MassHealth Personal Care Attendant (PCA) Program
The MassHealth Personal Care Attendant (PCA) Program helps MassHealth members with permanent or chronic disabilities hire their own personal care attendants. It is consumer-directed: the member is the employer. For the wider picture, see our Massachusetts Long-Term Care Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
At a glance
| Item | Details |
|---|---|
| Type of program | Self-directed (consumer-directed) home care |
| Who runs it | MassHealth, with Personal Care Management (PCM) agencies |
| Age | Any age |
| Care need | Needs physical help with at least two activities of daily living |
| Massachusetts 2026 income rule (long-term care) | Home care waivers: under $2,982 a month (300% of the SSI rate) |
| Massachusetts 2026 asset limit (single applicant) | $2,000 |
| Waiting list | No |
The PCA Program in brief
To sum up, MassHealth, with Personal Care Management (PCM) agencies oversees the PCA Program. It serves any age, and the care requirement is: Needs physical help with at least two activities of daily living. On waiting lists, the current picture is: No. The sections below repeat these points with more detail, and our state guide covers the Massachusetts rules that apply to every long-term care program. If the PCA Program is not the right fit, the related pages at the end point to other Massachusetts programs and general guides.
What the program is
In the PCA Program, the MassHealth member (the “consumer”) is the employer of record for day-to-day purposes. A Personal Care Management (PCM) agency does the initial evaluation, which sets the number of hours per week MassHealth will pay for, and offers skills training on hiring and supervising attendants. A fiscal intermediary processes timesheets, pays the attendant and handles payroll taxes. If the consumer cannot manage the employer role, a surrogate, often a family member, can do it for them. Attendants are paid an hourly wage set through the state’s collective bargaining agreement with PCA workers.
Under self-direction, the member or a representative hires, trains and supervises the workers. Payroll and tax paperwork runs through a fiscal intermediary. Who can be paid varies by program, especially for spouses. See Consumer-directed care and Paid family caregivers.
Who qualifies in 2026
In Massachusetts, the basic requirements for the PCA Program are that the person:
- Has MassHealth Standard or CommonHealth
- Has a permanent or chronic disability
- Needs physical help with two or more activities of daily living
- Can direct care or has a surrogate
Financial eligibility. The person must have MassHealth Standard or CommonHealth. Our state guide covers the rules. The table’s figures are Massachusetts’s 2026 long-term care numbers, taken from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs the PCA Program, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.
About the level-of-care assessment. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. A nurse or social worker working with MassHealth usually does it in person, wherever the person is living. Families should describe the worst days honestly and bring a list of conditions and medicines. See Nursing home level of care and Activities of daily living.
What services it can pay for
The plan of care decides which services are used. The PCA Program can cover:
- Help with bathing, dressing, eating and toileting
- Mobility and transfers
- Medication help
- Meal preparation, laundry and housekeeping tied to care
No program pays for everything. The PCA Program services are based on assessed need, and a family caregiver who is already helping is usually counted when the plan is written. If needs change, ask for a new assessment.
How to apply
Getting the PCA Program means passing a money test and a care test. Step by step:
- Contact a PCM agency.
- Complete the evaluation.
- Hire your attendant.
Our documents checklist and Applying for a waiver guide list the paperwork.
Waiting lists
The PCA Program is a MassHealth state plan service, so there is no waiting list for people who qualify. Delays usually come from scheduling the PCM evaluation or finding an attendant. Some PCM agencies keep lists of available workers.
More on how lists work: Waiver waiting lists.
How it relates to nursing home Medicaid
PCA does not require a nursing facility level of care, but many PCA consumers have needs that would otherwise lead to a nursing home or a move to assisted living. PCA can be used together with the Frail Elder Waiver or Senior Care Options. Massachusetts long-term care rules, including the look-back and estate recovery, apply to MassHealth members 55 and older who receive these services.
Rules shared with nursing home Medicaid. Massachusetts’s financial rules for the PCA Program track the nursing home rules closely. The five-year look-back still matters: a transfer for less than fair value can delay payment for long-term care services. MassHealth can also use estate recovery to seek repayment for long-term care services received after 55. People who keep income above a set allowance may have to pay part of it toward their care each month.
Income in a nursing home. In 2026, Massachusetts lets a nursing home resident keep $72.80 a month for personal needs; the rest of their income mostly pays toward care. Our state guide covers the nursing home rules in detail.
Tips for families
- Begin before it is urgent. Every step of the PCA Program takes time, and an early request protects your place.
- Keep copies of every the PCA Program form, notice and letter, and write down the name of each person you speak with and the date.
- Read every notice. If services are denied, cut or ended, the notice explains how to request a fair hearing and the deadline. Requesting one before the deadline often keeps services in place during the appeal.
- Tell MassHealth about changes in money, address or household as they happen.
- Expect yearly reviews of both Medicaid eligibility and the care assessment. See Renewals.
- Get help with complex the PCA Program cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how Massachusetts’s rules fit a family’s situation.
Common questions
Can my daughter be my PCA? Yes. Family members other than a spouse can be paid as PCAs. A surrogate cannot also be the paid PCA.
Is there a waiting list? No. It is a state plan benefit.
Who decides the hours? The PCM agency’s evaluation, approved by MassHealth, sets the weekly hours.
What if I cannot manage hiring? A surrogate can take on the employer tasks for you.
Related pages
- Massachusetts Long-Term Care Medicaid guide
- Consumer-directed care
- Three kinds of Long-Term Care Medicaid
- PACE programs
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.