Personal Care Services (PCS) is a Medicaid benefit for Vaya Total Care members who need help with activities of daily living, called ADLs. These activities are things like bathing, dressing, using the bathroom, eating, and doing light housework.
Am I eligible for PCS?
To qualify for PCS, you will need to meet with a nurse who will talk to you about how much help you need. This is called an assessment. To request an assessment, your provider will need to complete a referral called a Request for Independent Assessment for Personal Care Services: Attestation of Medical Need Form.
During the assessment, the nurse will ask what you need help doing and if anyone helps you with those things. After the assessment, Vaya will review the information to find out if you are eligible for PCS. If you are, we will see how many hours of help you need. We will also help you find a PCS provider in your area.
How to request additional PCS hours?
If you are at least age 18 and you receive a PCS authorization for fewer than 80 hours per month, you may request additional PCS hours by completing a Request for Reconsideration Form and emailing it to VayaStatePlanPCS@vayahealth.com or faxing the form to 828-707-9349. Please do not submit the request earlier than 31 days, or later than 60 days, after you receive the approval notification.
What if PCS is not right for me?
If PCS is not right for you, we will send you a letter to let you know. We will help you find the support you need through other programs.
To learn more, talk to your doctor about sending us a referral form. You or your doctor can also call us at 1-877-290-6315 for more information.
