Medicaid Benefits: Personal Care Services

This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.

2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 34 No - 17 NR - 0	2018 data limited to CN	Yes - 2	Yes - 20	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	No				-	-
Alaska	Yes	CN	Depends on income	Prior authorization required	-	-
Arizona	No				-	-
Arkansas	Yes	CN	NR	NR	-	-
California	Yes	CN	No	Plan of care required; 283 hours/month in the home, at place of work or community based adult services as appropriate.	-	-
Colorado	No				-	-
Connecticut	No				-	-
Delaware	Yes	CN	NR	NR	-	-
District of Columbia	Yes	CN	No	Require PA; Requires an assessment to determine the number of hours	-	-
Florida	Yes	CN	NR	NR	-	-
Georgia	No				-	-
Hawaii	No				-	-
Idaho	Yes	CN	No	No	-	-
Illinois	No				-	-
Indiana	No				-	-
Iowa	No				-	-
Kansas	Yes	CN	No	Limited to 12 hours per 24 hour period.	-	-
Kentucky	No				-	-
Louisiana	Yes	CN	No	Services authorizations may need exceed 32 hours per week	-	-
Maine	Yes	CN	$.50 to $3/day depending on payment amount, up to $30/month	No	-	-
Maryland	Yes	CN	No	Pre-authorize based on level of care	-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	Yes	CN	No	Medical necessity	-	-
Minnesota	Yes	CN	No	No	-	-
Mississippi	No				-	-
Missouri	Yes	CN	No	No	-	-
Montana	Yes	CN	No	40 hour weekly limit (excluding medical escort)	-	-
Nebraska	Yes	CN	No	Personal assistance services provided by a legally responsible relative are not reimbursable	-	-
Nevada	Yes	CN	No	Prior authorization required	-	-
New Hampshire	Yes	CN	NR	NR	-	-
New Jersey	Yes	CN	No	40 hrs per week	-	-
New Mexico	Yes	CN	No	No	-	-
New York	Yes	CN	NR	NR	-	-
North Carolina	Yes	CN	No	State Plan Personal Care Services limits services for adults to 80 hours per month unless they have a degenerative disease characterized by an irreversible memory dysfunction etc. they could qualify for up to an additional 50 hours with the max for adults being no more than 130 hours per month. Children (beneficiaries under 21) per policy are limited to 60 hours per month however are provisioned under EPSDT and may receive additional hours through EPSDT.	-	-
North Dakota	Yes	CN	No	300 hours per month in the home or at other sites as medically appropriate	-	-
Ohio	No				-	-
Oklahoma	Yes	CN	No	Covered as prescribed in treatment plan.	-	-
Oregon	Yes	CN	No	Personal care services are limited to 20 hours per month. Individuals whose assessed need exceeds the 20 hour limit may receive approval for additional hours through a prior approval process.	-	-
Pennsylvania	No				-	-
Rhode Island	Yes	CN	No	No	-	-
South Carolina	No				-	-
South Dakota	Yes	CN	No	500 hours annually	-	-
Tennessee	No				-	-
Texas	Yes	CN	NR	NR	-	-
Utah	Yes	CN	No	Limited to 60 hours per month.	-	-
Vermont	Yes	CN	NR	NR	-	-
Virginia	No				-	-
Washington	Yes	CN	No	Prior authorization required	-	-
West Virginia	Yes	CN	No	Member can receive up to 210 hours per month of Direct Care Worker Services based on assessed need	-	-
Wisconsin	Yes	CN	No	Prior approval required after 50 hours of service, per calendar year	-	-
Wyoming	No				-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 31 No - 25		Yes - 1 No - 30
Alabama	No
Alaska	Yes	CN		Coverage based on functional assessment, services provided in and outside of the home as necessary	Yes	Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN & MN		Plan of care required; 283 hours/month in the home, at place of work or community based adult services as appropriate	Yes - county must authorize	Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, 16 hours/week; necessary services may be in the home or in a board and care or assisted living facility but not in the work place	Yes	Hourly rates based on nursing facility and ICF/MR wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	No
Kentucky	No
Louisiana	Yes	CN & MN		Nursing facility LOC must be met including need for assistance with at least 1 ADL, limited to 32 hours/week	Yes	Fee for service
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $5/month	Level of care criteria must be met, services limited by monetary caps	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for level of need
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement; coverage limited to place of residence		Fee for service with payment ceiling at monthly nursing facility cost cap
Montana	Yes	A - See state-specific FN		40 hours/week		Negotiated rate per 15-minute unit
Nebraska	Yes	CN & MN		40 hours/week, personal assistant services not covered during institutionalization or for persons residing in assisted living facilities or other licensed residential settings	Yes	Fee for service
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN		Care plan must be developed by RN, beneficiary must be chronically wheelchair bound and able to select and direct attendant, services limited to the home or work site if medically appropriate		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant up to 40 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week, service covered in group homes but not in assisted living	Yes	Fee for service using hourly rates
