Does Medicaid Pay for Home Care in North Carolina?

Yes, NC Medicaid can help pay for care at home for people who qualify. The two programs families ask about most are Personal Care Services (PCS) and the Community Alternatives Program for Disabled Adults (CAP/DA). Here is a plain-language overview.

NC Medicaid Personal Care Services (PCS)

PCS helps NC Medicaid members with daily tasks such as eating, dressing, bathing, using the bathroom and moving around. Care is provided by trained aides who work for licensed home care agencies, either in the person’s own home or in a residential setting such as an adult care home.

According to NC Medicaid, a person may qualify if they have NC Medicaid, have a medical condition, disability or memory problem, and need help with daily tasks. The general thresholds are needing:

• some help with three of the five daily tasks, or
• help with two daily tasks, with a lot of help needed for one of them, or
• help with two daily tasks, with full help needed for one of them.

How to request PCS

• Talk to your doctor about the help you need with daily activities. Your doctor makes a referral for an assessment.
• NC Medicaid arranges an independent, in-person assessment, usually by a nurse who visits the home.
• If approved, a care plan sets the number of hours. For adults, the standard maximum is 80 hours per month, with more available in some situations.
• You can choose a licensed home care agency, such as @Home Care, to provide the care.

The CAP/DA waiver

CAP/DA helps adults age 18 and older with disabilities who are at risk of moving into a nursing home stay in their own homes instead. Depending on the person’s needs, services can include a personal care aide, adult day health, meal preparation and delivery, respite, home accessibility changes, emergency response systems, medical supplies and case management.

You can apply through the NC ePASS portal (epass.nc.gov) or call the NC Medicaid Contact Center at 888-245-0179, Monday through Friday, 8 a.m. to 5 p.m.

What about Medicare?

Medicare and Medicaid are different programs. Medicare generally does not pay for ongoing non-medical care, such as help with bathing, dressing, meals or companionship, when that is the only care a person needs. Many families use Medicaid, long-term care insurance or private pay for this kind of care.

Medicaid and @Home Care

@Home Care accepts Medicaid, along with private pay, long-term care insurance and all major credit cards. If you are not sure whether your loved one qualifies, call us. We are happy to explain the process and how our personal care services work.

Have questions about care for a loved one in the Piedmont Triad? Call @Home Care at 1-336-431-HOME (4663) or contact us to schedule a free in-home assessment. We serve Davidson, Forsyth, Guilford and Randolph counties from our office in Archdale.

Program details change. Always confirm eligibility and current rules with NC Medicaid. Sources: NC Medicaid (medicaid.ncdhhs.gov) and Disability Rights NC.