“If you or a loved one is a MassHealth member who receives hands-on support from a Personal Care Attendant (PCA) but are struggling to access these services during the COVID-19 outbreak, call the MassOptions hotline at 1-844-422-6277″
The PCA Program is a MassHealth program that helps people with permanent or chronic disabilities keep their independence, stay in the community, and manage their own personal care by providing funds to hire personal care attendants (PCAs).
The PCA consumer (the person receiving PCA services) is the employer of the PCA, and is fully responsible for recruiting, hiring, scheduling, training, and, if necessary, firing PCAs.
Who is eligible for the PCA Program?
You may apply for the PCA Program if you are eligible for MassHealth Standard or CommonHealth, and you have approval from your doctor for PCA services; a chronic or permanent disability that prevents you from performing your own personal care; and a need for physical (hands-on) assistance with at least two of seven activities of daily living (ADLs) (mobility, bathing/grooming, dressing/undressing, passive range-of-motion exercises, taking medications, eating, and toileting).
To begin using PCA services, contact a Ethos, who will need to obtain an authorization from MassHealth for you. If you are enrolled in the MassHealth Primary Care Clinician (PCC) Plan, your PCC may provide a referral for you. Ethos can get this referral for you.
If you are enrolled in a Senior Care Option (SCO) or the Program of All-Inclusive Care for the Elderly (PACE), personal care services will be provided through the SCO or PACE.
What is a personal care attendant?
A personal care attendant (PCA) is a person who is recruited and hired by you to physically assist you in performing ADLs and instrumental activities of daily living (IADLs). IADLs include household services such as laundry, shopping, housekeeping, meal preparation, transportation to medical providers, and other special needs. You may hire one or more PCAs, as necessary, to meet your needs.
How do I apply for PCA services?
To apply for PCA services, you must contact Ethos or another a PCM agency. You will then be evaluated for your need for PCA services and submit a prior-authorization request to MassHealth for you. You may also call MassHealth Customer Service at 1-800-841-2900.
Who decides if I am eligible for the PCA Program and how many PCA hours I can receive?
Ethos, or the PCM agency you select will provide information that will allow MassHealth to decide if you qualify for PCA services, and how many hours of PCA services you are eligible to receive. A registered nurse and occupational therapist will then be to your home to evaluate the type and level of physical assistance you need to perform your ADLs and IADLs.