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The PCA program provides personal care services to elderly and disabled Massachusetts residents. A goal of the program is to enable independent living and prevent unnecessary or premature nursing home institutionalization. Therefore, individuals who wish to remain living in their homes or in the homes of family members will want to look further into this program's benefits and eligibility criteria. This program is administered by Massachusetts Medicaid, called MassHealth, and participants must be enrolled in MassHealth Standard or CommonHealth. Unlike other home and community based services through MassHealth, benefits are considered entitlements, so eligible seniors are guaranteed personal care services once enrolled.
The PCA Program is based on Medicaid's principle of Cash and Counseling in which the participants are responsible for the self-direction of their care. Individuals are provided with funds, by way of a fiscal intermediary. Participants use these funds to hire and managed their own personal care attendants to assist them with their activities of daily living and other tasks around the home. The program participant acts as an employer.
In Massachusetts, individuals can hire friends, neighbors and even some family members to work as their personal care attendant. While spouses and legal guardians are not eligible to be hired, adult children, friends and former spouses can be hired and paid for the caregiving services they provide. State officials set a standard uniform hourly wage for caregiver employed through this program. At approximately $14.50 / hour, this figure is well below the average hourly rate for home care in Massachusetts, which is $23 / hour in 2016.
To qualify for this program, an individual must have a permanent disability that requires them to receive assistance to perform at least two of the activities of daily living such as bathing, grooming, eating and personal hygiene. The PCA Program does not have an age requirement though it is intended for adults, not children. If you are over 65, the state makes some additional exceptions for seniors to reduce their countable income.
Applicants must be financially qualified to receive Medicaid (MassHealth) which takes into consideration (for residents over 65) both their monthly income and their assets.
PCA Program Income Limits
For an individual applicant, the maximum monthly countable income is $1025 in 2017. However, this program allows seniors to deduct approximately $750 / month from their income so the effective monthly income limit for seniors is approximately $1,775. Couples have an income limit of $1355 per month.
PCA Program Asset Limits
The program limits are the same as MassHealth's limits for the elderly, single applicants are permitted $2,000 in countable assets and $3,000 for a couple.
Options for Persons Over the Limits
Having income or assets over MassHealth's limits does not necessarily preclude needy residents from receiving these services and supports. The state offers a Medically Needy program that allows families partial benefits with cost-sharing. Another option is to work a Medicaid planner or elder law attorney who can help to arrange one's finances so that they meet the eligibility guidelines. By re-allocating countable income and assets into income trusts and other forms of non-countable resources, persons who exceed the limits can still qualify for MassHealth. Read more application assistance.
Program administrators review the medical conditions of each applicant to determine the types of services and the number of hours per week they require assistance. Program staff set a specific budget for personal care services to ensure that the participant has help with the activities and instrumental activities of daily living. These include personal assistance with bathing, grooming, toileting, eating and personal hygiene as well as homemaker services, such as housecleaning, laundry, meal preparation and shopping for essentials. Assistance with transportation is also considered an eligible service.
One applies for PCA services by going through a Personal Care Management (PCM) Agency and completing a Senior Application to MassHealth. Candidates will need to document the level and nature of personal care needed. A complete list of agencies and contact information is available in this downloadable PDF Consumer Handbook. Alternatively, one can call MassHealth at 1-800-841-2900.