Waiver Description
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.
PCA is administered by MassHealth (Massachusetts Medicaid). Participants must be enrolled in MassHealth Standard or CommonHealth. Unlike other home and community based services (HCBS) available through MassHealth, benefits are considered entitlements. Thus, eligible seniors are guaranteed personal care services once enrolled.
With the PCA program, participants are able to self-direct their care. Participants are provided funds by way of a fiscal intermediary. These funds are then used to hire and manage their own personal care attendant, who assists 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.
Eligibility Guidelines
General Requirements
To qualify for this program, individuals must have a persistent or permanent disability that requires them to receive assistance performing at least two of their 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.
Financial Requirements
Applicants must also qualify financially to receive Medicaid (MassHealth), which takes into consideration both their monthly income and assets.
Income Limits
In 2023, the maximum monthly income limit for an individual applicant is $1,616. A married couple is allowed up to $2,186 a month. This figure is equivalent to 133% of the Federal Poverty Level (FPL) and changes annually.
Asset Limits
Single applicants are permitted $2,000 in countable assets, and married couples are allowed up to $3,000. However, several assets are considered exempt and are not counted toward this limit. This includes the home (with an equity value at or under $1,033,000, in 2023, and 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.
Over the Financial 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:
- Assistance with bathing, grooming, dressing, toileting, eating, mobility, and personal hygiene
- Homemaker services, such as housecleaning, laundry, meal preparation, and shopping for essentials
- Assistance with transportation to medical appointments
- Night attendant when necessary
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. A complete list of agencies and contact information is available here. One can also call MassHealth at 800-841-2900.
Additional information about the program can be found here.
