Can You Use MassHealth PCA Hours and a Private Aide Together?

Families do run both, but not in the same hour, and not by quietly paying your own PCA on the side for the same work. The MassHealth PCA regulations say plainly that a PCA must not be receiving compensation from any other person or entity for that activity time, and that MassHealth does not cover time when a PCA is not actually assisting with daily activities. Private pay aide care sits outside the program: separate money, separate paperwork, $45 an hour. Here is how the two fit together without creating a problem for the member or the PCA.

Why would anyone need hours beyond what the PCA program approves?

Three reasons come up over and over. The approved hours cover the tasks the evaluation measured and not the hours a family actually finds hard, which is often evenings and weekends. One PCA cannot work unlimited hours, so a member whose whole plan rests on a single person runs into the weekly limit. And when a PCA calls out, nobody sends a substitute.

On the weekly limit, the current program rules allow a PCA to work up to 50 hours in a week without an overtime prior authorization, and a prior authorization is required above 50 hours and up to 60. The regulations at 130 CMR 422.412(K) do not cover personal care services by a PCA exceeding 60 hours a week in the aggregate, and that aggregate counts hours across every member the PCA works for. We go through that in detail on the PCA weekly hour limit and overtime authorization page.

Can I pay my own PCA extra, out of pocket, for more hours?

Do not arrange that on your own. One of the conditions a PCA has to meet under 130 CMR 422.404 is that the PCA is not receiving compensation from any other person or entity for that activity time. Handing the same person cash for the same kind of care, in hours that sit next to their MassHealth hours, is exactly the arrangement that gets people into trouble, and the person who loses most is usually the member.

The regulations do not spell out what a member may or may not purchase privately outside the program, so we are not going to pretend there is a clean published rule covering every version of this. What we tell families is to ask their PCM agency and MassHealth first, in writing if possible, before any money changes hands. If you want extra hours covered, the cleaner structure is a different worker entirely, employed by someone else.

Can an agency aide work in the house while I am on the PCA program?

Yes, in different hours. This is the arrangement that actually works: the PCA covers the authorized tasks in the authorized hours, and a privately paid aide covers hours the program does not, such as a Saturday afternoon, an evening routine or a stretch of nights while the family is away. Nothing overlaps, each hour has one worker and one payer, and the timesheet tells a straight story.

What you cannot do is have both people on the clock for the same task at the same time and bill MassHealth for the PCA hour anyway. Keep the schedules written down. If a surveyor or your PCM agency ever asks, the answer should be boring.

What time will MassHealth not pay a PCA for?

Several categories are listed in the program regulations. Not covered is time when a PCA is not providing assistance with daily activities, under 130 CMR 422.412(D). Also not covered is time during which the member is participating in a community program funded by MassHealth, which the regulations list as including day habilitation, adult day health, adult foster care and group adult foster care, under 422.412(F). And a member who is a resident of a nursing facility or other inpatient facility is not covered under 422.412(E).

That middle one surprises people. If the member spends weekdays at an adult day health program, those hours are not PCA hours, and a plan built on the assumption that they are will come apart at the first review.

What happens to PCA hours if the member goes into the hospital?

Inpatient time is not PCA time, and this is the single most common place families accidentally submit hours they should not. We covered the details, including the discharge day, on the PCA hours during a hospital stay page. Private pay hours are a different matter, because they are not MassHealth hours at all, which is why some families use a privately paid aide for the first days home.

Who decides how many PCA hours you get, and can that change?

An evaluation does, and the regulations also provide for a reevaluation when a current authorization is expiring, so hours are not fixed forever. If your needs have grown, the evaluation is where that gets recorded, not a conversation with your PCA. If you are not sure how the enrollment, transfer and referral side works, start with the PCA program and PCM agency page.

What does the private side cost?

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. On a 30 day month, three hours twice weekly runs about $1,170, two hours a day about $2,730 and three hours a day about $4,095. An overnight is $540 for a twelve hour night, which is about $16,200 a month if you need every night. Around the clock is $1,080 a day, about $32,800 a month.

Most families adding hours alongside a PCA plan are buying a small, specific block, not round the clock care. A weekend morning or two evenings a week is a common shape.

What can neither a PCA nor a private aide do?

Clinical work. Our aides are trained, background checked and insured, and they are not nurses. They do not administer medication, including insulin, they do not change dressings and they do not make clinical judgments. An aide can be present while the client takes their own medication, help if something goes wrong and call for help. Injections, wound care and clinical assessment are skilled nursing, a separate service, priced separately. If the care plan truly needs a nurse, adding aide hours is not the fix.

Who do I call?

For anything about the PCA program or PCM, email pcm@careremedy.com. For private pay aide hours, call 781 957 8076 or email info@careremedyinc.com. Offices in Woburn, Springfield and Brockton.

Program rules change. The regulation citations above are to 130 CMR 422 as published by the state and the current PCA overtime policy, read in November 2026. Confirm anything that affects your own authorization with MassHealth or your PCM agency, and speak with your own attorney or benefits counselor before making a payment arrangement that involves a worker who is also paid by the program.