Can a Spouse Be a Paid PCA in Massachusetts?

No. A husband or wife cannot be paid as a PCA through the MassHealth Personal Care Attendant program. People find that out late and it is a hard conversation, so here is the actual rule and what the real options are.

What exactly does the rule say?

MassHealth regulations define a family member at 130 CMR 422.402 as the spouse of the member, the parent of a minor member including an adoptive parent, or any legally responsible relative. Then 130 CMR 422.411 says a PCA must not be a family member as defined there.

So the bar is not about skill or willingness. It is a category. A spouse is a legally responsible relative, and legally responsible relatives are not payable as PCAs. The same goes for a parent of a minor child and for a legal guardian.

Who can be paid, then?

Quite a lot of people, actually. Relatives who are not legally responsible for the member can be hired and paid, and that includes:

• An adult son or daughter caring for a parent
• A parent caring for an adult child
• A brother or sister
• A son in law or daughter in law
• A grandchild, a niece, a nephew, a cousin
• A friend, a neighbor, or somebody you find and hire yourself

That last point surprises people too. In this program the member is the employer. You find and hire your own PCAs. Our page on being the employer in the PCA program walks through what that actually involves, and getting paid to care for a parent covers the adult child case step by step.

What about a parent and a child?

It depends entirely on the child's age. A parent of a minor child is a legally responsible relative and cannot be paid. A parent of an adult child can be. The birthday genuinely changes the answer, which catches families off guard right around the time a disabled child turns eighteen and everything else about their benefits is changing too.

For a minor child there is a separate issue on top of that, which is how many hours get approved at all once parental responsibility is factored in. We covered that in PCA hours for a child and parental responsibility.

Can I be the surrogate and also be the PCA?

No. The surrogate and the PCA have to be two different people. The surrogate's job is to direct and supervise the care on the member's behalf, so letting one person be both the supervisor and the worker defeats the whole structure. The regulations are explicit that a surrogate cannot also be the PCA, and that the surrogate's own time is not paid.

A surrogate is required when the member is a minor or has a court appointed guardian. See who needs a PCA surrogate for the detail.

My spouse is the only person doing this. What are our options?

This is the real question behind the first one, so here are the honest answers rather than a brochure answer.

• Hire somebody else for the authorized hours. An adult child, a sibling, a neighbor, a hired PCA. The spouse keeps doing all the parts nobody pays for anyway, and gets some of the day back. For most couples this is the answer.
• Do not assume Adult Foster Care solves it. It is the program families most often hear about next, and legally responsible relatives and guardians are excluded from pay there as well.
• Ask about EAEDC. That is cash assistance rather than a wage, and the rules on who can be a caretaker are different. Ask your local office whether it applies to your situation.
• Check VA benefits if there is service history. Aid and Attendance pays the veteran, not the caregiver, but that money can then pay for help. A spouse is typically excluded from being the paid caregiver under the VA's directed care option too, so read the terms closely.
• Buy a few hours privately. Not the whole schedule. The two or three hours a day that would let the spouse sleep, work, or go to their own doctor.

Where does Care Remedy fit?

We hold a Personal Care Management contract, which means we are one of the agencies that can take a MassHealth PCA case: the intake, the evaluation, the paperwork, the hours request, and the training that helps a member manage their own PCAs. If you are trying to get into the program or move your case, that is work we do.

We also provide home health aide care paid privately, at $45 an hour , from one to eight hours a day, with no minimum contract and no assessment fee. Families use that to fill the gap the program leaves, or to get help immediately while an application is still moving. Three hours twice a week runs about $1,170 a month. Two hours a day runs about $2,730. Our aides are trained, background checked and insured, and they are not nurses, so they do not administer medication or change dressings.

Who to call

For anything PCA or Personal Care Management, email pcm@careremedy.com, which goes straight to that team. For private hours or transportation, call 781 957 8076 or email info@careremedyinc.com. Our offices are in Woburn, Springfield and Brockton.

One caution. Program rules change, and your own situation may have details that change the answer. We are a provider, not your attorney or your benefits counselor, so confirm anything here with MassHealth or with a benefits advisor before you plan around it.