PERSONAL ASSISTANCE SERVICES PROVIDER IN NORTH CAROLINA

SUPPORTING DAILY LIVING WITH DIGNITY THROUGH PERSONALIZED CARE

Personal Assistance Services in North Carolina help individuals with disabilities, chronic illnesses, or age-related challenges by providing hands-on support with daily living activities. These services are essential for maintaining independence and ensuring safety within home and community settings. Personal Assistance Services are authorized under North Carolina Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: North Carolina Department of Health and Human Services (NCDHHS)

Role: Administers Medicaid waiver funding for Personal Assistance Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: North Carolina Division of Health Benefits (NC Medicaid)

Role: Manages Medicaid waiver services and oversees Medicaid provider participation.

Agency: North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)

Role: Provides oversight for personal care services targeting individuals with developmental disabilities and behavioral health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Personal Assistance Services meet quality, safety, and person-centered care standards.

2. PERSONAL ASSISTANCE SERVICES OVERVIEW

Personal Assistance Services support individuals in performing essential daily activities, promoting independence while maintaining personal dignity and well-being.

Approved providers may deliver:

• Personal Care Assistance: Helping with bathing, grooming, dressing, and hygiene.

• Mobility Support: Assisting with transfers, ambulation, and safe movement around the home.

• Meal Preparation and Feeding: Preparing meals and assisting with eating as needed.

• Household Tasks: Light cleaning, laundry, and organizing personal spaces.

• Medication Reminders: Ensuring adherence to prescribed medication schedules.

• Health Monitoring: Observing changes in physical or mental health.

• Community Access Support: Assisting with attending appointments and social activities.

• Behavioral Support: Helping manage challenging behaviors in a supportive manner.

• Companionship: Providing social interaction and emotional support.

• Documentation: Maintaining accurate records of care provided and individual progress.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the North Carolina Secretary of State.

• Obtain EIN from the IRS and NPI (Type 2).

• Enroll as a Medicaid Waiver Personal Assistance provider via the NCTracks Provider Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for personal care, safety protocols, and client support.

• Ensure staff complete required background checks, health screenings, and training in personal care assistance.

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application via the NCTracks Portal for Personal Assistance Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, personal care policies, and staff training documentation.

Program Readiness Review:

• NCDHHS and DMH/DD/SAS evaluate provider readiness, including care protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Personal Assistance Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (North Carolina Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Personal Assistance Policy & Procedure Manual including:

  • Care planning, hygiene, and personal support procedures

  • Safety protocols for mobility support and fall prevention

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for care tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Infection control, hygiene, and safety practices

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Personal Assistance Program Director

Requirements: Bachelor’s or Master’s degree in social work, healthcare administration, or human services; experience in personal care management.

Role: Personal Care Aides (PCAs)

Requirements: High school diploma or GED; completion of approved PCA training program; experience in personal care and support; background clearance.

Role: Direct Support Professionals (DSPs)

Requirements: Experience in caregiving, mobility support, and client interaction.

All staff must complete:

• Training in personal care, safety, and client interaction

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety, emergency response, and infection control training

• Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Personal Assistance Services are available under the following North Carolina Medicaid Waivers:

• Innovations Waiver

• Community Alternatives Program for Disabled Adults (CAP/DA)

• Community Alternatives Program for Children (CAP/C)

• Traumatic Brain Injury (TBI) Waiver

• Home and Community-Based Services (HCBS) Waiver

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: North Carolina Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

North Carolina Department of Health and Human Services (NCDHHS)

Website: https://www.ncdhhs.gov/

NCTracks Provider Enrollment Portal

Website: https://www.nctracks.nc.gov/

North Carolina Division of Health Benefits (NC Medicaid)

Website: https://medicaid.ncdhhs.gov/

North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)

Website: https://www.ncdhhs.gov/divisions/mhddsas

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NORTH CAROLINA PERSONAL ASSISTANCE SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Personal Assistance Services in North Carolina, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for personal care and client safety

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and client outreach strategies

• Quality assurance systems for personal assistance and compliance monitoring

• Collaboration with healthcare providers, family caregivers, and community organizations

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.