Waiver Description
MassHealth PCA program allows family members to be paid for the personal care assistance they provide.
The Personal Care Attendant (PCA) program provides personal care services to elderly and disabled Massachusetts’ residents. A goal of this program is to enable independent living and prevent unnecessary or premature nursing home institutionalization. Thus, 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 requirements.
This program is administered by Massachusetts Medicaid, which is called MassHealth. Participants must be enrolled in MassHealth Standard or CommonHealth. Unlike other Home and Community Based Services (HCBS) through MassHealth, benefits are considered entitlements. Thus, 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 manage 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. If the applicant is not able to manage his or her care, a friend or relative may fill this role.
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 caregivers employed through this program. As 2022, the rate is approximately $18.15 / hour, which is well below the average hourly rate for home care in Massachusetts, which is approximately $31 / hour in 2022 according to Genworth’s Cost of Care Calculator.
Eligibility Guidelines
To qualify for this program, individuals must have a persistent or permanent disability that requires them to receive assistance to perform at least two of the activities of daily living, such as bathing, grooming, eating, toileting, mobility, and personal hygiene. In addition, a doctor or nurse practitioner must deem personal care services necessary. 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
In 2022, for an individual applicant, the maximum monthly countable income is $1,133, and for a married couple, it is $1,526. This figure is equivalent to 100% of the Federal Poverty Level (FPL) and changes on an annual basis. However, this program allows seniors to deduct what is called an Increased Unearned Income Disregard from their income.
PCA Program Asset Limits
The program asset limits are the same as MassHealth’s limits for the elderly. Single applicants are permitted $2,000 in countable assets and married couples are able to retain up to $3,000. However, several assets are considered exempt and are not counted towards this limit. This includes one home (with an equity value at or under $955,000 in 2022), if the applicant or his or her spouse lives in the home, burial plots, life insurance policies with a face value under $1,500, and personal items.
Options for Persons Over the Limits
Having income or assets over MassHealth’s limits does not necessarily prevent needy residents from receiving these services and supports. The state offers a Medically Needy program that allows families with high medical bills relative to their income to “spend down” their excess income in order to qualify for benefits. Another option is to work with a Medicaid planner or elder law attorney who can help rearrange one’s finances so 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 about application assistance.
Benefits and Services
Program administrators review the medical conditions of each applicant to determine the types of services and the number of hours per week assistance is required. (One can receive up to 50 hours of personal care assistance per week. In some cases, overtime may be approved.) 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, dressing, toileting, eating, mobility, and personal hygiene, as well as homemaker services, such as housecleaning, laundry, meal preparation, and shopping for essentials. Assistance with transportation to go to a medical appointment is also considered an eligible service. Night attendant services may be available if a participant requires assistance during the night.
How to Apply / Learn More
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 on the state’s website. Or one can call MassHealth at 1-800-841-2900.