New Mexico	Yes	CN		A - this benefit is not covered	Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN; services available outside the home if specified in care plan	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		Up to 80 hours/month in beneficiary's residence based on documented unmet needs under established clinical criteria	Yes	Fee for service based on 15-minute units
North Dakota	Yes	CN & MN		300 hours/month in the home or at other sites as medically appropriate	Yes	Fee for service
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN			Yes	Fee for service
Oregon	Yes	A - See state-specific FN			Yes	Established hourly rate based on level of care or negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months, may be provided at place of employment in addition to home if specified criteria are met		Cost based payment
Tennessee	No
Texas	Yes	CN & MN		Care limited to 50 hours/week in home, board and care facility or work place with limits	Yes	Fee for service using quarter hour or hourly rates
Utah	Yes	A - See state-specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate or daily rate depending on setting
West Virginia	Yes	A, B & C		60 hours/month unless additional coverage authorized, nursing assessment every 6 months		Fee for service
Wisconsin	Yes	CN & MN		50 visits/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 31 No - 25		Yes - 1 No - 30
Alabama	No
Alaska	Yes	CN		Limited to 8 hours/day or 35/week in and outside of the home as necessary		Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN		Plan of care required; 283 hours/month in the home, at place of work or adult day health care center as appropriate	Yes - county must authorize	Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, 16 hours/week; necessary services may be in the home or in a board and care or assisted living facility but not in the work place	Yes	Hourly rates based on nursing facility and ICF/MR wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	No
Kentucky	No
Louisiana	Yes	CN & MN		Nursing facility LOC must be met, limited to 32 hours/week, services provided outside the home must meet specified criteria	Yes	Fee for service
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $5/month	Level of care criteria must be met, services limited by monetary caps	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for level of need, services provided through mental health system capitated
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement; coverage limited to place of residence		Fee for service with payment ceiling at monthly nursing facility cost cap
Montana	Yes	A - See state-specific FN		40 hours/week		Negotiated rate per 15-minute unit
Nebraska	Yes	CN & MN		40 hours/week, personal assistant services not covered during institutionalization or for persons residing in assisted living facilities or other licensed residential settings	Yes	Federal minimum hourly wage, increased following training or licensure
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN		Care plan must be developed by RN, beneficiary must be chronically wheelchair bound and able to select and direct attendant, services limited to the home or work site if medically appropriate		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week, service covered in group homes but not in assisted living	Yes	Fee for service using hourly rates
New Mexico	Yes	CN		A - this benefit is not covered	Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN; services available outside the home if specified in care plan	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Yes	Fee for service based on 15-minute units
North Dakota	Yes	CN & MN		300 hours/month in the home or at other sites as medically appropriate	Yes	Fee for service
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN			Yes	Fee for service
Oregon	Yes	A - See state-specific FN			Yes	Established hourly rate based on level of care or negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	See state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months, may be provided at place of employment in addition to home if specified criteria are met		Cost based payment
Tennessee	No
Texas	Yes	CN		Care limited to 50 hours/week in home, board and care facility or work place with limits	Yes	Fee for service using quarter hour or hourly rates
Utah	Yes	A - See state-specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate or daily rate depending on setting
West Virginia	Yes	A, B & C		60 hours/month unless additional coverage authorized, nursing assessment every 6 months		Fee for service
Wisconsin	Yes	CN & MN		50 visits/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 31 No - 25		Yes - 1 No - 30
Alabama	No
Alaska	Yes	CN		Limited to 8 hours/day or 35/week		Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members - see state-specific FN	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN		Plan of care required, 283 hours/month		Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		Services limited to Enhanced Plan and Medicare/Medicaid Coordinated Plan, 16 hours/week	Yes	Hourly rates based on nursing facility and ICF/MR wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	No
Kentucky	No
Louisiana	Yes	CN & MN		Medical criteria for nursing facility placement must be met, 56 hours/week	Yes	Fee for service
