MassHealth and personal-care attendants

On Behalf of | Apr 26, 2023 | MassHealth, Medicaid/Medicare

Paying for health care is a major worry for people of all ages throughout Massachusetts. For those who might need more intensive care because of age, illness or infirmity, the dread as to what will happen with their finances, their property and wondering if they are eligible for coverage under MassHealth can be overwhelming.

MassHealth is Massachusetts’ version of Medicaid. It is for people who have limited assets and income. Many, however, can still get benefits if they meet the criteria and take certain steps to protect their property.

MassHealth helps many people who are 65 or older and need to enter a nursing home and reside there.

However, some people do not need to enter a facility. They can use MassHealth to get a personal-care attendant (PCA) and live at home. A significant number of elderly people and their families prefer this option.

Knowing the rules and being covered for PCA services under MassHealth often requires legal guidance.

Income eligibility for people who need PCA services under MassHealth

People who are at the required age of 65 and need a PCA must meet the income standards. The rules for this situation are specific for people whose income is more than 100% above the federal poverty level.

Anyone who is at or below 100% of the federal poverty level can get MassHealth without special eligibility. They can also get PCA services.

The federal poverty level is updated by MassHealth on an annual basis. Currently, individuals at 100% earn $1,215 monthly.

These numbers are imperative for elderly people who want to stay at home and get PCA. Once it is determined that a 65-year-old or older person’s income surpasses 100% of the federal poverty level, less of their non-working income might be counted when making the decision on approving their application for MassHealth.

PCA services are for elderly people who are dealing with an extended or permanent disability that prevents them from completing various daily activities that most people do on their own. That includes getting out of bed, dressing, using the toilet, bathing, taking medication and more.

PCA will allow those who qualify to reside in their home without needing to go to a nursing home. There are specific criteria to get PCA services. The disability must either be permanent or long-lasting; they need someone to help them with their daily activities; a doctor has authorized these services; and they have prior authorization from MassHealth.