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Can I get a Personal Care Assistant (PCA)?
The personal care assistance program provides services to you at home if you need help with day-to-day activities. A personal care assistant (PCA) is someone who is trained to help with basic daily routines.
A PCA may be able to help you if you have a physical, emotional or mental disability, a chronic illness or an injury. Having a PCA can help you be more independent in your own home.
If you have money you can pay for your PCA services, help with chores, or other home nursing needs. You may be able to connect to some of these services through the Minnesota Senior Linkage Line. Call them at 1-800-333-2433 or go online to: www.seniorlinkageline.com.
If you have a lower income or fall into certain financial categories you might be able to get PCA services paid for by the state through the Medical Assistance (MA) program. To be able to get PCA services through MA, you need to:
- Enroll with Medical Assistance (MA), Minnesota Care expanded benefits, Alternative Care or a waiver program
- Be able to make decisions about your care or have someone who is responsible for making decisions for you
- Live in a home or apartment, not a nursing home or hospital
- Meet certain rules about how much care you need
- Have a PCA assessment to see if you qualify for services
Call your county public health nurse to set up an assessment. If you are not sure who to call, the Senior Linkage Line at 1-800-333-2433 should be able to help. Ask about PCA options available, including types of agencies that provide personal care assistance services and how to hire your own staff.
For more information, contact your local county agency. If you are enrolled in a prepaid health plan, contact your health plan for specific instructions.
The assessment is done in your home once a year and takes about one hour. The assessment includes questions:
- To see if you need a responsible party
- About whether you need help to do basic activities on an average day
- About your medications
- About your health
- About your behavior
The PHN should know about what activities you need help with every day or every time you do them. For example, if you need help every time you take a shower, or a bath then tell that to the PHN. Give the PHN as much detail as you can about your health care needs or limitations. Make sure to tell the PHN about any changes in your health since your last assessment and if you think it has affected your need for PCA services.
If you don’t understand the PHN or think the PHN doesn’t understand you, tell them. Good communication is really important to get a good assessment. If English is not your native language, you may want an interpreter. If you think you need an interpreter or your interpreter is not doing a good job, let the PHN know.
After the assessment:
- You get a copy of your PCA Assessment and Service Plan within 10 days. Sometimes it’s called a MN Choices Assessment.
- You also get a service agreement letter that tells you how much PCA time you can get.
If you don’t agree with the Service Plan based on the PHN’s assessment, you can appeal the decision. There should be instructions on your assessment notice on how to appeal if your services are reduced or stopped. Follow the instructions.
In general, if your services are reduced from past years it is easier to win an appeal because the health plan/ state has the burden to prove that they have good reason to take away services. But if you are appealing and asking for more hours than you had, then that is a harder appeal to win.
How to appeal depends on if you have a managed health care plan or not. Managed health care plans are run by UCare, Medica and others.
If you have a managed care health plan:
Call them directly. Their phone number should be on your health insurance card and other health plan materials. Tell them that you want to appeal.
- You have to appeal within 60 days of the date of the assessment notice.
- If you want your benefits to continue during your appeal, you have to appeal within 10 days of getting the notice.
If you win the appeal and the health plan changes its decision, there is nothing more to do.
If you don’t win, the next step is to appeal to the state to ask a DHS Administrative Law Judge to review the health plan’s decision. You have 120 days to file an appeal to the state after your health plan makes their decision. See “Appeal Forms and Instructions” below.
If you don’t have a health plan:
You can appeal directly to the state for an appeal hearing with a DHS Administrative Law Judge. You must appeal in writing or on their website. A phone call is not enough to start an appeal with DHS.
- You have to appeal within 30 days of the date of the notice. But you can appeal as late as 90 days if you have “good cause” to appeal late. After 90 days it is too late to file an appeal.
- If you want to keep getting benefits during your appeal, you have to appeal within 10 days of getting the notice.
A DHS Judge reviews your case and sets a date for a telephone or in-person hearing where you can explain your side of things to the judge.
There are different ways you can get your appeal in to the state:
- Click on the “How do I” box towards top of page
- Under “Find” click on “edocs and forms”
- Click your language
- Type 0033 in the search bar
There are instructions and the form. Read everything carefully, fill the form out completely and click "Submit" on the bottom right. It is a good idea to print a copy for yourself. You can also print the blank form if you want to fill it out by hand.
By mail or fax: You can also get the form from the county. If you don’t want to use a form it is okay to just write a letter and mail or fax it.
Make sure you put these things in your letter:
- Say you want to appeal the reduction in your PCA hours and why.
- Ask to keep getting your benefits during the appeal process.
- If you want an in-person hearing, write that in the appeal. Otherwise your hearing will be scheduled to be held over the phone.
- If you need an interpreter, ask for one and say what language.
Make sure you put your case number and the date on your letter. Keep a copy for yourself. Give the letter to your county worker or mail or fax it to:
Minnesota Department of Human Services Appeals Office
PO Box 64941
St. Paul, MN 55164-0941
Phone: 651-431-3600 Fax: 651-431-7523
You get a notice of the hearing date from a Human Services Judge. If you need more time to get ready, ask the judge for a "continuance." The phone number for the judge is printed on the hearing notice.
Submit copies of your recent medical records to the judge. You can send them by fax or by letter addressed to the judge. If you are having your hearing in person you can bring your papers to the hearing. You have the right to get copies of your medical records at no cost. Ask your doctor for copies.
If you are appealing a reduction of your PCA hours, it is a good idea to submit copies of your previous PCA assessments. Your PCA agency should have copies of the old PCA assessments. Your health plan should have them too. Make sure you send copies of anything you send or show the judge to your health plan also.
You and any witness you have testify at the hearing about the daily hands-on help you need to complete your activities.
After the hearing, you get a written decision from the judge. If the judge rules against you, you can ask for “reconsideration,” or you can appeal the judge’s decision to the District Court in the county where you live. The written decision has instructions on how to appeal.
- type “appeal FAQ” in the search bar
- click on “FAQ about state appeal hearings”