PERSONAL CARE ASSISTANT (PCA) SERVICES PROVIDER IN MASSACHUSETTS

Fatumata Kaba
Aug 8
3 min read

SUPPORTING INDEPENDENCE THROUGH CONSUMER-DIRECTED PERSONAL CARE FOR INDIVIDUALS WITH CHRONIC ILLNESS OR DISABILITIES

In Massachusetts, PCA Services are offered through a unique consumer-directed model managed by MassHealth (the state Medicaid program). Unlike other states where agencies employ aides directly, MassHealth PCA consumers act as the employer of their PCAs. However, provider agencies (called PCM agencies) play a key role in assessing eligibility and supporting access to PCA services.

1. GOVERNING AGENCIES

Agency: MassHealth (Massachusetts Medicaid)

Role: Administers and funds the PCA program under the Medicaid State Plan

Agency: Executive Office of Health and Human Services (EOHHS)

Role: Oversees regulation and contracts for PCA services and PCM agencies

Agency: Personal Care Management (PCM) Agencies

Role: Conduct evaluations, assist with PCA hiring and training, and help consumers with management

Agency: Fiscal Intermediary (FI) Providers

Role: Handle payroll, tax compliance, and timesheets for PCA workers

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight of state Medicaid-funded PCA services

2. PERSONAL CARE ASSISTANT SERVICE OVERVIEW

Personal Care Assistants provide hands-on, non-medical support with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Typical tasks include:

Bathing, grooming, and dressing
Toileting and hygiene support
Eating and meal preparation
Transferring and ambulation assistance
Laundry, light housekeeping, and shopping
Cueing and supervision for memory support

All services are authorized via a PCA Evaluation and detailed in a Prior Authorization (PA) approved by MassHealth.

3. ELIGIBILITY & CONSUMER MODEL

Massachusetts uses a self-directed model:

The consumer is the employer: They hire, train, schedule, and terminate their own PCAs.
The PCM agency provides functional skills training and evaluation but does not directly employ the PCA.
The FI provider pays the PCA and handles tax reporting on behalf of the consumer.

To qualify for PCA services:

The individual must be MassHealth eligible (Standard or CommonHealth)
Require hands-on assistance with two or more ADLs
Be capable of managing their care independently or through a surrogate

4. BECOMING A PERSONAL CARE MANAGEMENT (PCM) AGENCY

To support the PCA program, your agency must be awarded a PCM contract by MassHealth.

Requirements:

Nonprofit or public agency status (typically required)
Experience in disability services, care planning, and ADL assessments
Staff RNs or qualified evaluators
Multilingual and culturally competent services
Capacity to assist with intake, skills training, and MassHealth documentation

PCM agencies do not employ PCAs. Instead, they act as administrative and clinical intermediaries between the consumer, MassHealth, and the FI.

5. DOCUMENTATION REQUIREMENTS (FOR PCM AGENCIES)

Articles of Incorporation and 501(c)(3) status
Staff licenses (RN, OT) and resumes
Functional skills training curriculum
Policies on consumer rights, grievances, and language access
MassHealth contract compliance policies
Confidentiality and HIPAA documentation
Referral, evaluation, and prior authorization templates

6. STAFFING REQUIREMENTS

Role: PCA Evaluator (RN or Licensed Therapist)

Requirements: Must perform functional skills assessment and develop PCA plans

Role: PCA Skills Trainer

Requirements: Provides training and documentation support for consumers managing their own aides

Role: Program Coordinator

Requirements: Manages compliance, documentation, and referral relationships

Training Requirements:

MassHealth PCA training manual
ADA compliance and person-centered practices
Confidentiality, rights protection, and HIPAA
Cultural competence and language access standards

7. MASSHEALTH PAYMENT & FISCAL INTERMEDIARY SYSTEM

PCA workers are paid by a Fiscal Intermediary (FI) (e.g., Tempus Unlimited or Northeast Arc)
PCM agencies are reimbursed by MassHealth for evaluations, authorizations, and skills training
PCAs are typically paid hourly, and rates are determined by the PCA union agreement

Key systems:

EIM/EVV (Electronic Visit Verification) may apply
Timesheets and documentation are submitted by consumers and PCAs to the FI

8. TIMELINE TO LAUNCH (FOR PCM AGENCY)

Phase: Nonprofit Formation and Infrastructure Setup

Timeline: 2–4 weeks

Phase: Staffing, Training, and Policy Manual

Timeline: 3–5 weeks

Phase: Apply for MassHealth PCA Program Contract (RFR opens periodically)Timeline: Varies based on open RFR

Phase: Referral Coordination and Service Launch

Timeline: Ongoing, once approved

9. CONTACT INFORMATION

MassHealth Customer Service

Website: https://www.mass.gov/topics/masshealth

Phone: 1-800-841-2900

MassHealth PCA Program Info

Website: https://www.mass.gov/personal-care-attendant-program

Fiscal Intermediary Providers (e.g., Tempus Unlimited)

Website: https://www.tempusunlimited.org

MassHealth Provider Enrollment (ePAY/eCredentialing)

Website: https://massfinance.ehs.state.ma.us/

PERSONAL CARE ASSISTANT (PCA) SERVICES PROVIDER IN MASSACHUSETTS

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS PCA SERVICES

We support mission-aligned organizations and nonprofits in launching or partnering with PCM agencies to deliver high-quality, person-centered PCA support across Massachusetts.

Scope of Work: