North Carolina home care programs

Home health: the medical benefit

In North Carolina, skilled home health is Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with North Carolina Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In North Carolina the agency route is State Plan Personal Care Services (PCS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

North Carolina's consumer-directed option is Consumer-directed care — Personal Assistant Services (CAP/Choice). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Consumer-directed care — Personal Assistant Services (CAP/Choice) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

North Carolina offers structured family caregiving through Coordinated Caregiving. A family member who lives with the person provides day-to-day care and is paid a daily stipend rather than hourly wages.

An agency that holds the Medicaid contract enrolls the household, coaches the caregiver, checks in on a set schedule and keeps the care notes. Unlike consumer-directed care, the caregiver does not become anyone's employee by the hour, and the agency, not the family, is the Medicaid provider.

Other ways North Carolina pays for care at home

Waiver in-home services: 1915(i) Community Living and Supports (CLS), Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Disabled Adults (CAP/DA), NC Innovations Waiver, and NC Traumatic Brain Injury Waiver. These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Home and Community Care Block Grant (HCCBG). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
• Needs daily help and wants an agency to supply and manage the aide: State Plan Personal Care Services (PCS).
• Wants to choose the aide, including a relative where allowed: Consumer-directed care — Personal Assistant Services (CAP/Choice).
• Lives with a family member who provides care most of the day: Coordinated Caregiving.
• Meets nursing-home level of care and needs more than personal care: 1915(i) Community Living and Supports (CLS), Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Disabled Adults (CAP/DA), NC Innovations Waiver, and NC Traumatic Brain Injury Waiver.