MEDICAID "PERSONAL CARE SERVICES"

Personal Care Services-a service designed to help people unable to perform some activities of daily living to remain in their homes-has been added to New Mexico's Medicaid program. Although the coverage was added effective September 1, actual availability of services has been sluggish due to delays in enlisting agencies needed to help provide the services.

The new services are available only to individuals who are eligible for regular, full-scope Medicaid. In addition, individuals must be found to have a level of care need that would qualify them for nursing home placement. Applicants for this new service must be 21 or older, however personal care services are already coverable for individuals under age 21 through Medicaid's "EPSDT" coverage.

According to the state's new Personal Care Services regulations, services consist of a "prescribed course of regular personal care services and daily living assistance [which] permits a person to live in his or her home rather than an institution and allows him or her to achieve the highest possible level of independence." Services-which are specified for each individual in an approved plan of care--include dressing, bathing, grooming, meal preparation/assistance, household services, transporting, shopping, cognitive assistance, communicating and cuing. Eligible individuals must be unable to perform some or all activities of daily living (ADLs) or independent activities of daily living (IADLs) due to disability or functional limitations, including cognitive impairments.

Individuals have the choice of receiving the services under either a "Consumer-Directed" or "Consumer-Delegated" option. Under the Consumer-Directed option, the individual will retain much greater control over the hiring, training, scheduling and supervision of their personal care worker. However, all eligible individuals will have to work with a personal care agency, which helps with establishing eligibility and plans of care, as well as some or all "employer" functions. As mentioned, implementation of the services was slow to start because of initial lack of availability of such agencies. As of November, only four personal care agencies had begun accepting applicants-in the Albuquerque, Santa Fe, Clovis, and Hobbs areas. The state's Medicaid agency is making special efforts to recruit more, statewide.


Family members-other than spouses, or the parent of a minor--can serve as personal care workers. Unfortunately, the federal laws authorizing Personal Care Services prohibit spouses and the parents of eligible minors from serving.

Medicaid beneficiaries interested in obtaining Personal Care Services should request them from their Salud! managed care plan. If they are not enrolled with Salud! they should contact a participating personal care agency. Beneficiaries can use their own physicians to perform necessary medical assessments. For updated information on services availability, individuals can call the Medicaid agency's toll-free number-1-888-997-2583-and ask to be transferred to Doyle Smith or Angela Medrano.

Adoption of Personal Care Services was strongly supported by a broad range of persons with disabilities and their advocates, whose participation in the development of rules and policies for the services was instrumental to the inclusion of many of the expansive and consumer-centered features.