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	2-4 hours/week based on specified LOC criteria, assistance with IADLs dependent on need	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for LOC
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement		Fee for service with payment ceiling at monthly nursing facility cost cap
Montana	Yes	A - See state-specific FN		40 hours/week		Negotiated hourly rates
Nebraska	Yes	CN & MN		40 hours/week	Yes	Federal minimum hourly wage, increased following training or licensure
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN		Care plan must be developed by RN, beneficiary must be chronically wheelchair bound and able to select and direct attendant		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week	Yes	Fee for service using hourly rates
New Mexico	Yes	CN			Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Yes	Negotiated hourly rates up to reasonable cost
North Dakota	Yes	CN & MN		240 hours/month	Yes	Fee for service
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN			Yes	Fee for service
Oregon	Yes	A - See state-specific FN			Yes	Established hourly rate for individual providers and negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months		Cost based payment
Tennessee	No
Texas	Yes	CN		Functional limitation criteria must be met, care limited to 50 hours/week		Fee for service using quarter hour or hourly rates
Utah	Yes	A - See state-specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate or daily rate depending on setting
West Virginia	Yes	A, B & C		60 hours/month, nursing assessment every 6 months		Fee for service
Wisconsin	Yes	CN & MN		50 visits/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 32 No - 24		Yes - 1 No - 31
Alabama	No
Alaska	Yes	CN		Limited to 8 hours/day or 35/week		Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members - see state-specific FN	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN		Plan of care required, 283 hours/month		Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		Services limited to Enhanced Plan, 16 hours/week		Hourly rates based on nursing facility wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	Yes	CN & MN		Care must be supervised by RN	Yes	Fee for service using hourly rates
Kentucky	No
Louisiana	Yes	CN & MN		Medical criteria for nursing facility placement must be met, 56 hours/week	Yes	Fee for service
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	2-4 hours/week based on specified LOC criteria, assistance with IADLs dependent on need	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for LOC
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement		Fee for service with monthly payment ceiling at 60% to 100% of average nursing facility rate depending on services provided
Montana	Yes	A - See state-specific FN		40 hours/week		Negotiated hourly rates
Nebraska	Yes	CN & MN		40 hours/week	Yes	Federal minimum hourly wage, increased following training or licensure
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN		Care must be supervised by RN, beneficiary must be chronically wheelchair bound		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week	Yes	Fee for service using hourly rates
New Mexico	Yes	CN			Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Yes	Negotiated hourly rates up to reasonable cost
North Dakota	Yes	CN & MN		120 hours/month	Yes	Fee for service
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN			Yes	Fee for service
Oregon	Yes	A - See state-specific FN			Yes	Established hourly rate for individual providers and negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months		Cost based payment
Tennessee	No
Texas	Yes	CN		Functional limitation criteria must be met, care limited to 50 hours/week		Fee for service using hourly rates
Utah	Yes	A - See state-specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate up to 54.5% of nursing facility rate
West Virginia	Yes	CN & MN		60 hours/month, nursing assessment every 6 months		Fee for service
Wisconsin	Yes	CN & MN		250 hours/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 32 No - 24		Yes - 1 No - 31
Alabama	No
Alaska	Yes	CN		Limited to 8 hours/day or 35/week		Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members - see state-specific FN	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN		Plan of care required, 283 hours/month		Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		16 hours/week		Hourly rates based on nursing facility wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	Yes	CN & MN		Care must be supervised by RN	Yes	Fee for service using hourly rates
Kentucky	No
Louisiana	Yes	CN & MN		Medical criteria for nursing facility placement must be met, 56 hours/week	Yes	Fee for service
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	2-4 hours/week based on specified LOC criteria, assistance with IADLs dependent on need	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for LOC
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement		Fee for service with monthly payment ceiling at 60% to 100% of average nursing facility rate depending on services provided
Montana	Yes	A - See state-specific FN		40 hours/week		Negotiated hourly rates
Nebraska	Yes	CN & MN		40 hours/week	Yes	Federal minimum hourly wage, increased following training or licensure
