Medicaid Personal Care (MAPC) 101

This information is to help clarify how MAPC works, how the billing is done and how the hours are determined. Here are a few details:

Referrals

The person must receive “hands on” personal care in order to qualify for each category of assistance. For MAPC, they must qualify for and bill at least 2 hours per day. For consumers with residential agencies and receive MAPC through CLA, must qualify for at least 1 hour per day.

What does it mean by “authorized hours”?

When a consumer has a total of 5 hours per day of authorized hours, for example, this is assigned based on cares provided on the average day and throughout the week. But when those cares are not provided that day (ill, out of home, hospitalized, refusal of cares, etc.) then we cannot bill the full authorization of hours.

What this means is: When you take into account the total authorized hours every day as part of the consumer’s budget, the county and brokers must be aware that this is not a guaranteed amount of money that can be billed for that individual every day or week.

When a referral is made to MAPC, it is often requested to complete the PCST so the broker can take this information to the county to develop a budget for this individual.

All assessments must be done in the home. This can cause difficulties for consumers and residential providers as no budget can be created via MAPC hours until the person returns home and can be assessed in the home. This is an MAPC rule which frustrates everyone.

Our only possibility is to have the consumer go home for a “day visit” and we can do the assessment on that day.

Also remember that all new assessments that include Addendums can take up to 2 months for approval to start billing those hours.

MAPC is a regulated service and every rule must be followed or those funds will be requested back by the state after auditing. There is little opportunity for flexibility, which creates problems when working out an individual’s overall support plan. MAPC allows for an individual to receive funding for cares provided according to the Nursing Plan of Care in the person’s home and with workers determined qualified according to Medicaid regulations.