North Carolina Medicaid Personal Care Services (PCS) Eligibility Guide
If you are seeking North Carolina home care services through Medicaid Personal Care Services (PCS), it’s important to understand the eligibility requirements and application process. Below is a clear breakdown of who qualifies, how to apply, and who can submit referrals.
Who Qualifies for North Carolina Medicaid Personal Care Services (PCS)?
To qualify for North Carolina Medicaid PCS, you must meet three core requirements:
- Have a qualifying medical condition, disability, or cognitive impairment
- Demonstrate a need for assistance with Activities of Daily Living (ADLs)
- Meet general North Carolina Medicaid eligibility requirements including income and household size.
1. Meet the Medical and ADL Requirements
✔ Medical Condition Requirement
You must have a documented medical condition, disability, or cognitive impairment that supports the need for personal care assistance.
✔ Activities of Daily Living (ADL) Requirement
To qualify for PCS in North Carolina, you must require hands-on assistance with Activities of Daily Living (ADLs), such as:
- Eating
- Dressing
- Bathing
- Toileting
- Mobility
You must:
- Need assistance with at least two (2) ADLs
- Have at least one ADL requiring extensive or full dependence assistance
These requirements help determine eligibility for in-home personal care services under Medicaid.
2. Meet North Carolina Medicaid Eligibility Requirements
In addition to medical and ADL qualifications, you must meet general North Carolina Medicaid eligibility guidelines, including:
- Household income
- Family/household size
Eligibility details can be reviewed on the official NC Medicaid website.
How to Apply for North Carolina Medicaid PCS
If you believe you or your loved one qualifies for Medicaid home care services in North Carolina, here are the next steps:
1. Visit the NC Medicaid Website
Go to Medicaid.NC.gov to:
- Check eligibility
- Apply for Medicaid services
- Review program details
2. Contact the Enrollment Broker
You may need to contact the enrollment broker for:
- Additional information
- Assistance with selecting a health plan
3. Contact Your Local Department of Social Services (DSS)
North Carolina residents can contact their local DSS office to:
- Learn about specific Medicaid programs
- Apply for services
- Receive eligibility guidance
4. Contact A Primary Choice
You may also contact A Primary Choice, Inc. using the contact information provided in this email and/or referral form.
A representative will gladly guide and assist you — and/or the Medicaid beneficiary — through the application process.
Basic information required includes:
- Name
- Medicaid Number
- Date of Birth
- Other identifying details as needed
Who Can Make Referrals for North Carolina Medicaid PCS?
Referrals for North Carolina home care services under Medicaid PCS can be made by:
CAP Case Managers
- CAP Case Management Entities (CME’s)
- CAP/C
- CAP/DA
Healthcare Professionals
- Hospital Case Managers
- Discharge Planners
- Social Workers (County DSS, Skilled Nursing Rehab Centers, Dialysis Centers, etc.)
- Referral Coordinators
- Office Managers or RNs at:
- Primary Care Offices
- Neurologists
- Pediatricians
- Senior Primary Care practices
Managed Care Organizations (MCOs)
Case Managers, Nurses, or Care Managers from:
- Trillium Health Resources
- Vaya Health
- Partners Health Management
- Alliance Health
Medicaid Standard Plan (PHP) Case Managers
- AmeriHealth Caritas North Carolina
- Carolina Complete Health
- Healthy Blue North Carolina
- UnitedHealthcare Community Plan of North Carolina
- WellCare of North Carolina
Additional Referral Sources
- Advocacy groups serving seniors and/or children with NC Medicaid
- Family members whose loved one has a North Carolina Medicaid number and an obvious need
- Home health care agencies (skilled/therapy services)
- Non-skilled home care agencies
- Senior center managers/directors