Nevada	Yes	CN		Approved hours of care dependent upon need	Yes	Fee for service
New Hampshire	Yes	CN & MN		Care must be supervised by RN, beneficiary must be chronically wheelchair bound		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week	Yes	Fee for service using hourly rates
New Mexico	Yes	CN			Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Yes	Negotiated hourly rates up to reasonable cost
North Dakota	Yes	CN & MN		120 hours/month	Yes	Fee for service
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN			Yes	Fee for service
Oregon	Yes	A - See state-specific FN			Yes	Established hourly rate for individual providers and negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months		Cost based payment
Tennessee	No
Texas	No
Utah	Yes	A - See state-specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	Yes	CN & MN		Functional limitation criteria must be met		Fee for service
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate up to 54.5% of nursing facility rate
West Virginia	Yes	CN & MN		60 hours/month, nursing assessment every 6 months	Plan of care and after 60 hours/month	Fee for service
Wisconsin	Yes	CN & MN		250 hours/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

2003

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 31 No - 25		Yes - 1 No - 30
Alabama	No
Alaska	Yes	CN		Limited to 8 hours/day or 35/week		Fee for service using hourly rates
American Samoa	No
Arizona	Yes	CN & MN		Coverage limited to ALTCS members - see state-specific FN	Yes	Fee for service using time units
Arkansas	Yes	CN		64 hours/month		Fee for service using hourly rates
California	Yes	CN		Plan of care required, 283 hours/month		Fee for service using hourly rates, or negotiated rates
Colorado	No
Connecticut	No
Delaware	No
District of Columbia	Yes	CN & MN		8 hours/day up to 1,040 hours/year, care must cost less than in nursing facility		Fee for service using hourly rates, adjusted for multiple beneficiaries same address
Florida	No
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN		16 hours/week		Hourly rates based on nursing facility wages, rates vary for independent providers and agencies
Illinois	No
Indiana	No
Iowa	No
Kansas	Yes	CN & MN		Care must be supervised by RN	Yes	Fee for service using hourly rates
Kentucky	No
Louisiana	No
Maine	Yes	CN & MN	$.50-$3/day, depending on payment, up to $50/month	2-4 hours/week based on specified LOC criteria, assistance with IADLs dependent on need	Yes	Fee for service using hourly rates with annual payment ceiling based on LOC
Maryland	Yes	CN & MN			Yes	Per diem with acuity adjustment
Massachusetts	Yes	CN & MN			Yes	Fee for service
Michigan	Yes	CN & MN				Fee for service using hourly rates adjusted for LOC
Minnesota	Yes	A - See state-specific FN			Yes	Fee for service
Mississippi	No
Missouri	Yes	CN		Care must be supervised by RN, alternative to institutional placement		Fee for service with monthly payment ceiling at 60% to 100% of average nursing facility rate depending on services provided
Montana	Yes	CN & MN		40 hours/week		Negotiated hourly rates
Nebraska	Yes	CN & MN		40 hours/week	Yes	Federal minimum hourly wage, increased following training or licensure
Nevada	Yes	CN			Yes	Negotiated hourly rates
New Hampshire	Yes	CN & MN		Care must be supervised by RN, beneficiary must be chronically wheelchair bound		Fee for service
New Jersey	Yes	CN & MN		Plan of care required, personal care assistant 25 hours/week, Community Mental Health-supervised care 8 hours/day up to 35 hours/week	Yes	Fee for service using hourly rates
New Mexico	Yes	CN			Yes	Fee for service
New York	Yes	CN & MN		Services provided at 2 levels, must be supervised by RN	Initiation of care and at 6 month intervals	Fee for service
North Carolina	Yes	CN & MN		3.5 hours/day up to 60 hours/month, services not covered during same hours as home health or private duty nursing, additional hours/day up to 20 hours/month if specified criteria met	Yes	Negotiated hourly rates up to reasonable cost
North Dakota	No
Northern Mariana Islands	No
Ohio	No
Oklahoma	Yes	CN & MN			Yes	Per diem
Oregon	Yes	CN & MN			Yes	Established hourly rate for individual providers and negotiated rate for agencies
Pennsylvania	No
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN		Limited to mentally ill in residential facilities with fewer than 17 beds		Fee for service using hourly rates
South Carolina	No
South Dakota	Yes	CN		120 hours/3 months		Cost based payment
Tennessee	No
Texas	Yes	CN & MN			Yes	Established hourly rate for individual providers and negotiated rate for agencies
Utah	Yes	A - See state specific FN		60 hours/month, RN must supervise care, cannot occur same day as home health aide visit	Yes	Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	Yes	CN & MN		Functional limitation criteria must be met		Fee for service
Washington	Yes	CN		Scope of coverage dependent upon functional needs assessment		Hourly rate up to 54.5% of nursing facility rate
West Virginia	Yes	CN & MN		60 hours/month, nursing assessment every 6 months	Plan of care	Monthly rate based on hours of care
Wisconsin	Yes	CN & MN		250 hours/year		Fee for service using hourly rate for care and visit rate for supervision
Wyoming	No

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