Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Service Criteria


Covered personal care services include assistance with activities of daily living (e.g., bathing, dressing, grooming, toileting), assistance with housekeeping, shopping and meal preparation, accompanying the recipient to medical appointments, and providing assistance with medically oriented tasks that are assigned to a trained personal care worker supervised by an RN.

To be eligible for personal care, an individual's physician must provide a written order that such services are medically necessary. Services must also be based on a plan of care and supervised by a Registered Nurse. Amounts over 50 hours per year must be pre-authorized.

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