PERSONAL CARE SERVICES PROVIDER IN IDAHO

ASSISTING INDIVIDUALS WITH DAILY LIVING TASKS TO PROMOTE INDEPENDENCE AND QUALITY OF LIFE

Personal Care Services in Idaho help individuals with disabilities, chronic illnesses, or aging-related needs perform essential Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) in their homes or community settings. These services are authorized under Idaho’s Medicaid State Plan and Home and Community-Based Services (HCBS) waiver programs, helping participants maintain independence and avoid institutionalization.

1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Personal Care Services

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Personal Care Services meet Medicaid quality, safety, and participant-centered care standards

2. PERSONAL CARE SERVICE OVERVIEW

Personal Care Services provide hands-on assistance to help participants perform daily tasks they cannot complete independently due to physical, cognitive, or developmental limitations.

Approved providers may deliver:

• Assistance with ADLs such as bathing, grooming, toileting, dressing, eating, and mobility

• Assistance with IADLs such as preparing meals, light housekeeping, laundry, and medication reminders

• Cueing and supervision for participants who need prompting to complete tasks

• Transfer and ambulation assistance (e.g., moving safely within the home)

• Basic health monitoring and reporting changes to supervisors

• Support for safety awareness and injury prevention at home

All services must align with goals and needs outlined in the participant’s Individualized Service Plan (ISP) and authorized through Medicaid service approvals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Idaho Secretary of State

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

• Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment

• Maintain general liability and professional liability insurance

• Develop policies for participant-centered service delivery, incident reporting, emergency response, and documentation

• Ensure all staff meet background screening requirements and complete training in personal care assistance

4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application for Personal Care Services through Idaho’s Medicaid Management Information System (MMIS)

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff credentialing and training documentation, operational policies, and participant intake forms

Program Readiness Review:

• IDHW reviews provider readiness, including staffing standards, participant protection procedures, Medicaid billing compliance, and service documentation systems

Approval & Medicaid Enrollment:

• Upon approval, configure billing codes for Personal Care Services (typically billed in 15-minute units)

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Idaho Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• HCBS-Compliant Policy & Procedure Manual including:

  • Participant intake, assessment, and care planning procedures

  • Personal care task assistance protocols and documentation standards

  • Emergency preparedness, critical incident reporting, and supervision policies

  • HIPAA confidentiality, participant rights, and grievance handling procedures

  • Staff credentialing, background checks, training logs, and competency evaluations

  • Medicaid billing, service tracking, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Personal Care Services Program Manager / Supervisor

Requirements: Experience in human services, healthcare, or personal assistance program management preferred; background screening clearance

Role: Personal Care Aides / Direct Care Staff

Requirements: High school diploma or GED; CPR/First Aid certification preferred; successful completion of personal care assistance training; background screening clearance

All staff must complete:

• HIPAA confidentiality and participant rights training

• Emergency preparedness, infection control, and abuse prevention training

• Person-centered care and ADL/IADL assistance training

• Annual competency evaluations and continuing education updates

7. MEDICAID WAIVER PROGRAMS

The following Idaho Medicaid programs and waivers authorize Personal Care Services:

• Medicaid State Plan Personal Care Services Program

• Aged and Disabled (A&D) Waiver

• Developmental Disabilities (DD) Waiver (for supportive personal care needs)

Approved providers may deliver:

• Hands-on personal care tasks assisting with ADLs and IADLs

• Cueing and supervision services for participants needing prompts

• Mobility and safety support services in home and community settings

8. TIMELINE TO LAUNCH

Phase: Business Formation and Credentialing Setup

Timeline: 1–2 weeks

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 1–2 months

Phase: Idaho Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Configuration and Claims Management

Timeline: 30–45 days

9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Medicaid Division

Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Centers for Medicare & Medicaid Services (CMS)

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

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — IDAHO PERSONAL CARE SERVICES PROVIDER

WCG supports personal assistance providers, home care agencies, and community service organizations in launching Medicaid-compliant Personal Care Services under Idaho’s HCBS waiver programs and Medicaid State Plan benefits.

Scope of Work:

• Business registration and EIN/NPI setup

• Medicaid provider enrollment assistance

• Development of Personal Care Services Policy & Procedure Manual

• Staff credentialing templates and participant intake/service tracking forms

• Medicaid billing system setup and claims management

• Website, domain, and email setup

• Personal care assistance documentation systems and task reporting templates

• Quality assurance programs for service delivery monitoring and participant satisfaction

• Community outreach and care coordination partnership development strategies

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.