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Personal Care Attendant Program

The Personal Care Attendant (PCA) Program is a MassHealth program that helps people with long-term disabilities live independently at home by giving eligible MassHealth members funds to hire PCAs to help with activities of daily living.

It is a “consumer directed” program funded by MassHealth. Consumers assume the responsibility for hiring their own personal care attendants to meet their specific care needs.

9/11 memorial statue
A 9/11 memorial statue on Norfolk Common
/Photo by Stephen Corso

What can PCAs help you with?

PCAs can help with activities of daily living (ADLs) such as:

  • Mobility and transfers
  • Bathing and grooming
  • Dressing and undressing
  • Range of motion exercises
  • Taking medications
  • Eating
  • Toileting

PCAs can also help with instrumental activities of daily living (IADLs) such as:

  • Meal preparation and clean up
  • Laundry
  • Housekeeping
  • Transportation to medical appointments
  • Shopping
  • Maintaining adaptive equipment

Eligibility requirements for the PCA Program

PCA services are open to Medicaid/MassHealth eligible consumers, regardless of their age, as long as they meet these other conditions:

  • The consumer must have a permanent or chronic disability and must require physical assistance with two or more ADLs.
  • The consumer’s physician must prescribe PCA services.
  • The consumer must live in the community
  • The consumer must be able to manage the program independently or have a surrogate who is willing to assist them.

PCA deduction for seniors

MassHealth has special income eligibility rules for people age 65 and older who need PCAs. The rules allow a PCA deduction that lowers countable income and makes it easier to meet the MassHealth Standard income limits.

Seniors age 65 or older and individuals needing long-term care who would qualify for MassHealth Standard except that their income or assets are too high, can become eligible by meeting a deductible and/or spending down their assets. Seniors who are in need of PCA services can take a special PCA deduction from unearned income.

Seniors age 65 or older who qualify for personal care attendant services through MassHealth can take a special PCA deduction from unearned income. For 2013, the PCA deduction equals $752 for an individual. The PCA deduction is calculated by subtracting the Deductible Income Standard from 133% of the Federal Poverty Guidelines.

The PCA deduction reduces countable income and allows some over-income seniors to qualify for MassHealth Standard. Seniors must have countable income greater than 100% of the Federal Poverty Guidelines before the PCA deduction to qualify. Seniors taking the PCA deduction cannot take the standard $20 income disregard.

What caregivers need to know about the PCA Program

  • MassHealth reimburses the work done by PCAs based on the amount of time approved.
  • Only 1 in 4 consumers in the PCA Program are over the age of 65.
  • The average annual benefit under the PCA Program is $17,500, which is roughly six times higher than the annual benefit in the state’s home care program. But there are eight times as many elders in the home care program as there are in the PCA Program.
  • There is no age limitation for participation in the PCA Program.
  • A PCA is a person hired, trained and directed by you, the consumer, to do things that you are physically unable to do for yourself. The help a PCA provides enables you to live more independently.
  • The PCA can be someone already known and trusted, including certain family members such as siblings, children, cousins, in-laws and grandparents. MassHealth does not allow a consumer to hire their parents, spouse, surrogate or legal guardian as their PCA.

What MetroWest caregivers should know

Three of the area’s Aging Service Access Points are among the 28 agencies that manage the PCA Program. That includes BayPath Elder Services, Inc. (visit website), which offers the program to residents of its 14 towns (Ashland, Dover, Framingham, Holliston, Hopkinton, Hudson, Marlborough, Natick, Northborough, Sherborn, Southborough, Sudbury, Wayland, Westborough). BayPath can also provide services to residents outside of that area, including MetroWest towns like Acton, Bellingham, Boxborough, Canton, Maynard, Medfield, Medway, Millis, Needham, Norfolk, Stow, Walpole, Waltham and Wellesley.

For other MetroWest residents, Tri-Valley, Inc. (visit website), which serves Bellingham, Franklin, Hopedale, Medway, Mendon and Milford, also offers a PCA program. For information about PCA programs elsewhere in the state, you can call 1-800-AGE-INFO.  

The PCA staff at BayPath, Tri-Valley or other ASAPs with the program will evaluate all client referrals. This information is then submitted to MassHealth for approval. Following approval, the ASAP staff work with the consumer, providing instruction and support in the hiring, training and managing of PCAs.

The consumer submits bi-weekly time sheets for PCA service and a fiscal intermediary issues paychecks. The consumer has the option of designating a surrogate to take responsibility for the administrative aspects of their program.

Related information and additional web resources

  • PCA Consumer Handbook – Available at Massachusetts official state site.
  • Where to find a PCA – A comprehensive list of available professional PCAs can be found on the Massachusetts PCA Workforce Council’s PCA directory.

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BayPath Elder Services, Inc

Caregiving MetroWest is a no-cost program of BayPath Elder Services, Inc.

MetroWest Health Foundation

Caregiving MetroWest was made possible in part by grants from the MetroWest Health Foundation.