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Medicaid Personal Care

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1. Whom do I call to receive services?

Contact the Loudoun County Department of Family Services (DFS) at 703-777-0353 and ask to speak with a senior benefits specialist. Tell the senior benefits specialist that you are interested in Medicaid Personal Care so that a Medicaid application can be sent to you.

The application is long and requires that you submit proof of identity, such as a Social Security card, and proof of income. We advise you to start working on it as soon as possible. You may call the senior benefits specialist for assistance.

The Medicaid application must be completed prior to receiving services and a determination must be made if you are eligible for Medicaid. The senior benefits specialist will refer you to an Adult Services social worker. The social worker will contact you to arrange a visit to your home with a public health nurse.

2. What will happen when you visit my home?

During the visit, many questions will be asked regarding your health, medications, abilities, nutrition, etc. A separate letter will be sent to you outlining the information you will need to prepare prior to the visit. The visit will take approximately one hour, and several documents will need to be signed. If you are unable to sign, it is necessary for someone to be there to sign on your behalf.

3. How do you decide if I’m eligible?

Two factors determine your eligibility - your needs assessed by the social worker and nurse and
your income and resources assessed by a senior benefits specialist. These are two separate processes.

To determine your needs, we will ask you questions about your ability to perform day-to-day tasks such as bathing and dressing. We need to know if you are able to do these tasks by yourself or if you need some assistance. The program is designed to serve individuals who need help in a lot of areas (bathing, walking, dressing, feeding, going to the bathroom, etc.) as it is meant to be an alternative to nursing home placement. If you only need minimal assistance with bathing and some help with housekeeping, Medicaid will not pay for you to have Medicaid Personal Care.

The senior benefits specialist will determine if you meet the income and resource criteria when you complete your Medicaid application. The benefits worker must have the completed application and all requested verification before a final decision can be made regarding your approval for Medicaid. The senior benefits specialist has 45 days from the date the application is received by social services to make a determination.

4. How do I choose which agency will provide the care?

During the visit to your home, you will be given a list of local home health agencies that are in the area and can provide this assistance to you. You are free to choose any agency that accepts Medicaid. After the public health nurse and social worker leave your home, the paperwork will be reviewed by a physician with the Loudoun County Health Department and sent to the agencies you have chosen. When the agencies receive the information, they will look for an aide to staff your case. If the agency is able to locate an aide, they will contact you to arrange another visit to your home. You can call the agency directly to check on the status of finding a home health aide.

5. How do I pay for home care?

If you are found eligible for Medicaid Personal Care, Medicaid will pay for a portion or all of the home care services. Prior to receiving services you must complete a Medicaid application. A portion of your income will be set aside for your needs. The remainder of your income must be paid toward the cost of your care. You are allowed to keep at least $1151 per month. You should anticipate that your co-payment will be approximately the difference between your total monthly income and $995 per month. If you receive SSI there is no cost for service. The benefits worker will determine how much you will owe each month as a co-payment. The co-payment is paid to the home health agency. It is your responsibility to send the co-payment directly to the home health agency at the beginning of each month.