A DHSR home care license for each county you serve
Only a home care agency licensed by DHSR to operate in the county or counties where PCS is provided can bill for it.
North Carolina · Medicaid PCS · Clinical Coverage Policy 3L
NC Medicaid personal care services: what a home care agency needs
Medicaid personal care services (PCS) pay for hands-on in-home aide care for North Carolina beneficiaries who qualify. To provide them you need your DHSR license first, then Medicaid enrollment, the Provider Interface and EVV. Here is how referrals reach you and what NC Medicaid expects once they do.
- Rule-verified October 1, 2026
- Quoted from Clinical Coverage Policy 3L (amended Jan. 1, 2026)
- From NC Medicaid’s PCS page
Quick answer
NC Medicaid personal care services (PCS) are hands-on help with bathing, dressing, mobility, toileting and eating for Medicaid beneficiaries who qualify through an independent assessment. Under Clinical Coverage Policy 3L, only "a home care agency licensed by the DHSR to operate in the county or counties where the PCS Services are being provided" can bill for them.
So the order is: get your DHSR home care license, enroll with Medicaid (signing the DHHS Provider Administrative Participation Agreement), enroll in the Provider Interface, and set up electronic visit verification. Beneficiaries then choose providers from a randomized list, and you have 2 business days to accept each referral.
Becoming a PCS provider
Four things, starting with the license.
Medicaid enrollment
Meet Medicaid participation qualifications and sign the DHHS Provider Administrative Participation Agreement. DHSR, the Division of Health Benefits and NCTracks are separate, so keep each informed of counties and address changes.
The Provider Interface
Every PCS provider enrolls in the Provider Interface, the web system that carries referrals, independent assessments and service plans.
An EVV solution
Use the state’s electronic visit verification solution or a compliant alternative, tell each beneficiary about EVV in writing, and train staff on it at least once a year.
How clients qualify and choose a provider
To qualify, a beneficiary needs a medical condition, disability or cognitive impairment and unmet needs for "Three of the five ADLs with limited hands-on assistance", or two ADLs with one needing extensive assistance or full dependence. NC Medicaid, PCS The five ADLs are bathing, dressing, mobility, toileting and eating. Policy 3L, 5.4.1
Hours are capped: up to 60 a month under 21 and up to 80 a month for adults, with up to 50 more for adults who meet extra criteria, such as needing more supervision because of a degenerative memory disease. Policy 3L, 5.3.1
Beneficiaries choose: "Each beneficiary may select at least three providers from a randomized list of available providers" licensed for home care in their county. They can change provider during the service period, and the new provider writes a new service plan within seven business days of accepting the referral. Policy 3L, 5.4.11
You may not win clients with gifts: agencies are "prohibited from offering gifts or service-related inducements of any kind". Policy 3L, 7.5
Referrals, step by step
Tick steps off as you go; progress is saved in this browser only.
The beneficiary gets a physician referral
StartTheir primary care practitioner or attending physician refers them on NC Medicaid’s form (NC Medicaid-3051).
An independent assessment
Before servicesNC Medicaid or its designee assesses eligibility. NC LIFTSS / Acentra Health carries out the assessments (833-522-5429).
The beneficiary chooses providers
At assessmentThey pick at least three providers from a randomized list of agencies licensed for home care in their county.
You accept or decline within 2 business days
2 business daysThe referral comes through the Provider Interface. If you do not accept, it goes to the beneficiary’s next choice.
Write the online service plan
After acceptingBased on the independent assessment, addressing every unmet ADL, IADL, special assistance or delegated medical monitoring need, with the frequencies the assessment sets.
Deliver care and verify every visit
Every visitAides follow the service plan, and each visit is captured through EVV.
CareRulebook
Medicaid comes after your license
To bill for PCS you need the DHSR home care license first, and DHSR reviews your policies, procedures and personnel documents before it licenses you. CareRulebook writes every policy on DHSR’s initial survey checklist for your agency.
- 31 policies, 47 rule requirements mapped
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$199CareRulebook founding price for the first 50 North Carolina agencies, then $249. Not a DHSR or Medicaid fee.
