PACER Center
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PCA Assessment Tips
- Understand PCA eligibility requirements! In order to receive PCA services, applicants must already be receiving Medical Assistance (MA) or are eligible to receive MA services.
- Be prepared! Keep a record of aggressive, Level 1 behaviors and any need for assistance with ADLs.
- Gather support! Get documents from doctors, teachers, therapists, care providers, etc. that demonstrate the person’s need for PCA services.
PCA Appeals Tips
- Understand PCA eligibility requirements! In order to receive PCA services, applicants must already be receiving Medical Assistance (MA) or are eligible to receive MA services.
- Be prepared! Keep a record of aggressive, Level 1 behaviors and any need for assistance with ADLs.
- Gather support! Get documents from doctors, teachers, therapists, care providers, etc. that demonstrate the person’s need for PCA services.
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Minnesota Personal Care Assistant (PCA) Changes
Minnesota changes eligibility requirements for PCA program
-PACESETTER, Winter 2010
Minnesota’s Personal Care Assistance Program (PCA) received major cuts during the 2009 legislative session, totaling $128 million in state and federal dollars.
Because of the budget cuts, fewer people will be eligible for PCA services, and PCA service hours will be reduced an average of two hours per day for more than 6,000 persons with disabilities.
Beginning in January, there will be new requirements to receive PCA services. To receive services, a person must either be dependent in at least one activity of daily living such as dressing, bathing, or grooming, or have what is called a Level 1 behavior.
Level 1 behavior is defined as physical aggression towards self or others or destruction of property that requires the immediate response of another person.
Beginning July 1, 2011, a person must be dependent in two activities of daily living to receive PCA services.
From Jan. 1 until June 30, 2010, all recipients of PCA services will be re-assessed according to the new criteria, except for those who receive PCA services through a waiver program or the Alternative Care Program.
“You do have the right to appeal any changes to your benefits or eligibility,” says Wendy Ringer, director of PACER’s Health Information Center.
PCA Eligibility Requirements:
- Dependency in an Activity of Daily Living (ADL)
- January 1, 2010 through June 30, 2011 – person must be dependent on 1 ADL
- Starting July 1, 2011 – person must be dependent on 2 ADLs
OR
- Level 1 Behavior
Definition of Dependency and ADL:
- Dependency now requires hands-on physical assistance to complete the task or cuing and constant supervision to complete the task.
- Activities of Daily Living (ADLs) include:
- Grooming
- Dressing
- Bathing
- Transferring
- Mobility
- Positioning
- Eating
- Toileting
Definition of Level 1 Behavior:
Level 1 Behavior is behavior that requires the immediate response of another person, has occurred in the last 12 months, and involves at least one of the following:
- Physical aggression towards self
- Physical aggression towards others
- Destruction of property
PCA Reassessment:
Reassessment of PCA services for current recipients
From January 1, 2010 through June 30, 2010, all persons receiving PCA services will be re-evaluated based on the 2009 legislation for PCA services. Please see the MN Disability Law Center: PCA Changes Website and the DHS PCA 6-Month Reassessment Project website for more information. The DHS Reassessment for PCA Services website also provides information on PCA reassessment processes.
For more detailed information on the assessment process, please refer to the MN DHS Personal Care Assistance website.
Additional PCA Resources:
For more information and links about PCA changes in Minnesota, please refer to the following links:
- MN Disability Law Center: PCA Changes Web Resource
- MN Department of Human Services (DHS): Personal Care Assistance
- Check out the PCA recipient page (under construction) and the PCA policy pages
The MN Disability Law Center: PCA Change Web Resource site provides a Frequently Asked Questions on PCA page, as well as a PDF
document, which answers questions including:
- PCA eligibility
- New assessments for PCA
- Termination or reduction of PCA service
- PCA appeals process
Please see the MAZE: Insurance and Appeals document for more information on PCA appeals requirements and process.
Changes to PCA Services: 2009 Legislative Session and Governor’s Unallotment is a summary written by the MN Disability Law Center that lists exact cuts and effective dates for the PCA service program.
2009 MN Personal Care Assistance Program Statute
To learn more about PCA changes and services, contact PACER’s Family-to-Family Health Information Center at (952) 838-9000 or (800) 53-PACER, toll free in Minnesota.
PACER's site offers many PDF files for download, which require