What Is a Fiscal Intermediary in the MassHealth PCA Program?

The fiscal intermediary is the payroll organization MassHealth contracts with to handle the employer paperwork behind your PCA: it processes the hours you approve, issues the paycheck, withholds and files the taxes, carries workers compensation for your PCAs and sends the W2 at year end. It is not your PCA's employer. You are. And it is a different organization from your PCM agency, which is where most of the confusion starts.

Two organizations, two jobs. The PCM agency helps you run the program. The fiscal intermediary runs the payroll.

What does the fiscal intermediary actually do?

• Receives and processes the PCA activity forms you review and approve through electronic visit verification
• Issues the payments to your PCAs
• Files and pays your share of state and federal employment taxes, including unemployment and Paid Family and Medical Leave
• Obtains workers compensation insurance covering your PCAs
• Issues the W2 forms at the end of the year
• Sends the new hire welcome packet and the visit verification start packet, issues the PCA identification number, and handles new hire paperwork such as the W4, the M4, the I9 and direct deposit
• Helps your PCA get set up on electronic visit verification
• As of spring 2026, can run a background check on a PCA you are considering if you ask for one

Is the fiscal intermediary my PCA's employer?

No. You are, and the consumer handbook is blunt about it: PCAs are employees of the consumer employer, not of the Commonwealth of Massachusetts and not of the fiscal intermediary. You recruit, hire, schedule, train, supervise and if necessary fire your own PCAs. The fiscal intermediary never tells your PCA when to show up and cannot discipline anyone for you. Two rules follow from that and both are strict: you must never endorse, deposit or cash your PCA's paycheck, and PCAs are never paid in cash.

What is the difference between the fiscal intermediary and my PCM agency?

Different contracts, different jobs. A personal care management agency helps you apply for and manage the program. It explains the rules, assesses whether you can run the program on your own or need a surrogate, sends prior authorization requests to MassHealth, provides ongoing skills training, and works with you on a written service agreement that has to include a backup plan for when a PCA does not arrive.

The evaluation runs through the PCM too. A skills trainer visits your home, a summary form goes to your doctor for signature, and an evaluation team including a nurse and an occupational therapist decides the type and amount of help you need with activities of daily living and household tasks. You review and sign that evaluation before it goes to MassHealth, which then approves, modifies or denies it. You meet a skills trainer at least every three months during your first year and annually after that, and the PCM is who you go to when your needs change and the approved hours no longer fit.

What a PCM does not touch is money. The state's own orientation material says it plainly: PCM agencies have nothing to do with PCA payment issues. Care Remedy is a MassHealth personal care management agency. We are not a fiscal intermediary, and we do not issue your PCA's paycheck.

Who do I call when my PCA has not been paid?

The fiscal intermediary, not your PCM and not MassHealth customer service. The fiscal intermediary holds the timesheet, the payroll record and the tax withholding, so it is the only one that can find a missing payment or correct an activity form you already submitted. Call them first, with your PCA if possible, because the two of you hold different halves of the record. If the fiscal intermediary cannot resolve it, your PCM agency is the next call, and the union and the Attorney General's office sit behind that for a PCA who still is not paid.

What delays a PCA paycheck?

Two mistakes cause most of it: an unsigned timesheet, and the wrong half of the clock. Entering 12:00 am when the shift was 12:00 pm is the classic, and it will stall a check. Timesheets have to show the hours actually worked and must not be signed in advance of the work. Your PCA signs under pain and penalty of perjury, and when you approve the hours you are certifying that your PCA worked them. If the information is not true, the Attorney General's office can bring fraud charges against the PCA and against the consumer, so never sign a blank form and never let a PCA do it either.

One more trap worth knowing: if a PCA works overtime hours that MassHealth did not approve in advance, you as the employer can be left owing the difference yourself. Watch the weekly schedule against your approved hours. If your hours were reduced and the schedule no longer works, see how to appeal a cut in PCA hours, and for how the number is set in the first place, how MassHealth decides how many PCA hours you get.

Do I choose my fiscal intermediary, and does any of this cost me money?

You choose your PCM agency, and MassHealth customer service at 800 841 2900 keeps the list of them. The fiscal intermediary works differently: the handbook describes it as an organization under contract with MassHealth rather than something you shop for the way you pick a PCM, so ask your PCM agency which fiscal intermediary handles your payroll rather than assuming the choice is yours. Neither one bills you for taking part in the program. The costs that can land on you are narrower than people fear: unapproved overtime, and holiday hours once the holiday allowance is used up.

What if I need help the PCA program does not cover?

PCA hours cover hands on help with daily activities and household tasks, in the amount MassHealth approved, and nothing beyond that. They do not cover a ride to an appointment, and they do not cover the hours you wish you had. Private home health aide care is $45 an hour, one to eight hours a day, with no minimum contract and no assessment fee. Wheelchair accessible transportation is $115 each way and $230 round trip within five miles, then $2 a mile beyond that.

Our aides are trained, background checked and insured, and they are not nurses. They do not administer medication, including insulin, do not change dressings and do not make clinical judgments. An aide can be present while you manage your own medication, help if something goes wrong and call for help.

Program rules, forms and background check requirements change, and your approval is specific to you. Confirm anything that affects your own case with your PCM agency or with MassHealth before you act on it.

Care Remedy is a MassHealth personal care management agency with offices in Woburn, Brockton and Springfield. For PCA and PCM questions or a referral, email pcm@careremedy.com or call 781 957 8076. You can also read how to enroll with or transfer to our PCM agency.