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Staff Access
Services for Specific Populations
MassHealth's Personal Care Attendant (PCA) Program
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COVID Specific Content
During the COVID Public Health Emergency (PHE) parent of a minor child may serve as the child's Home Health Aide (HHA): when a member "is experiencing a disruption in receipt of PCA services due to COVID-19", the member can fill those gaps with a home health aide- and home health aides can be a parent of a minor child. If the parent/ home health aide is just filling gaps in PCA coverage during the PHE, they don't have to go through the usual home health aide training and certification. This bulletin has more details.
End of COVID-specific content
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Patient Handouts from the CRC
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Also see:
MassHealth's PCA Consumer Handbook
(see also: Programs in other states)
The PCA Program is a consumer-directed service, funded through MassHealth, in which a person with a disability hires, trains and supervises an attendant to assist the individual with various tasks so they can be as independent as possible.
PCAs provide consumers with:
- Activities of Daily Living (ADLs)
- must require assistance with at least two ADLs
- mobility
- bathing and grooming
- dressing and undressing
- passive range-of-motion exercises
- taking medications
- eating
- and toileting
- Instrumental Activities of Daily Living (IADLs)
- Performance of household services such as laundry, shopping and housekeeping, accompanying to medical appointments
PCA time is NOT approved for activities such as recreation, babysitting, or vocational training. Nor is PCA time allowed for verbal prompting or cuing, or supervision.
The PCA program is a participant-directed program. This means that the individual with the disability is the employer. This is different from more traditional home health care programs in which an agency provides the worker. The PCA program is designed to give individuals with disabilities control over how their own personal care needs are met.
Sections:
Who is eligible?
How Do I apply?
How many hours of service will I get?
I receive other services. Can I still use PCA services?
Can I have a PCA and a Home Health Aide at the same time?
I live with my family. How will this affect my PCA services?
What is the difference between the AFC and PCA programs?
What is a Surrogate?
Who can I hire as a PCA?
How can I find a PCA?
What is a Fiscal Intermediary and how does my PCA get paid?
Can I have a PCA help me at work?
PCAs' Employment Rights
PCA Overtime Rules
PCAs in the News
See also: Tips for Talking with your PCA
(link to article)
Who is eligible?
You may be eligible for PCA services if you are a MassHealth Standard or CommonHealth member and:
- You have a permanent or chronic disability that impairs your ability to perform ADLs and IADLs without physical assistance.
- You need physical assistance with two or more ADLs (see ADL list above)
- Personal Care services are prescribed by your physician or nurse practitioner
Children may be eligible for PCA services if they are over the age in which parents would ordinarily be expected to help with personal care, except in exceptional circumstances. BCIL tells us as a rough guide they've not seen anyone in recent memory younger than age 5.
MassHealth determines that PCA services are medically necessary.
How Do I apply?
Through your local Personal Care Management Agency (PCM), which may be a local Independent Living Center or Elder Service Agency. Expect that the process will take some time- typically a couple of months.
How many hours of service will I get?
The Personal Care Management Agency (PCM) will conduct an evaluation, including a home visit, which will describe your personal care needs in detail, and recommend how many hours of PCA services you need each week. After approval by your physician or nurse practitioner, this evaluation is sent to MassHealth, which makes the final decision about whether you are eligible and how many hours of PCA services will be approved for you. PCA services are usually approved for one year at a time. For more severe cases, you may receive 80 or more hours of care per week, whereas the less severe cases may receive 3 or 4 hours per week.
I receive other services. Can I still use PCA services?
PCA services can be used in combination with some other services, such as Visiting Nurse, Occupational or Physical Therapy, or Home Health Care services.
Some other services may not be used together with PCA: MassHealth-funded Adult Day Health, Day Habilitation, Adult Foster Care, or Group Adult Foster Care, and Homemaker services funded through the Mass. Rehabilitation Commission, or, with limited exceptions, when you are in a hospital or rehabilitation facility or long-term care facility.
(Some hospitals are piloting letting patients who are on global payment contracts retain their PCAs while in-hospital to maintain continuity of care and avoid losing long-term PCA relationships).
It is important that you inform your PCM of any other services you receive, so they can help you determine how these will coordinate with PCA services.
Can I have a PCA and a Home Health Aide at the same time?
You can have both a PCA and a Home Health Aide at once as long as they are performing different services. Once you begin receiving PCA services through MassHealth, you are given approval to receive specific medically necessary services. You would no longer be able to receive these same services from a Home Health Aide since it would be considered a dupicate service. However, you could still use Home Health Care services for care not covered by your PCM.
I live with my family. How will this affect my PCA services?
If you live with family members they will be expected to assist with most household chores if they are physically able. For example, routine laundry, housekeeping, shopping and meal preparation should include the needs of the family member with the disability.
What is the difference between the Adult Foster/Family Care (AFC) and PCA program?
The main difference is that AFC program requires that you and the caregiver live together.
