What Happens to My PCA Hours If I Move in Massachusetts?

Your PCA hours do not travel with you automatically. The MassHealth personal care attendant regulations require you to notify three separate parties of a new address, and a move that changes your living situation can trigger a new evaluation, because your hours were calculated from the home you were living in at the time.

A move is a paperwork event before it is a moving day. Three notifications, one possible reevaluation.

Who do I have to tell that I moved?

All three of them. The member responsibilities section of the regulations, 130 CMR 422.420, requires the member to notify the MassHealth agency, the PCM agency and the fiscal intermediary of a change of address and contact information. Telling one does not tell the others, and the fiscal intermediary is the one that pays your attendants, so leaving it out is how paychecks go to the wrong address. The same section separately requires you to tell your PCM agency about a change in your medical condition or living situation that may require an adjustment in hours. The regulation does not give the member a deadline, so do it the week you have a moving date rather than after the boxes are unpacked.

Will my PCA hours change when I move?

They can, because the evaluation is about the home as much as about you. The regulations have the PCA evaluation take place in your actual or proposed place of residence in the community, and they require a reevaluation when there is a significant change in your living situation. Hours for household tasks also rest on assumptions about who else lives in the home, so moving in with family, or moving out on your own, is exactly the kind of change that gets looked at again.

It cuts both ways. A first floor apartment with a roll in shower and grab bars may be assessed as needing less help with bathing than the house you left. A third floor walk up with a tub may be assessed as needing more. How the hours get counted in the first place is explained on how MassHealth decides PCA hours using time for task.

Do I keep the same PCAs after I move?

That is your decision, not MassHealth's. The PCA program is self directed, which means you are the employer who hires, schedules and discharges your own attendants, and a change of address does not end their employment. The practical problem is the commute. If your new address adds forty minutes each way to somebody's drive, expect at least one of your attendants to give notice. Start recruiting before the move, not after, so you are not covering shifts yourself in a house you have just unpacked.

Do I need a new prior authorization?

Ask your PCM agency, because the regulations do not say that a move by itself restarts the clock. What they do say is that prior authorization is a condition of payment, that the approval notice carries an expiration date, and that your PCM agency has to request the next authorization at least 21 days before that date. Reevaluations are generally annual. So your current authorization has its own end date that the move does not change on its own, while the reevaluation trigger for a significant change in living situation may still bring that review forward. The agency holding your file is the only one who can tell you which applies to you.

Can I keep my PCM agency if I move across the state?

Only if that agency serves your new address. The regulations give you the choice of PCM agency, and they let MassHealth reassign you if your agency is unable or unwilling to serve you. Care Remedy is a MassHealth personal care management agency with offices in Woburn, Springfield and Brockton. If you are moving and need an agency that covers the new town, email pcm@careremedy.com. How enrollment and transfers work is on our PCM agency enrollment and transfer page.

What if I am moving into assisted living, a rest home or a group home?

Get the answer in writing before you sign anything, because some settings end PCA payment outright. The regulations do not pay for PCA services while you are in a nursing facility or other inpatient facility, or in a provider operated residential facility subject to state licensure, such as a group home. They also do not pay for PCA hours during a MassHealth funded day program, adult foster care or group adult foster care. Rest homes and assisted living residences are not named in that list, which is exactly why you should not assume either way. Ask MassHealth and your PCM agency about the specific building before you give up a lease. A hospital or rehabilitation admission is a different situation, covered on what happens to PCA hours during a hospital stay.

What happens if I move out of Massachusetts?

Plan on starting over. MassHealth is a Massachusetts program, and the PCA regulations themselves do not address an out of state move, so the question belongs to MassHealth eligibility rather than to the PCA rules. Contact MassHealth before you go, and ask the Medicaid agency in the state you are moving to what their equivalent self directed program requires and how to apply.

What should I do first?

• Call your PCM agency as soon as you have an address, not a moving date.
• Notify MassHealth and the fiscal intermediary separately.
• Ask whether the new home triggers a reevaluation, and when your current authorization expires.
• Ask each attendant, in plain terms, whether they can do the new commute.
• If the new address is outside your agency's area, line up a PCM agency that covers it before you move.

Who do I call at Care Remedy?

PCA and PCM questions and referrals go to pcm@careremedy.com. For anything else, call 781 957 8076. Offices in Woburn, Springfield and Brockton.

This page is general information about the MassHealth PCA regulations, not legal or benefits advice. The regulations are amended from time to time and individual cases differ, so confirm your own situation with MassHealth, your PCM agency or an attorney before you act on it.