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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Applicant/Member information section. Clearly print your last name, first name, middle initial, social security number, date of birth, gender, street address, city, state, and zip code.
In the health problems section, list and describe all medical and mental health issues that affect your daily living activities. Be thorough to ensure accurate representation of your needs.
Next, complete the daily living activities chart. Indicate whether you need hands-on help for each activity listed (mobility, bathing, dressing, etc.) and specify how often you require assistance.
Provide caregiver information by listing names and relationships of those who assist you. This helps clarify support systems in place.
Finally, certify the accuracy of your information by signing and dating the form at the bottom. If applicable, include an Authorized Representative Designation Form.
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The primary qualifications for a Personal Care Attendant (PCA), also referred to as a Personal Care Aide, are a high school diploma or equivalent and PCA training and certifications.
How to get a PCA MassHealth?
To apply for PCA services, you must contact a PCM agency. The agency will evaluate your need for PCA services and submit a prior-authorization request to MassHealth for you.
Does MassHealth pay caregivers?
The caregiver is paid approximately $19.50 / hour. Program participants who are unable to self-direct their care, can choose an individual, a surrogate, to help manage their care.
What requirements are needed for PCA?
How To Become A PCA: Skill Education Requirements Obtain Necessary High School Diploma or Equivalent Education Level. Complete State-Approved Training Programs for Personal Care Aides. Acquire First Aid and CPR Certifications to Enhance Safety Skills. Develop Interpersonal Skills to Connect with Clients Effectively.
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MassHealth release of Information formCac form MassHealthMass gov Affidavit to Verify Zero IncomeMassHealth Premium Assistance direct deposit form
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Nov 20, 2018 PCA-SUPP (Rev. 11/18). Page 1. Personal-Care-AƩendant Supplement. Applicant/Member informaƟon. Last name. First name. MI. Telephone number
The Federal Personal Responsibility and Work Opportunity Reconciliation Act requires government agencies to eliminate public benefits to individuals who
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