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Minnesota Personal Care Assistant (PCA)

Medical Assistance (MA) under the TEFRA option allows MA eligibility for children with disabilities in families with incomes too high to qualify for MA. TEFRA is short for the Tax Equity and Fiscal Responsibility Act, the federal law that set the rules for this option.

What are PCA services, and is my child eligible?

Personal Care Attendant (PCA) services allow an individual to come into your home and assist your child who has a disability. In order to receive PCA services, your child must be in a managed care plan through Minnesota Assistance (MA) or be certified as disabled by the state and on either MA disability or TEFRA.

How do I get PCA coverage for my child?

If your child is on MA and meets the PCA criteria, PCA services can be obtained through your managed care insurance company. In this circumstance, you would contact your insurance company and request an evaluation for PCA services.

• Directory of MN health plan member services phone numbers

Alternatively, you can have your child assessed for disability by contacting your county and requesting a MnCHOICES Assessment. An assessor will collect information for the State Medical Review Team (SMRT), which provides the disability certification. This allows children already on MA to receive disability services and those not on MA to qualify for MA through the TEFRA option. Both options make PCA services available to children if they meet the PCA criteria during their MnCHOICES Assessment. It is possible for children to be certified as disabled, but NOT qualify for PCA services.

How many PCA hours will I receive?

The amount of time given to each child is based on dependencies in Activities of Daily Living (ADLs), which include feeding, toileting, bathing, hygiene, dressing, mobility, and transfers. Dependency means that a caregiver must provide hands-on assistance or constant, continuous cues to complete a given activity. Severe, level 1, behaviors are also considered, as well as other medical circumstances. (To learn more about ADLs, and how to advocate during the assessment, see PACER’s handout “Personal Care Assistants: Getting the Help You Need”.

Notice and appeals

Once the assessment is completed you will receive a notice within 10 business days informing you of the amount of time your child has been approved for. If you disagree with the assessment, you have 30 days to file an appeal. Your appeal needs to be based on the ADLs that were not assessed as “dependencies” or other qualifying information that was not considered. The appeal cannot be based on an expectation of more time or because of challenging behaviors.  Staff from PACER’s Health Information Center and the MN Disability Law Center recently presented “PCA Services: Assessment, Eligibility and Appeals.” A Power Point of the presentation is available here.

Flexible scheduling of PCA hours

PCA hours are flexible and can be used in a manner that best meets your family’s needs. You will be given a number of units for a six-month time period. One unit is 15 minutes. Simple calculations will allow you to determine how many hours per day or week (seven-day period) your child will receive. PCA hours are granted one year at a time, in two six-month periods. The total amount of time must be used within each six-month period. Any unused time will be forfeited. If you exceed the allotted time, you will be charged for any excess time used. This means that you can conserve hours to be used during school vacations or on weekends if they occur within the allotted six-month period. 

For example: You receive a notice in March that your child qualifies for 12 units of PCA care each day, or three hours per day, equivalent to 21 hours per week. The child attends an aftercare program during the school week but has no structured activities on the weekend. You could choose to use your hours as 10.5 hours each weekend day to cover Saturday and Sunday. Alternatively, you could choose to cover five hours per weekend day and reserve the remaining 11 hours each week to be used during the approaching summer break. You are given the flexibility to schedule PCA care during times that work for your family.

Hiring an agency

The next step requires you to hire a PCA agency. Agencies tend to serve a certain population or area, so there are many questions to consider.

First, do they serve children?  Most agencies serve either children or adults. 

Second, the location of the PCA agency may be a factor, as many agencies tend to draw from the area near where they are located. This is at least a point worth discussing. 

Most importantly, you will be asked to choose between two types of delivery systems for PCA, known as Traditional PCA or PCA Choice.

The first option is Traditional PCA. In this circumstance, the agency performs all the duties of hiring PCAs. They provide advertising, background checks, hiring, training, and payroll services. They will also provide specific training on your child’s needs and develop a care plan for your child. Once the agency identifies a potential candidate, they are referred to you to interview and determine whether they are the right fit for your child and your family.

The second option is PCA Choice. In this instance, the agency provides a background check and some basic training on paperwork and payroll services. You do the advertising, preliminary screening, hiring, and firing. You are responsible for teaching the PCA the details about your child and how to manage their needs. This works well if you know someone personally who would be a good fit for your child and family, or if you want to take a more active role in choosing your PCA. PCAs in this arrangement are generally paid better as the agency receives a smaller amount for the services they provide. 

You must choose one approach or the other. You either provide the PCAs to the agency or they provide them to you. If you have traditional PCA and you meet someone who might be a good fit, you must refer them to the agency for hire. There is no situation where the county or state will reimburse PCA care directly to you or the PCA, as all funds must go through a third party. In the case of a Consumer Support Grant (CSG) or Consumer Directed Community Support (CDCS), you are required to hire Financial Management Services to be the intermediary to receive the funds from the county and provide payroll services for your grant or CDCS. 

Here is the provider directory where you can find a PCA agency by choosing PCA on the first page and typing in your zip code or county (for a broader selection) on the next page.

Agency responsibilities

Once a PCA agency has been identified, they will interview you and your child. They are responsible for identifying a “responsible party” when a minor or young adult is not able to be responsible for managing their own PCA services. They will then write a care plan and set up goals, based on the completed assessment. They will also ask you what kind of person you would like hired and who would be most appropriate to meet your child’s needs. 

The agency is responsible for background checks on all applicants and confirming that the applicant has passed the online assessment and is enrolled with DHS as a provider. They are also responsible for providing training and will have agency paperwork that the PCA will need to fill out on each visit. In traditional PCA, the agency will also provide the advertising, hiring, and training. Once they have identified a candidate, described your child’s condition, and determined that the PCA is comfortable with the situation, you will set up an interview to determine if the candidate is right for you and your family. The agency is also responsible for providing a qualified professional (QP) who will act as a supervisor to the PCA and ensure that all rules and regulations are being followed appropriately.

Other options

If your child is on a waiver, you can choose to apply for Consumer Directed Community Supports, a program that allows you to provide PCA-like services for your child. If the child is on straight MA, parents have the option to write a Consumer Support Grant, which also allows them to be a parent provider.

PCA reassessments

PCA reassessments occur annually and involve an assessor determining if there have been any changes in your child’s condition. This can result in either an increase or decrease in the PCA hours, depending on improvement, lack of progress, or deterioration that has occurred over the past year. If the child has a significant event during the year, such as a major surgery or a crisis that changes their condition, a PCA reassessment can be requested sooner by contacting your county disability services office, or case manager. Remember, you have the right to appeal, within 30 days, if you disagree with the reassessment.

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Due to the COVID virus, many accommodations have been made to protect individuals while still maintaining services. For more information about these changes, read this MN Department of Human Services document.

It is not known whether these changes will be permanent or temporary.

The current PCA program is undergoing changes expected to be implemented over the next few years. There is a task force at the state level currently reevaluating the program. Once finalized, changes will be implemented at the time of your renewal or when you apply for new services. We will keep you posted as we learn of modifications to the program. Visit Community First Services and Supports to learn more.

To learn more about PCA changes and services, contact PACER’s Health Information Center by calling (952) 838-9000 or email [email protected].