Medicaid Personal Care Assistant (PCA) Services
Program DescriptionThe Personal Care Assistant (PCA) Program is an optional statewide service offered to New Jersey Medicaid recipients who are experiencing some functional impairment and need a personal care assistant to help them with some aspects of daily living, such as dressing or bathing.
The purpose of the program is to accommodate long-term chronic or maintenance health care, as opposed to short-term skilled care as is provided under Medicaid’s home health program. PCA services are non-emergency health related tasks done by qualified staff in a medically eligible beneficiary’s home.
An estimated 22,000 people receive this service at any given time. The program is administered by the Division of Disability Services, Office of Home and Community Services.
QualificationsIn order to qualify for PCA services recipients must be:
Participating on Medicaid Plan A or G of the New Jersey FamilyCare program;
• Have a doctor's order to receive this service, but they do not have to be permanently disabled;
• Live in a community-based residence (private home, apartment, rooming house, or boarding home) or group home, skill development home, supervised apartment or other congregate living program where personal care is not provided as a part of the service package included in the living arrangement; and
• Have a documented need for hands-on personal care.
ServicesServices include assistance with activities of daily living (ADLs) and household duties essential to the patient’s health and comfort. PCA services are performed under the supervision of a registered professional nurse employed by a Medicaid provider.
Services may be provided by community-based home care agencies under contract with Medicaid or by independent clinics under contract to the Division of Mental Health Services (DMHS).
PCA services must be prior authorized by the Division of Disability Services.
Accessing PCA ServicesRecipients may contact community-based home care agencies under contract with Medicaid directly in order to select an agency to provide services.
Community-based home care agencies listed by New Jersey county may be obtained by contacting DDS, Office of Home and Community Services (OHCS) at (609) 292-4800. Information may be sent to requesters by fax, email or regular mail.
Eligibility DeterminationUpon selection of a community-based home care agency by the recipient the following process will occur in order to determine eligibility and award of services:
Provider agency will obtain necessary personal and medical information to verify Medicaid eligibility;
A nurse will visit the recipient’s home to perform an assessment of need for personal care assistance;
Provider agency will submit a prior authorization request to the Division of Disability for review upon the results of the assessment; and
Division staff will review the request and notify the provider agency of the decision on eligibility and number of hours awarded per week.
The final decision on award of service hours is made by the Division of Disability Services professional staff based on the nursing assessment and the recipient’s need for personal care assistance.
2013 Personal Care Services Cost Report The 2013 Cost Report forms and instructions can be found at www.nj.gov/humanservices.dds
The forms are Excel spreadsheets. While you must complete the entire Cost Report, you will only be required to submit Schedule A1, A2 and Schedule C1 (columns a, b, c, d, e, f, g) to the Division. You will also only be expected to provide information on the costs and expenditures for “personal care assistant services as described in N.J.A.C. 10:60-3.3.” – which are Medicaid PCA Services.
The 2013 Cost Report will be due no later than May 1, 2014. The three schedules listed above, together with the completed Cost Report Cover Page should be e-mailed to: AnnaMarie.Treglia@dhs.state.nj.us
Should you have questions, please contact Michael Nuskey at (609) 631-2455.