Utilizing the MassHealth PCA Program
July 19, 2024
July 19, 2024
This is a continuation of the MassHealth PCA overview article.
To utilize the PCA program, you first need to get in touch with a Personal Care Management (PCM) agency. Here is a link to all of the agencies in Massachusetts. Many of these agencies are not aware that children as young as three can qualify for PCA hours, and will tell you that they will not evaluate you. Keep trying! Parents we know have had luck with the following agencies:
Northeast Arc of Massachusetts (Note: some staff will evaluate three-year-olds while some others will refuse. Your mileage may vary.)
You can either call the agency directly to self-refer, or you can have your primary care provider send the paperwork to start a referral on your behalf. If you self-refer, the agency will reach out to your provider for you to get the necessary paperwork.
Once you have gotten a referral to a PCM agency, they will book a meeting (or meetings) for the evaluation. For the evaluation, members of the agency will come into your home and talk to you about you or your child's abilities, their equipment, and what they are and are not able to do independently. Some evaluators are knowledgeable and understanding and will ask you nuanced questions to request the most PCA hours for you, but some do not. It's best to go into the meeting knowing how much work you do for your child on a daily basis - or maybe what you should be doing for your child on a daily basis but don't have the bandwidth for. Things like:
Stairs in the home making transfers longer than usual
All of the equipment you use - gait trainer? stander? wheelchair? other chairs?
All of the prosthetics or other things you wear that take longer to get dressed and undressed
Incontinence issues - changing diapers, outfits, sheets
Exercises that need to be done in the home, like stretching
Medication prep, food prep, and feeding
Extra work needed for bathing or other personal hygiene
Once you go through the evaluation process, the agency will submit the necessary forms to MassHealth and they will come back with an approval, modification, or denial. You will be approved anywhere from zero to the full number of hours that were requested, which is why you want to have an evaluation with as high a number of hours as you can.
(If you did not get approved, or got approved for fewer hours, check out the next article on appealing.)
Yay, woohoo! You've been approved for PCA hours as soon as you get that approval letter (or even earlier - it should tell you when the date starts). But before you start charging hours, your agency should reach out to you to meet once again to walk you through all the required paperwork with the Fiscal Intermediary, Tempus Unlimited. Tempus manages payroll for your PCAs, even though MassHealth funds the PCA program. You must use Tempus for payroll; there are no other fiscal intermediaries in Massachusetts. There will be some paperwork you have to fill out, and some forms you need to keep on display in your home. The agency will also go over what paperwork needs to be filled out for any PCAs you hire. A PCA cannot be a parent or legal guardian of the member, if the member is a minor, or a spouse, but can be almost anybody else. See this PDF for more details.
You can email the PCA paperwork to Tempus at MAFMS@tempusunlimited.org, or you can mail or fax the forms as well. Give Tempus a few business days to process the paperwork (they're pretty quick!), and then call and confirm that you're all set.