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Medicaid Can Pay for a Direct Care Provider for Your Child
Personal Care Services are a Medicaid benefit meant to help you care for your child with special needs in your home. Personal care services assist a child or adult with daily living activities at home including: Bathing, Dressing, Feeding, Laundry, Light Housekeeping, Meal Preparation and Toileting.
Eligibility
To be eligible for personal care services, your child must have a ForwardHealth card and need services for medical or disability related reasons. And, Medicaid must approve your child’s care plan before services can begin.
Starting the Medicaid Process:
1st: Have your child’s primary care provider write a prescription and document that these services are medically necessary. To find a personal care agency in your area ask your child’s clinic or service coordinator or see the Consumer Guide to Choosing a Personal Care Agency dhs.wisconsin.gov/guide/pca.htm.
2nd: Contact the personal care agency to set up an in-home visit. The agency will use a screening tool to decide if your child needs services and, if so, the number of hours Medicaid will cover each week.
Be Realistic! Before your child’s evaluation, think about all the things you do for your child and how much time these tasks take. You know your child best and your input is very important in this process.
3rd: After your child’s eligibility has been confirmed, a personal care agency representative will meet with your family to make a care plan. The agency will also complete prior-authorization paperwork and contact your child’s doctor so Medicaid covers the cost of these services.
Tip for Families:
Contact your personal care agency to request an evaluation for more personal care hours if your child’s health or medical needs change. For example, a child who has been hospitalized and has wound care needs may qualify for more personal care hours.
What if Our Personal Care Agency Can’t Find Workers for My Family?
Many agencies in Wisconsin cannot recruit or retain enough qualified workers to meet the needs of every family who has a child eligible for personal care. In this case some agencies rely on families to find their own workers. Here are a few ideas to help you find a worker:
- Talk with your child’s school. School aides or other paraprofessionals often want to work extra hours, especially during summer months.
- Connect with a local university or technical college. Students in health programs like nursing and therapy, social work, or education are good candidates.
- Ask respite providers, babysitters, summer camp counselors or after-school program staff.
- Talk with other parents. They may know someone in your area.
If a child is under age 18, a parent or guardian cannot be paid by Medicaid to provide personal care services. However, when a child turns 18, a parent or guardian can be employed to provide these services. This is a good option for families who have a hard time finding personal care workers.
Is “Personal Care” the Same as “Respite”?
No. The main difference is that respite care is meant to give you time off from your care giving duties to unwind, while personal care is like having a helper, in your home with you, to do some of your child’s daily living activities. Some families may qualify for both programs. It depends on your child’s care needs.
Do Personal Care Services Have to be Provided in Our Home?
Yes. Medicaid requires that your child receives personal care services in your home. Personal care staff are not allowed to work with your child at school or out in the community.
Still Have Questions? Need Help Finding Services?
- Regional Centers for Children and Youth with Special Health Care Needs dhs.wisconsin.gov/cyshcn/index.htm
- Well Badger Health Resource Center wellbadger.org or call 800.642.7837