Qualifications for Medicaid's Long-Term Personal Care Services

Article Submitted by Lori Baltrukevich with ComForcare Senior Services.
For more information, she can be reached at 985-781-6619.

Who is eligible? Medicaid recipients who are either:

• 65 years of age or older, or
• 21 years of age or older with disabilities (Disabled is defined as meeting the eligibility criteria established by the Social Security Administration for disability benefits.)

These individuals must also:

• meet the requirements for nursing facility of care, AND
• be able to direct their care independently or through a responsible representative, AND
• meet one of the following criteria:

• be in a nursing facility and be able to be discharged if community-based services are available, OR
• be likely to require nursing facility admission within the next 120 days, OR
• have a primary care-giver who has a disability & is over the age of 70, OR
• face a substantial possibility of deterioration in mental or physical condition or functioning if either home and community-based services or nursing facility services are not provided in less than 120 days.

What are personal care services?
Personal care services are those services that provide assistance with activities of daily living and instrumental activities of daily living. They may be either the actual performance of the personal care task for the individual or supervision and prompting so the individual performs the task by him/herself. They include tasks such as

What is not covered under personal care services?
Personal care services ARE NOT to be used for