The AFC program also requires that you need help with at least one ADL, where the PCA program requires that you need help with at least two. The AFC program also includes a nurse and a case manager- they do not work on-site in your home but can help with support and medical needs on a case-by-case basis. For more information about the AFC program, see this handout.
What is a Surrogate?
If you cannot independently manage your PCA program, you may have the help of a surrogate. The surrogate is often a family member but may be any other person you choose who has the ability to manage the program. A surrogate can assist you with managing any part of the PCA program with which you have difficulty, but a surrogate does not necessarily run your PCA program for you. When you apply for PCA services your PCM will determine whether you are able to manage the program independently, what skills training you will need to learn how to manage the PCA program, and whether you will need any help from a surrogate.
Who can I hire as a PCA?
As a consumer-directed program, the PCA program allows for great flexibility and control in who you can hire as a PCA. There are some restrictions, however. The following individuals cannot be hired as PCAs:
- spouse
- surrogate
- legally responsible relative (legal guardian) or
- parent or foster parent of a minor child
Advocacy tip- Parents of ADULTS with disabilities: one parent may serve as legal guardian and/or surrogate and the other may be paid as a PCA.
Additionally, your PCA must be: legally authorized to work in the United States and have a social security number; able to understand and carry out directions given by you; and willing to receive training and supervision in all PCA services from you.
How can I find a PCA?
Consumers who receive supports under the MassHealth PCA program have a website sponsored by the PCA Workforce Council to find and hire PCAs: www.masspcadirectory.org.
Please note: consumers may continue to use RewardingWork.org until their current RW subscription expires- then they would switch to using the Mass PCA Directory.
Rewarding Work
One way to find and hire a personal care attendant is to use the free online Massachusetts PCA Directory- Rewarding Work. The directory is a listing of personal care attendants who are looking for jobs. The Directory provides contact information, hours and services, experience, education, willingness to travel, and other work-related information about each applicant.
The Directory is operated by Rewarding Work Resources, Inc., a nonprofit organization.
Your Personal Care Management (PCM) agency can also help you find a PCA, or you can ask friends, family members, religious leaders, and other community members if they know of anyone looking for PCA work.
-This section adapted from: www.massresources.org's PCA page (No longer operational.)
-This page was primarily adapted from: http://www.masscp.org/PCA%20Program/PCA_FAQ.html http://www.bostoncil.org/docs/program.html, MassHealth provider regulations 130 CMR 422.411
Related News: Disability Abuse Registry Proposed, MGH Community News, April 2017
What is a Fiscal Intermediary and how does my PCA get paid?
What is a fiscal intermediary?
A fiscal intermediary is an agency hired by MassHealth to help you with the employer required tasks of employing a PCA, such as: receiving and processing your PCA Activity Forms (also called time sheets); preparing your PCA’s paychecks and direct deposits; sending the paycheck to you to give to your PCA; filing and paying your share of state and federal taxes, including unemployment; buying workers’ compensation insurance for your PCA; and issuing a W-2 to your PCA. With the assistance of the FI, you will be able to pay your PCAs with MassHealth funds.
Who pays my PCA? The FI is responsible for receiving and processing your PCA Activity Forms and issuing checks for your PCA. The FI will send the checks to you and you will pay your PCA. Your PCA has the option to be paid by direct deposit.
Can I have a PCA help me at work? (FAQs)
The following article is a series of employment related questions that are frequently asked by individuals with disabilities who use PCA services. The answers are provided by Ray Glazier, a wheelchair user who utilizes the services of a Personal Care Attendant (PCA) at work and home. His experience includes over twenty years as Director at Abt Associates Center for the Advancement of Rehabilitation & Disability Services.
Q: The accident that paralyzed me also bankrupted me, but at least I have MassHealth coverage for my PCA services and other stuff I've finally been offered a job, but not sure I can earn enough to pay my PCAs out of pocket. What can I do?
A: As a working person with a disability, you can still keep your broad MassHealth coverage and participation in its PCA program; you will qualify for the special coverage available through the MassHealth Buy-In program called CommonHealth, provided you work at least 40 hours per month or are self-employed. If you earn more than the MassHealth Standard income limit, you will pay a reasonable monthly premium to MassHealth as a CommonHealth consumer. The good news is that there is no income or asset limit in CommonHealth, so your advancement potential on the job is unlimited and you can save as much as you are able to. (Editor’s note: though when you turn 65 you will be subject to an asset limit for ongoing eligibility.)
Q: OK. But what is that "reasonable" monthly premium?
A: Your individual CommonHealth premium is calculated according to a sliding scale based on percentage of the federal poverty level, which takes into account income and family size. The two catches are that this is only individual coverage and you must also subscribe to your employer's health plan if it is offered to you. If you have a family, you'll want your employer's health plan's family coverage anyway.
Q: Why would I need two insurance plans if I don't have a family?
