
and is intended for individuals who can
be safely maintained at home.
In order to receive PCS, the individual
must be able to direct care or have
someone with daily contact who is able
to direct care. In addition, if the patient
has a condition that is unstable, i.e., expected
to show sudden deterioration or
improvement, and requires some type of
skilled professional or nursing judgment,
he or she will not be eligible for PCS care.
Personal Care Aides/Home Attendants
may not perform tasks that are
deemed “skilled.” They differ slightly
from “home health aides” who can
provide skilled care in Certifi ed Home
Health agencies (CHHA) because they
are supervised by nurses.
However, aides in the Medicaid Consumer
Directed Personal Assistance Program
(CDPAP) are not bound by these
restrictions, and may perform tasks that
would otherwise be considered “skilled”.
In order to receive PCS, one must
fi rst apply for and become eligible for
community Medicaid. Once found
eligible, the individual can be evaluated
by a Managed Long Term Care agency
(MLTC) to determine the number of
hours the agency will provide.
New York State has two types of 24-
hour care available when medically necessary.
(1) Live-in 24-hour personal
care services means “the provision of
care by one personal care aide for a patient
who, because of the patient’s medical
condition, needs assistance during
a calendar day with toileting, walking,
transferring, turning and positioning, or
feeding and whose need for assistance is
suffi ciently infrequent that a live-in 24-
hour personal care aide would be likely
to obtain, on a regular basis, fi ve hours
daily of uninterrupted sleep during the
aide’s eight hour period of sleep.” Th e
patient’s home must have sleeping accommodations
for a personal care aide.
If this is not the case, split-shift (two 12-
hour aides) must be authorized.
(2) Split-shift or “Continuous personal
care services” means “the provision of
uninterrupted care, by more than one personal
care aide, for more than 16 hours in
a calendar day for a patient who, because
of the patient’s medical condition, needs
assistance during such calendar day with
toileting, walking, transferring, turning
or positioning, and needs assistance with
such frequency that a live-in 24-hour
personal care aide would be unlikely to
obtain, on a regular basis, fi ve hours daily
of uninterrupted sleep during the aide’s
eight hour period of sleep.”
Given the diff erent rules and the diffi -
culty of navigating the system, it is advisable
to seek assistance from a qualifi ed
elder care attorney.
Ronald A. Fatoullah, Esq. is the principal
of Ronald Fatoullah & Associates, a law
fi rm that concentrates in elder law, estate
planning, Medicaid planning, guardianships,
estate administration, trusts, wills,
and real estate. Stacey Meshnick, Esq. is a
senior staff attorney at the fi rm who has
chaired the fi rm’s Medicaid department for
over 15 years. Th e law fi rm can be reached
at 718-261-1700, 516-466-4422, or toll free
at 1-877-ELDER-LAW or 1-877-ESTATES.
Mr. Fatoullah is also a partner with Advice
Period, a wealth management fi rm, and he
can be reached at 424-256-7273.
The Elder Law Minute