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.

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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/

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10. SCOPE OF WORK

• Nonprofit registration and MassHealth credentialing guidance
• Policy manual development for PCA assessments and consumer support
• Templates for evaluations, service logs, and consumer training
• Compliance tracking and contract readiness review
• Fiscal Intermediary partnership facilitation
• Website, intake forms, and multilingual outreach materials