The most common reason people are found ineligible is cueing. If your mother needs reminding rather than lifting, PCA does not cover it, however much supervision she actually needs. The regulation excludes cueing, prompting, supervision, guiding and coaching by name. PCA pays for physical, hands on assistance with at least two activities of daily living, and nothing else counts toward the two.

What are the seven ADLs?

These are the only things that count toward the two you need. The regulation lists them:

• Mobility. Physical help with transfers, walking, or using equipment.
• Medications. Assisting the member to take prescribed medication.
• Bathing and grooming.
• Dressing and undressing.
• Passive range of motion exercises.
• Eating, including tube feeding.
• Toileting, bowel and bladder needs.

What does not count toward the two?

The IADLs. Laundry, shopping, housekeeping, meal preparation and cleanup, transportation to medical appointments, and special needs like wheelchair maintenance. A PCA can do all of these once you are approved, and none of them get you approved.

This is the trap. A person can be unable to shop, cook, clean, do laundry or get to a doctor, and still be found ineligible, because the question is not how much help they need. It is whether somebody has to physically put hands on them for two of the seven above.

A registered nurse does the evaluation in the home. What they are measuring is physical assistance, not how hard the week is.

The eight things that make you ineligible

1. You need cueing, not hands on help. The single biggest one. Someone who can physically dress themselves but will not without prompting does not meet the standard for dressing. This is why many families dealing with memory loss are turned down.
2. You only need help with one ADL. Two or more is the rule, as determined by the PCM agency.
3. You only need IADL help. See above. Errands and housekeeping do not qualify you.
4. The need is not permanent or chronic. The disability has to be permanent or chronic in nature. Recovering from surgery and needing help for six weeks is not what this program is for.
5. You are in a nursing facility or an inpatient facility. PCA does not cover hours while you are living there.
6. The hours overlap a day program. Time spent in day habilitation, adult day health and similar programs is not covered, because you are already being supported there.
7. Your MassHealth coverage type does not qualify. Coverage matters, and not every MassHealth category is the same. Check which one you actually have before anything else.
8. The task is ordinary parenting. For a child under eighteen, help that any parent provides at that developmental stage is not covered. What a child needs beyond their age is the part that counts.

Things that will not disqualify you but will not get paid

• Time your attendant is in the house but not assisting. PCA pays for the task, not for the shift.
• Babysitting, respite, recreation, education and vocational rehabilitation. Those are separate services and they are excluded here.
• Anything medical that another provider should be doing.
• Hours not recorded through Electronic Visit Verification. If the visit is not captured in EVV, it does not get paid. Make sure your attendant understands this on day one.
• More than 60 hours a week in total. There is an aggregate weekly cap.

Who cannot be your PCA

This catches people out because the word family sounds broader than it is. The regulation defines a family member as your spouse, the parent of a member who is a minor, or a legally responsible relative . Those people cannot be paid. Neither can your surrogate, your administrative proxy, or your foster parent.

Everyone else can. An adult son or daughter, a sibling, a friend, a neighbor. If the person already helping you is one of those, they can be your attendant and be paid for it.

You were found ineligible. Now what?

Being turned down for PCA does not mean nothing exists. It usually means the need is supervision rather than physical assistance, and there are programs built for exactly that. Ask about these, in this order:

• Adult Foster Care and Group Adult Foster Care, which are MassHealth programs for people who need daily supervision and cueing. This is the usual answer for the person PCA just turned away.
• Your local ASAP, the Aging Services Access Point for your town, for homemaker and personal care hours outside the PCA program.
• DDS, if there is an intellectual or developmental disability in the picture.
• An appeal, if you believe the evaluation missed something. Think about whether the nurse saw a typical day or a good day, because people perform better than usual in front of a stranger with a clipboard.

One thing to do before the evaluation

Write down, for a week, exactly which of the seven ADLs somebody physically does for you and how long it takes. Not how tired you are. Not how much worry it causes. Which tasks, whose hands, how many minutes. That list is what the evaluation turns on, and most people walk into the visit without it and underreport on the spot.

Want us to look at it with you?

Call 781-957-8076 . Tell us which ADLs need physical help, what your MassHealth coverage says, and whether anyone is already doing the work unpaid. We will tell you honestly whether PCA is a realistic route for you or whether you should be chasing a different program, before you spend weeks on it.

This page summarizes the MassHealth PCA regulations at 130 CMR 422 in plain language as of October 2026. The regulation governs, eligibility is determined by MassHealth, and the rules can change. MassHealth Customer Service is 800-841-2900.