Medicaid self-directed care
Self-Directed Community First Choice Services and Personal Care Services (SD-CFCS/PCS)
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- Who qualifies
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People who are eligible for Medicaid, need help with one or more activities of daily living because of a medical condition, have services authorized by the state's utilization review contractor, have the ability to direct services authorized by a health care professional, and can understand and make complex care decisions (or have a personal representative who can). For Community First Choice Services you must also meet nursing home level of care.
You or your personal representative hire, train and manage your personal care attendant. The provider agency handles payroll, taxes and pre-employment checks.
- Can a family member be paid
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Yes. Yes. Adult children and other relatives may be eligible to be paid as a personal care attendant under CFCS/PCS.
- Can a spouse be paid
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Depends. Only under Community First Choice Services, and only if the spouse meets the rules for a legally responsible individual: the care must exceed what is normally expected of a spouse, and the state must find that using the spouse is necessary for the person's health and welfare or to avoid a move to a nursing home. A spouse cannot be paid under Personal Care Services alone.
A paid spouse cannot also be the person's personal representative, and cannot be paid for general household tasks that benefit the whole family. Someone on a Personal Care Services only plan who wants to hire a spouse must ask for a re-screening to see if they now meet nursing home level of care.
- Hours limit
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Paid legally responsible individuals, such as a spouse, are generally capped at 40 hours per week.