Personal Care Option
What is PCO?
PCO is a program designed to assist certain Medicaid eligible consumers to obtain non-medical assistance at home with activities of daily living (ADLs) determined by HSD-approved level of care (LOC) criteria. The PCO program offers a range of services to consumers who are unable to perform some or all activities of daily living because of a disability or functional limitation. PCO services permit an eligible consumer to live in his or her home rather than in an institution.
Who is Eligible?
- Must have full Medicaid benefits
- Must be 21 years of age and over
- If not yet 21 years of age, Molina Healthcare TPA can accept a Long Term Care Assessment Abstract (MAD 379) 90-days prior to the birthday of turning 21 years of age
- Must meet the State-approved medical eligibility requirements
How do I apply for PCO? New PCO Clients - Not yet enrolled in CoLTS
Effective November 1, 2009, individuals interested in applying for PCO and are NOT enrolled with either AMERIGROUP Community Care or Evercare of NM and are NOT receiving Personal Care Options services must call Molina Healthcare TPA to begin the application process at 505-348-0311 or toll free at 1- 866 -916-3250.
1. If the individual is eligible to apply for PCO, Molina Healthcare TPA will send a welcome packet with important forms. The packet will include a Long Term Care Assessment Abstract (MAD 379) that must be completed by the individual's medical doctor and submitted to Molina Healthcare TPA.
Important Note: Molina Healthcare TPA will accept either a MAD 075 (previous PCO Medical Assessment Form) or MAD 379 up to July 31, 2011 only. PCO packets submitted to Molina Healthcare TPA with the MAD 075 after July 31, 2011 will be returned to the submitter.
2. Molina Healthcare TPA will work with one of our contracted home healthcare assessment agencies to schedule an in-home assessment within 30 days with the PCO applicant. At the time of the in-home assessment, the individual will receive from the assessor a list of provider agencies to choose from.
3. Once the in-home assessment is completed, the assessment agency will forward the document to Molina Healthcare TPA. When Molina Healthcare TPA receives the completed in-home assessment, a Molina Healthcare TPA nurse will review the assessment and the MAD 379 for a level of care determination. If the applicant is determined medically eligible for PCO and is not yet enrolled in CoLTS, Molina Healthcare TPA will authorize temporary PCO services and notify the consumer and selected PCO agency of the temporary authorization.
4. Once the individual is enrolled with a CoLTS MCO, the CoLTS MCO will determine on-going PCO services.
Clients Enrolled with a CoLTS MCO (AMERIGROUP or Evercare)
1. Please contact your CoLTS MCO Service Coordinator for assistance with applying for PCO services.
Important information: Effective December 30, 2010, the MAD 075 from is no longer valid for application for PCO services. The MAD 075 has been replaced by the MAD 379 long-term care assessment abstract.
Long Term Care Assessment Abstract (MAD 379)
Helpful Website Links
Other Useful Information:
Coordination of Long-Term Services (CoLTS) Program
CoLTS is a Medicaid managed care program that provides and coordinates services to certain Medicaid recipients. This includes all physical health and/or long-term care services, such as: doctor visits, hospital services, home and community-based services and long-term services (i.e. nursing facility services). Individuals enrolled in CoLTS receive their services under a managed care setting.
Individuals can choose from two CoLTS Managed Care Organizations (MCO) to receive services. Persons who get services under this managed care setting include: CoLTS c Waiver (CCW) (formerly the Disabled & Elderly Waiver) recipients, Personal Care Option (PCO) consumers, nursing home residents, people who have Medicare and Medicaid and are not getting long-term services, and people approved for the Mi Via Waiver who were approved through the CoLTS c Waiver (formerly Disabled & Elderly Waiver) or brain injury category of eligibility. People in Mi Via who are enrolled in CoLTS get their Mi Via services as they did before CoLTS, but now get their physical health services under CoLTS.
The two CoLTS MCOs are AMERIGROUP Community Care and Evercare of New Mexico. Contact information is as follows:
- AMERIGROUP: Phone number (505) 875-4320 (Albuquerque local) or (877) 269-5660 (toll-free)
- Evercare: Phone number (877) 236-0826 (toll-free)
New Mexico Aging and Long-Term Service Department (ALTSD) Resource Center: Toll–free phone number (800) 432-2080
The ALTSD is responsible for day-to-day management of certain home and community-based programs including PCO, Traumatic Brain Injury, CoLTS c waiver (also known as the Disabled and Elderly waiver), Mi Via self-directed waiver, for elderly and disabled persons on Medicaid and individuals with brain injury eligible for home and community-based services.
New Mexico Department of Health (DOH), Developmental Disabilities Supports Division (DDSD): Toll free (800) 283-5548 (Albuquerque) or (877) 696-1472 (Santa Fe)
The DDSD is responsible for day-to-day management of the Medicaid Developmental Disabilities, Medically Fragile, and Mi Via waiver programs, for persons with developmental disabilities and for persons who are medically fragile and have or are at risk for developmental disability.
New Mexico Department of Health (DOH), Public Health Division (PHD), AIDS Waiver Manager: (505) 476-3618 (Santa Fe)
The PHD is responsible for day-to-day management of the AIDS and Mi Via waiver Programs for persons living with AIDS.
New Mexico Human Services Department/Income Support Division (HSD/ISD): Toll-free phone number (888) 473-3676
The HSD/ISD is the state agency that determines financial eligibility for HSD programs including Medicaid, Insure New Mexico!, food stamps, Temporary Assistance for Needy Families, and other programs.
New Mexico HSD/Medical Assistance Division (MAD): Toll-free phone number (888) 997-2583
The HSD/MAD is the administering agency for the New Mexico Medicaid and Insure New Mexico! programs. Within the HSD/MAD Long-Term Services and Support Bureau, this includes oversight of Institutional Care Medicaid services (nursing facilities, intermediate care facilities for the mentally retarded, and hospital swing beds), the Coordination of Long-Term Services (CoLTS) program, the Program of All-Inclusive Care for the Elderly (PACE) program, Home and Community-Based Services (HCBS) waivers, and the utilization review/third-party assessor contract.
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