A: Your employer's health insurance plan will not cover PCA services no matter how good it is; no private insurance does, nor does Medicare. The only source for PCA coverage is Medicaid (MassHealth here). So you need CommonHealth, unless you are a veteran who qualifies for the VA's Home Health Aide benefit.
Q: But what about PCA services on the job?
A: For your routine personal care assistance needs like toileting, eating, medication assistance, the source remains your MassHealth PCAs, same as at home. Currently the MassHealth PCA Program evaluation does not take into account employment status. And your employer has only the ADA work-specific personal assistance services obligation as reasonable accommodation under Title I, which must be provided by the employer to enable qualified persons with disabilities to perform job functions, including personal care on required business travel. Job-related assistance might include reader and scribe services for the blind or interpreter services for the Deaf, while a worker with mobility limitations might require help with filing, paperwork, accessing or retrieving work-related items, etc.
Q: But this is my first experience of employment as someone with a disability, and I'm not sure about workplace personal assistance needs will be.
A: This is where a vocational rehabilitation counselor from the Mass. Rehab. Commission (MRC) can work with you and your employer to identify potential assistance requirements based on a review of the job-specific tasks in relation to your abilities and limits.
Q: I can foresee difficulty recruiting PCAs for assistance at the worksite during my work hours.
A: True, the PCA who gets you up in the morning and ready for work may not be available to come to the jobsite to help you with lunch. But the free PCA exchange has many candidates with diverse time and locality availability. You might also be able to recruit co-workers for paid help by enrolling them as service providers in the PCA program.
-Excerpted from Disability Issues, Vol. 35, No. 3 (Fall 2015), December 03, 2015. Read it online.
PCAs' Employment Rights
PCA Overtime Rules
- As of September 1, 2016, a consumer of PCA services is limited to scheduling individual PCA providers to work no more than 50 hours per week unless the consumer has MassHealth approval for overtime.
- PCA providers are limited to working no more than 50 hours per week, whether for one consumer or in total for work performed for multiple consumers.
- (These limits above were initially 40 hours, but advocates successfully lobbied for the increase to 50 hours before needing authorization for OT.)
- A consumer may request authorization to schedule a PCA to work in excess of 10 hours of overtime in a single week under certain circumstances. When authorizing a consumer to schedule a PCA to work overtime in excess of 10 hours, MassHealth will review the consumer’s request and, if approved, will provide either a temporary authorization of up to 12 weeks or a continuity of care authorization for the duration of the consumer’s prior authorization period.
- Temporary Approvals a consumer can apply when the consumer has a temporary need. The request must include the specific reasons(s) needed. Examples include:
- The consumer has planned travel, and it would not be feasible to bring multiple PCAs to provide the consumer’s PCAs services.
- The consumer’s PCAs is temporary unavailable (e.g. vacation, family leave).
- The consumer has a temporary need to schedule their PCA to work additional approved PA hours. (e.g. post-acute hospitalization)
- The consumer’s PCA works greater than 66 hours per week and the Consumer needs time to hire additional PCAs.
- Continuity of Care (COC) approvals last for the duration of the consumer’s PCA prior authorization period and must include specific reason(s). If a PCA works greater than 66 hours per week, the consumer must apply for a Temporary Authorization. A consumer may request when:
- The consumer has complex medical needs that require the specialized skills of the experienced PCA.
- The consumer has communication barriers that require the specialized skills of the experienced PCA.
- The consumer has specialized medical conditions that necessitate fewer PCAs. Examples might include circumstances in which additional PCAs in the consumer’s home would compromise the consumer’s health due to a highly compromised immune system, or a circumstance in which a consumer has significant cognitive impairments or behaviors that impact safety, and that the hiring additional PCAs would cause disruption in security, health and/or safety to the consumer.
- The consumer receives Hospice care.
- The consumer’s PCA has worked with the consumer for 5 or more years.
- (Above from, and more information, including detailed criteria, at: http://www.mass.gov/eohhs/docs/masshealth/memlibrary/pca-coc.pdf)
- Creates a compliance policy which is still under development, but that will likely include 3 warning letters to PCAs with the proposed sanction of termination from the program for occurrences after the warning letters.
- Proposes implementing Electronic Visit Verification (EVV) by January 2018.
- Requires the use of the Rewarding Work website- in addition to marketing efforts, plan to update regulation to require PCA participation in the directory and require consumers sign-up on the directory to receive approval.
- Also see a detailed FAQ for consumers.
- More information: MassHealth PCA Overtime Rules Modified- Now Can Approve Up to 10 Hours OT Without Prior Authorization, MGH Community News, November 2016; MassHealth PCA Overtime Rules Tighten, MGH Community News, July 2016, and updated transition info MassHealth PCA Over-Time Update, MGH Community News, October 2016.
- Background: Court approves overtime pay for PCAs - MGH Community News, August 2015
PCAs in the News
Programs in Other States
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