Medicaid Benefits: Online Database

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Benefits by Service: Personal Care Services (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 1

No: 30

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
No
Alaska
Yes			Limited to 8 hours/day or 35/week	Fee for service using hourly rates	CN
Arizona
Yes		Yes	Coverage limited to ALTCS members - see state-specific FN	Fee for service using time units	CN & MN
Arkansas
Yes			64 hours/month	Fee for service using hourly rates	CN
California
Yes			Plan of care required, 283 hours/month	Fee for service using hourly rates, or negotiated rates	CN
Colorado
No
Connecticut
No
Delaware
No
District of Columbia
Yes			8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility	Fee for service using hourly rates, adjusted for multiple beneficiaries same address	CN & MN
Florida
No
Georgia
No
Hawaii
No
Idaho
Yes		Yes	Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, 16 hours/week	Hourly rates based on nursing facility and ICF/MR wages, rates vary for independent providers and agencies	CN
Illinois
No
Indiana
No
Iowa
No
Kansas
No
Kentucky
No
Louisiana
Yes		Yes	Medical criteria for nursing facility placement must be met, 56 hours/week	Fee for service	CN & MN
Maine
Yes	$.50-$3/day, depending on payment, up to $50/month	Yes	2-4 hours/week based on specified LOC criteria, assistance with IADLs dependent on need	Fee for service using hourly rates with annual payment ceiling based on LOC	CN & MN
Maryland
Yes		Yes		Per diem with acuity adjustment	CN & MN
Massachusetts
Yes		Yes		Fee for service	CN & MN
Michigan
Yes				Fee for service using hourly rates adjusted for LOC	CN & MN
Minnesota
Yes		Yes		Fee for service	A - See state-specific FN
Mississippi
No
Missouri
Yes			Care must be supervised by RN, alternative to institutional placement	Fee for service with payment ceiling at monthly nursing facility cost cap	CN & MN
Montana
Yes			40 hours/week	Negotiated hourly rates	A - See state-specific FN
Nebraska
Yes		Yes	40 hours/week	Federal minimum hourly wage, increased following training or licensure	CN & MN
Nevada
Yes		Yes	Approved hours of care dependent upon need	Fee for service	CN
New Hampshire
Yes			Care plan must be developed by RN, beneficiary must be chronically wheelchair bound and able to select and direct attendant	Fee for service	CN & MN
New Jersey
Yes		Yes	Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week	Fee for service using hourly rates	CN & MN
New Mexico
Yes		Yes		Fee for service	CN
New York
Yes		Initiation of care and at 6 month intervals	Services provided at 2 levels, must be supervised by RN	Fee for service	CN & MN
North Carolina
Yes		Yes	3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Negotiated hourly rates up to reasonable cost	CN & MN
North Dakota
Yes		Yes	240 hours/month	Fee for service	CN & MN
Ohio
No
Oklahoma
Yes		Yes		Fee for service	CN
Oregon
Yes		Yes		Established hourly rate for individual providers and negotiated rate for agencies	A - See state-specific FN
Pennsylvania
No
Rhode Island
Yes			Limited to mentally ill in residential facilities with fewer than 17 beds	Fee for service using hourly rates	CN & MN - see state-specific FN
South Carolina
No
South Dakota
Yes			120 hours/3 months	Cost based payment	CN
Tennessee
No
Texas
Yes			Functional limitation criteria must be met, care limited to 50 hours/week	Fee for service using quarter hour or hourly rates	CN
Utah
Yes		Yes	60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Fee for service	A - See state-specific FN
Vermont
No
Virginia
No
Washington
Yes			Scope of coverage dependent upon functional needs assessment	Hourly rate or daily rate depending on setting	CN
West Virginia
Yes		Plan of care and after 60 hours/month	220 hours/month, nursing assessment every 6 months	Monthly rate based on hours of care	A & B
Wisconsin
Yes			250 hours/year	Fee for service using hourly rate for care and visit rate for supervision	CN & MN
Wyoming
No
American Samoa
No
Guam
No
Northern Mariana Islands
No
Puerto Rico
No
Virgin Islands
No

Definition/Notes: Link to Personal Care Services Footnote


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