Can I Fire My PCA? How to Replace One in Massachusetts

Yes. You are the employer in the MassHealth PCA program, so ending a PCA's employment is your decision and you do not need your PCM agency to approve it. What you do have to do is complete termination paperwork, notify two separate offices, and get the next person cleared before the first shift you cannot cover yourself.

Can I really fire my own PCA?

The consumer employer recruits, hires and, when necessary, terminates PCAs. That is the design of the program, not a loophole. Your PCM agency supports you and your fiscal intermediary runs payroll, but neither one employs your PCA and neither one can make this decision for you or overrule it.

It also means the follow through is yours. Nobody else will file the paperwork, and the program will keep expecting accurate timesheets from you in the meantime.

Do I need a reason, or have to give notice?

The consumer employer handbook does not require you to state a reason or serve a notice period. It tells you to complete termination paperwork when a PCA no longer works for you.

That said, you are an employer, and employers have obligations under state and federal wage law that no handbook replaces. If the situation involves a dispute over hours worked, an injury, a disability question, or anything that feels like it could become a legal matter, talk to your PCM agency first and consider talking to an attorney before you act. For an ordinary case of someone who is unreliable or not a good fit, you can simply end it.

One piece of practical advice: write down dates. Missed shifts, late arrivals and the conversations you had about them are worth a few lines in a notebook. You may never need them, and if you do need them you will not be able to reconstruct them from memory.

Who do I have to tell?

Both of these offices, and the handbook names the same event for each one:

• Your PCM agency, whenever you have hired or terminated a PCA, or a PCA has quit.
• Your fiscal intermediary, for the same event, because it handles the employment paperwork and payroll.

The handbook does not specify an order, so call both the same day and do not assume one tells the other. If a PCA has died, the same termination paperwork applies, which is a hard call to make and worth asking your PCM agency to walk you through.

What happens to the final timesheet and last paycheck?

Approve the hours that were actually worked, including the hours worked on the last day, and submit them the way you always do. Your approval certifies those hours, so review the final one carefully rather than waving it through to end the relationship faster.

The handbook does not publish a deadline for a final paycheck in this program. Ask the fiscal intermediary when the last payment will go out, because that is the question your former PCA will call you about, and the FI is the office that can answer it. Do not withhold approval of worked hours as leverage in a disagreement.

Will I lose my authorized hours?

Your hours belong to you, not to the PCA who was working them. They come from your MassHealth prior authorization, which is based on your own evaluated need, and the handbook does not treat a termination as a reason to change it. PCAs may only work within the hours your authorization allows, which is the relationship between the two.

What you should not do is leave hours unstaffed for months without telling your PCM agency what is happening. Keep them in the loop while you are short, and ask directly whether anything about your authorization is affected in your situation.

Can my PCA file for unemployment, and does that cost me?

Unemployment insurance is one of the benefits PCAs have in this program, so a former PCA may be able to file a claim. On the cost side, the fiscal intermediary files and pays your employer share of state and federal taxes, including unemployment, on your behalf. You are not writing those checks personally.

The handbook does not spell out what a claim means for you as the consumer employer or what you may be asked to respond to. If you get correspondence about an unemployment claim, send it to the fiscal intermediary and ask them to tell you what, if anything, you need to do.

Who covers the shifts while I find somebody?

You are supposed to already have an answer to this. The service agreement your PCM agency writes must include a backup plan for when your regular PCA is unavailable, and you are expected to identify a backup PCA. If that line in your service agreement is currently the name of a relative who moved away two years ago, fix it now rather than during the next gap.

Here is the part that catches people. A backup PCA cannot just start. They have to complete the new hire paperwork and be issued a PCA identification number before you schedule them, which means a backup who exists only as a phone number in your drawer is not actually a backup. Get your backup through the paperwork while you still have your main PCA. You are also allowed to hire more than one PCA rather than asking a single person to absorb every extra hour.

More on that in what to do when your PCA calls out and what being the employer in the PCA program involves.

Can my surrogate fire a PCA for me?

It depends which role you mean, and the two are not interchangeable. A surrogate can take on part or all of the consumer employer responsibilities, and must attend the PCM evaluation. An administrative proxy can only perform administrative functions. Neither one can be your PCA.

If your PCM agency determines you need a surrogate, you have 30 days to find one, and it is a volunteer position rather than a paid one. This matters more than it sounds: if no surrogate is chosen, the PCM agency may refer you to MassHealth for termination from the program. Ask your PCM agency to put in writing which decisions your surrogate is authorized to make, including hiring and termination, so there is no argument about it later. See who needs a surrogate in the PCA program.

What if my PCA just quits with no notice?

Same two phone calls, same paperwork. Call your PCM agency and your fiscal intermediary, approve the hours that were worked, and move to your backup. A PCA who quits is one of the exact events the handbook tells you to report, so do not sit on it waiting to see whether they come back.

What if I need somebody in the house tomorrow?

Paid aide coverage is the stopgap when the PCA paperwork has not caught up with the gap in your schedule.

Try the free and funded routes first. Your PCM agency is the first call, because that is what they are there for, and a relative or neighbor who is willing to go through the new hire paperwork is cheaper than anything we sell.

If the gap is now and the paperwork will take longer than you can wait, our home health aide care is $45 an hour, one to eight hours a day, with no minimum contract, no assessment fee and no four hour minimum per visit. Three hours twice a week runs about $1,170 a month. Two hours a day is about $2,730 and three hours a day about $4,095. An overnight is $540 for a twelve hour night. We employ, train, insure and schedule the aide, so the hiring and timesheet work is not yours.

Privately paid aide hours are billed to you and are separate from your MassHealth funded PCA hours. Tell your PCM agency what you are arranging so the two schedules do not create a timesheet problem, and ask them how to record it.

Our aides are trained, background checked and insured, and they are not nurses. They do not administer medication of any kind, including insulin, do not change dressings, and do not make clinical judgments. They can be present while a client manages their own medication, help if something goes wrong, and call for help. Skilled nursing is a separate service.

Who do I call about what?

• Termination and hiring notifications, your authorized hours, the service agreement and backup plan, surrogate questions: your PCM agency.
• Termination paperwork, new hire paperwork, final pay, unemployment correspondence: your fiscal intermediary.
• Eligibility and coverage: MassHealth Customer Service at 800 841 2900, TDD and TTY 711.

Care Remedy is a PCM agency and serves clients across Massachusetts from offices in Woburn, Springfield and Brockton. For PCA and PCM questions or a referral, email pcm@careremedy.com. For aide coverage, call 781 957 8076 or email info@careremedyinc.com.

Program rules change and employment law is specific to your situation. Confirm program requirements with your PCM agency or MassHealth, payroll questions with your fiscal intermediary, and anything that may become a legal dispute with your own attorney.