Spread the word...This is BIG! Personal Care Services (PCS) are now available for Medicaid eligible children and youth with disabilities through the Medicaid Comprehensive Care Program. As a result of the settlement agreement in the Alberto, N. lawsuit, the Texas Medicaid state plan has been amended to include a personal care service benefit specifically designed for children with disabilities and chronic health conditions enrolled in Medicaid. There are no waiting lists as this is a state plan service. Previously, children with physical disabilities or medical needs were eligible for PCS through Texas Medicaid’s Primary Home Care Program but children with cognitive or behavioral disabilities were not eligible. Now they are! Most children who received PCS under Primary Home Care will now be served through the new PCS program for children.
What are personal care services?
PCS are those services that assist eligible clients in performing activities of daily living (ADLs), instrumental activities of daily living (IADLs), and other health-related functions. (Texas Medicaid Bulletin, No. 207) These activities basically include a wide range of daily activities that children are typically engaged in. For example, a child with cerebral palsy may need assistance with bathing, toileting, eating, dressing, etc. A child with autism may need supervision and cueing to perform daily tasks, communicate with others, or simply to be able to attend certain activities. PCS also encompasses things like grocery shopping and laundry for young adults or for younger children if their disability causes extra support needs in those areas for their family. PCS can also provide assistance for nurse delegated services, such as g-tube feedings, if the child’s physician and nurses believe delegation is appropriate. Personal care services can be the life line that many families need to prevent institutionalization of their child and to maintain a healthy family.
Who is eligible?
According to the Texas Medicaid Bulletin, No. 207, the personal care services benefit is available to Medicaid clients who:
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are younger than 21 years of age;
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are enrolled with Texas Medicaid fee-for-service, Primary Care Case Management, or Medicaid managed care; and
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have physical, cognitive, or behavioral limitations related to a disability or chronic health condition that inhibits the client’s ability to accomplish ADLs, IADLs, or health-related functions.
This service is available to children on Medicaid waivers, but the things they will look at to determine PCS hours for a child on a Medicaid waiver will be different. The PCS services will likely "wrap around" other waiver services to fill in the gaps.
How can referrals for PCS be made?
Anyone who identifies the potential need for these services may refer a child for an assessment. Referrals can be made by parents, guardians, case managers, health care providers, and others. Referrals for PCS may be made to the appropriate Department of State Health Services Health Service Region (see blue pages of telephone directory), or by calling the TMHP Community Health Services Department toll-free at 1-888-276-0702. Once a referral is made, a Department of State Health Services case manager will be assigned and will schedule an assessment. Prior authorization for this service is required.
Is this really new?
Yes, and this is good news! Limited PCS services were previously provided to some children with medical needs through the Primary Home Care Program (PHC) at the Department on Aging and Disability Services (DADS). PCS services, however, were not previously available to children with cognitive or behavioral disabilities. Children with these disabilities will now be eligible to be assessed for personal care services.
For more information, contact Colleen Horton, Public Policy Director, Texas Center for Disability Studies, colleen.horton@mail.utexas.edu or Elizabeth Tucker, EveryChild, Inc., etucker@everychildtexas.org
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