2011 Mental Health Day on the Hill

Legal Aid News | Posted on February 05, 2013


Children and adults with mental illnesses have been able to use Personal Care Assistant (PCA) services as part of a plan of care to help them function in their homes and communities. PCA services are available statewide, and are an important support even when an adult or child is receiving other community –based mental health services. However, eligibility criteria were made more restrictive beginning January 1, 2010.

To qualify for PCA services, a person will now need to show either:

  • a dependency in an activity of daily living (ADL) requiring hands on assistance, or cuing and constant supervision (not just prompting) in order to complete a task


  • a “level I behavior”, which now means physical aggression to self or others or destruction of property requiring the immediate response of another person.
  • These changes make it much harder for a person who is vulnerable but not dangerous, or who needs assistance but not constant hands on help, to get PCA services.

What is the result of this change?

  • At least 165 children and adults on fee-for-service MA have had this vital service terminated and 107 were denied due to the new criteria. We don’t know the numbers for those on managed care plans.
  • Half—about 5,300 people– have had their PCA services reduced. This does not include those on managed care plans.

More restrictions are in store for this service:

Beginning July 2011, everyone must show two dependencies in ADLs. Having a level one behavior, or only one ADL dependency no longer gets you through the door.

  • About 2790 more people will likely lose eligibility for PCA services.
  • 65% are adults and kids who meet the Level 1 behavior criteria
  • 47% are under age 18
  • Half are people of color, including those in immigrant communities.

Won’t substituting mental health services solve this problem for adults and kids with mental health needs?

  • The 2009 Legislature allocated $8 million in 2012-13 to develop “alternative services” for persons with mental illnesses, but this will not fill the void created by the PCA cuts. In fact, a DHS sponsored stakeholder group recommended restoring the PCA program to the 2009 criteria.
  • Persons whose PCA services are terminated or reduced are supposed to be assisted to obtain other appropriate services. For many, this is not happening—or they already have those services, but still need the help at home that the PCA program provides.
  • Community mental health services are not a substitute for PCA services. Mental health services like AMHRS and CTSS for kids are meant to be rehabilitative. PCA services are meant to maintain stability in daily functioning. AMHRS and CTSS are usually limited to a few hours a week and are not always available statewide, unlike PCA services. For example, the average hours of CTSS services statewide is only 61 per year.

This is serious! What can I do about this?

  • Your legislators, the Governor and DHS need to hear from you, your friends and family about specific problems the next round of PCA cuts will create. It is especially important to hear from those whose independence is in jeopardy.
  • Tell your legislators to support and work on bills which will fix or improve the PCA law. Especially important are:
    • SF348/HF940, creating a home care rating for those with Level 1 behavior or one ADL dependency, that would give them a half hour per day (3.5 hours per week), bringing a federal match.
    • Encourage legislative support for the new federal “Community First Choice Option” (1915(k) option) which may have more flexibility as a community support for person with mental illnesses, and a federal match.
  • Tell your legislators to oppose any legislation which would make it harder for adults and kids with mental illnesses to access PCA services, which is a low cost, effective service that helps people stay independent in the community.
  • If you or someone you know is hurt by these cuts, think about appealing!
    Information on appealing is at www.mndlc.org under “News”.

For information go to http://www.namihelps.org