What is Personal Care Option?
The Medicaid Personal Care Option Program (PCO) is for qualified individuals that meet the following criteria:
- Must be 21 years of age
- Must be eligible for a full coverage Medicaid program
- Must meet medical necessity regulations
- Under Centennial Care, each member must choose a MCO (Managed Care Organization/Insurance Company). Each member will have access to Care Coordination services and will receive a Health Risk Assessment (HRA) that will help members work together with their MCO to create a Care plan. This HRA is a telephone call from their MCO. If the HRA shows that the member has medical, behavioral health conditions or long-term-care needs that require a higher level of Care Coordination, the member will receive a Comprehensive Needs Assessment (CNA). The CNA will be completed in the members residence.
The PCO program offers a range of services to Members who are unable to perform some or all activities of daily living because of a disability or functional limitation.
PCO services permit members to live in his or her home rather than at an institution and allow him or her to maintain or increase their independence.
Why does The Personal Care Option program have the word “Option” in it?
The program has the word “Option” in the title because Members have an option of two different service delivery models.
The two models are:
Member-Directed model and the Member-Delegated model.
In both models the Member:
- May pick an attendant, which may be a family member
- Must work with a Medicaid approved provider
- Remains in the community and maintains their independence
In both models the provider is responsible for:
- Submitting all billing to Medicaid
- Making sure that all attendants have passed a Caregiver Criminal History Screening test