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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

22-1041m Help Members Live Independently with Personal Care and Homemaker Services

Date: 11/30/22

Support is available for members to be more independent while meeting their daily living needs

Personal Care and Homemaker Services Community Supports (CS) helps members who need assistance with Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).

Personal Care and Homemaker Services can help advance the individual’s independence within the home and community and helps the individual meet daily living needs.

Eligibility

Members may qualify for Personal Care and Homemaker Services if the individual:

  • Is at risk for hospitalization or institutionalization in a nursing facility; or
  • Lost the ability to function and has no other support system; or
  • Was approved for In-Home Supportive Services.

This service cannot be utilized in lieu of referring to the In-Home Supportive Services program. Member must be referred to the In-Home Supportive Services program when they meet referral criteria.

If a member receiving Personal Care and Homemaker services has any change in their current condition, they must be referred to In-Home Supportive Services for reassessment and determination of additional hours. Members may continue to receive the Personal Care and Homemaker Services Community Support during this reassessment waiting period.

Services available

The Personal Care Services and Homemaker Services can help members with:

  • ADLs such as bathing, dressing, toileting, ambulation, or feeding.
  • IADLs such as meal preparation, grocery shopping, and money management.
  • Activities for individuals who could otherwise not remain in their homes.
  • Services provided through the In-Home Support Services program such as house cleaning, meal preparation, laundry, personal care services (bowel and bladder care, bathing, grooming, and paramedical services).
  • Assistance to medical appointments and supervision for the mentally impaired.

Billing service code

Billing for Personal Care and Homemaker services must use service code T1019 with modifier U6.

Authorization Guide

For more information on CS authorization guides and eligibility criteria, access California Health & Wellness Plan’s (CHWP’s) provider website at www.CAHealthWellness.com.

Additional information

Physicians and other providers are encouraged to access CHWP’s provider portal online for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.

This information applies to Community Supports (CS) Providers.