Aides: qualifications and training
Policy 3L sets a minimum: "PCS Aides shall be a high school graduates or equivalent; or Eighteen (18) years of age or older." Policy 3L, 6.1.1 Aides must also meet the home care licensure rules, including competency checks by an RN and the Nurse Aide Registry for extensive assistance. Director, RN and aide rules →
Each PCS aide’s personnel record documents training in, at minimum: beneficiary rights; confidentiality and privacy; personal care skills for bathing, dressing, mobility, toileting and eating; documenting and reporting accidents and incidents; recognizing and reporting abuse and neglect; and infection control. Aides serving beneficiaries who receive the extra hours also need training or experience in dementia care. Policy 3L, 6.1.2
Medicaid will not pay for PCS given by someone with certain convictions, such as felony health care fraud, patient abuse, or abuse, neglect or exploitation listed with the NC Health Care Personnel Registry. Policy 3L, 6.0
EVV, quality improvement and audits
- Electronic visit verification. "Providers are required to use an Electronic Visit Verification EVV solution" to capture in-home aide visits. Keep written proof that each beneficiary was told about EVV and that staff were trained on it, initially and at least annually. Policy 3L, 7.4
- Quality improvement. Keep a Quality Improvement Plan updated at least quarterly, run a continuous quality improvement program, and survey beneficiary satisfaction in writing at least once a year. Policy 3L, 7.7
- Annual attestation. "PCS Providers shall submit by December 31 of each year an attestation to NC Medicaid" that you comply with the quality improvement requirements. Policy 3L, 7.7 e
- Audits. Cooperate with NC Medicaid’s desktop and on-site quality, compliance and payment reviews, and keep clinical and billing records accessible. Policy 3L, 7.6
These Medicaid duties sit alongside the DHSR licensing rules, including your own plan of care, 90-day RN supervisory visits and annual program evaluation. Plans of care and supervision →
Myths
Can the Medicaid PCS service plan be your plan of care?
No. DHSR says the Medicaid personal care services plan is not a plan of care and cannot replace one.
"The Service Plan is not a Plan of Care and may not be substituted as a Plan of Care."
Can in-home aides give medications in North Carolina?
No. In-home aides may assist clients with self-administration of medication ordered by a prescriber, but may not administer it.
"No, In-home aides may not administer medications."
Frequently asked questions
How do I become a Medicaid personal care services provider in North Carolina?
You need a DHSR home care agency license for each county you serve, Medicaid enrollment with a signed DHHS Provider Administrative Participation Agreement, enrollment in the Provider Interface, and an electronic visit verification (EVV) solution. Referrals then come to you through the Provider Interface when beneficiaries choose your agency.
Who qualifies for NC Medicaid personal care services?
A Medicaid beneficiary with a medical condition, disability or cognitive impairment and unmet needs for three of the five ADLs (bathing, dressing, mobility, toileting, eating) with limited hands-on help, or two ADLs with one needing extensive assistance or full dependence. An independent assessment decides eligibility.
How many PCS hours can a beneficiary get?
Up to 60 hours a month for a beneficiary under 21 and up to 80 hours a month for one 18 or older, with up to 50 more hours for adults who meet additional criteria such as needing more supervision because of a degenerative memory disease.
What are the qualifications for a PCS aide?
Policy 3L sets the minimum as a high school graduate or equivalent, or 18 or older, with documented training in beneficiary rights, confidentiality, personal care skills for the five ADLs, accidents and incidents, recognizing and reporting abuse and neglect, and infection control. Aides must also meet North Carolina’s home care licensure rules.
Can a PCS provider offer gifts to attract clients?
No. Agencies providing PCS may not offer gifts or service-related inducements of any kind to get beneficiaries to choose them or switch to them.
Is the Medicaid service plan the same as the plan of care?
No. DHSR says the Medicaid PCS service plan is not a plan of care and cannot replace one, so a licensed agency still needs its own plan of care under the home care rules.
Who do I contact about PCS?
NC Medicaid’s Personal Care Services Unit on 919-855-4360 or PCS_Program_Questions@dhhs.nc.gov. Beneficiaries in a Prepaid Health Plan contact their plan about PCS benefits.
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Sources
- 10A NCAC 13J, The Licensing of Home Care Agencies · NC Office of Administrative Hearings · retrieved October 1, 2026
- Home Care Frequently Asked Questions (rev. 5/30/25) · NC DHSR · retrieved October 1, 2026
- NC Medicaid Clinical Coverage Policy 3L, State Plan Personal Care Services (PCS) in In-Home Settings (amended January 1, 2026) · NC Medicaid, Division of Health Benefits · retrieved October 1, 2026
- Personal Care Services (PCS) · NC Medicaid, Division of Health Benefits · retrieved October 1, 2026