Overview of Nevada Medicaid Personal Care Services Program
Nevada’s Personal Care Services Program, or PCS Program, is a statewide Medicaid program that assists persons of any age with disabilities or chronic conditions, including those related to aging, in living independently. Intended to delay unnecessary nursing home admissions, in-home assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is provided. This includes activities such as bathing, grooming, mobility, eating, light housecleaning, shopping for essentials, and laundry.
Persons can reside in their own personal home or the home of a loved one and receive benefits via the Personal Care Services Program. Program beneficiaries cannot live in group residential facilities.
While personal care services can be received through a provider agency, program participants have the option to self-direct their care. This allows program participants to select and manage the personal care assistant (caregiver) of their choosing. While friends, and some relatives, such as an adult child, can be hired as the caregiver, persons who are legally responsible for the program participant cannot be hired. As a result, spouses, legal guardians, and parents of minors, cannot be paid to provide care. An Intermediary Service Organization (ISO) handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments.
Nevada’s PCS Program is an entitlement; meeting eligibility requirements ensures one will receive program benefits. In other words, there is never a waiting list to receive personal care services.
The Personal Care Services Program is part of Nevada’s Regular State Plan Medicaid program. For persons over 65 years old, the state Medicaid program is called Medical Assistance to the Aged, Blind and Disabled (MAABD).
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. Put differently, meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of the Personal Care Services Program
While the exact services one can receive assistance with is based on their functional assessment service plan (FASP), persons may receive assistance with the following activities.
– Basic Housecleaning
– Bathing
– Continence Care
– Dressing
– Eating
– Grooming
– Laundry
– Meal Preparation
– Mobility
– Shopping for Essentials
– Toileting
– Transferring (i.e., from a chair to a wheelchair)
Eligibility Requirements for NV’s Personal Care Services Program
Nevada’s PCS Program is for NV state residents of any age with a chronic condition or disability. The applicant must not have a spouse or a parent (if the applicant is a minor) who is available and able to provide them with the personal care assistance they require. The following criteria is relevant for seniors aged 65 and over.
Financial Criteria: Income, Assets & Home Ownership
Income
The income limit for a single applicant is equivalent to 100% of the Federal Benefit Rate (FBR) for a household of one. This figure increases each January, and in 2024, is $943 / month. When an applicant is married, regardless of whether or not their spouse is also an applicant, there is a couple income limit of $1,415 / month. This figure is equivalent to 100% of the FBR for a household of two.
Assets
In 2024, the asset limit for a single applicant is $2,000. For married applicants, with one or both spouses as applicants, the asset limit is $3,000.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is thought this rule is not relevant for Nevada’s Personal Care Services Program.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Nevada Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant’s spouse resides in the home.
– The applicant has a dependent relative living in the home.
Learn more about the potential of Medicaid taking the home here.
Medical Criteria: Functional Need
Many Medicaid long-term care programs require an applicant need a Nursing Facility Level of Care (NFLOC), but this is not the case for Nevada’s Personal Care Services Program. While the level of care need requirement is lower, the need for care must be “medically necessary”. This is determined by a functional assessment completed by a physical or occupational therapist. An inability to complete one’s Activities of Daily Living (bathing, dressing, grooming, toileting, transferring [i.e., from a chair to standing], mobility, eating) and Instrumental Activities of Daily Living (laundry, meal preparation, light housecleaning) is generally indicative of assistance being “medically necessary”.
While it is common for persons with Alzheimer’s Disease or a related dementia to meet the level of care need, a diagnosis of dementia in and of itself does not mean one will automatically be functionally eligible.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for NV Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Utilizing Miller Trusts, often called Qualified Income Trusts, is a common strategy used to lower an applicant’s monthly countable income for long-term care Medicaid eligibility. Essentially, “excess” income is deposited into the trust, no longer counting as income. Miller Trusts, unfortunately, are not permitted for applicants to become income-eligible for the Personal Care Services Program.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid-Compliant Annuities, which turn countable assets into a stream of income, is another option. There are many other planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Nevada to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply to Nevada’s PCS Program, some persons will require more extensive care in the future, such as home and community based services via a Medicaid Waiver or Nursing Home Medicaid. For these programs, the Look Back Rule is relevant, and violating it results in a Penalty Period of Medicaid ineligibility. While there are many Medicaid planning strategies, they should only be implemented with careful planning well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for the Personal Care Services Program
Before You Apply
Prior to applying for Nevada’s PCS Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, prior bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
To apply for Nevada’s Personal Care Services Program, persons must first be a Nevada Medicaid recipient, or in other words, a recipient of Medical Assistance to the Aged, Blind and Disabled (MAABD). Persons can apply online at Access Nevada, or alternatively, complete and submit a paper “Application for Assistance” to one’s district Division of Welfare and Supportive Services (DWSS) office. Contact information for northern DWSS offices can be found here, and southern DWSS offices, here. DWSS offices can also provide application assistance and / or answer Medicaid eligibility questions.
Persons who are already enrolled in Nevada Medicaid should call the Medicaid prior authorization call center at 800-525-2395 (option 1, followed by option 4) to request an assessment for personal care services.
Learn more about the Personal Care Services Program here.
The Personal Care Services Program is administered by the Nevada Department of Health and Human Services Division of Health Care Financing and Policy (DHCFP). The Division of Welfare and Supportive Services (DWSS) determines financial eligibility.
Approval Process & Timing
The Medicaid application process in Nevada can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.