State Plan Personal Care Services (PCS) is a Medicaid benefit for eligible members of the Vaya Health Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan. These services help members who require assistance with Activities of Daily Living (ADLs), including bathing, dressing, toileting, eating, and transferring/functional mobility in the home.
Members must participate in an independent assessment to determine PCS program eligibility. To request a PCS Independent Assessment (e.g., new request, change of status, change of provider, or disenrollment), providers should complete and submit the Request for Independent Assessment for Personal Care Services and Attestation of Medical Need Form.
Any member referred to or seeking admission to an Adult Care Home licensed under N.C.G.S. § 131D-2.4 must be referred to Vaya for the Referral Screening Verification Process (RSVP). Members living in an Adult Care Home will not receive a PCS assessment or prior approval without verification of a Referral Screening Identification. If you have questions about your role in this process, contact Vaya’s Diversion RSVP Manager at 1-800-893-6246, ext. 6564.
PCS resources
- NC Medicaid: PCS Information
- NC Medicaid Program Specific Clinical Coverage Policies (CCPs) (CCP 3L, State Plan Personal Care Services)