PCAs who work for clinically eligible Consumers who require assistance with feedings via enteral tube or digital rectal stimulation may receive a pay differential. This differential will only apply to those PCAs working for a Consumer who meets the clinical eligibility criteria for complex care and whose Prior Authorization (PA) includes the complex care modifier in accordance with PCA program regulations at 130 CMR 422.414 and 422.418(C), respectively. When applicable, the PCA complex care differential will be combined with the seniority rate steps.

These rates and rules follow the terms of the collective bargaining agreement negotiated between the PCA Quality Home Care Work Force Council and 1199SEIU United Healthcare Workers East (1199SEIU) and are in accordance with 101 CMR 309.00: Rates for Certain Services for the Personal Care Attendant Program.

Consumers: Contact your PCM agency if you have any questions, or your plan administrator if you are enrolled in a One Care or Senior Care Options (SCO) plan or PACE organization.

PCAs: Please address questions to your Consumer, Surrogate, or Administrative Proxy (AP). Note that in accordance with PCA program regulations at 130 CMR 422.418(C), PCAs are required to complete New Hire Orientation (NHO) to obtain the payment differential for complex care.

During COVID MassHealth paused enforcement of the overtime policy. Effective January 1, 2026, MassHealth will reinstate enforcement of the overtime policy. There are no changes to the rules for overtime between 40 and 50 hours; this means that PCAs can work for up to 50 hours without an overtime authorization.

Beginning January 1, 2026, Consumer-employers will be required to obtain an overtime authorization when they schedule a PCA to work over 50 hours in a week. This also applies to PCAs who work for more than one Consumer-employer. To obtain the overtime authorization, Consumer-employers must provide relevant documentation that supports the request for overtime to their PCM agency.

Effective January 1, 2026, program regulation 130 CMR 422.418(A) prohibits any PCA from working more than 66 hours, in the aggregate, in a single week.

Under recently enacted federal law, for years 2025 through 2028, in certain circumstances, a PCA can claim a deduction for overtime compensation that is reported on Form W-2, Form 1099, or other specified statement furnished to the individual. For tax year 2025, the amount of overtime compensation qualifying for this deduction will be found on Form W-2 in Box 14 using code “QOC.” For tax years 2026 through 2028, this amount will be found on Form W-2, Box 12 using code “TT.”

Effective January 1, 2026, PCAs must be at least 16 years old in accordance with program regulation 130 CMR 422.404(A)(1)(d)(4). Individuals under 16 will no longer be eligible for PCA employment beginning January 1, 2026, including those already employed as a PCA. MassHealth will issue notices to PCAs and Consumers impacted by this change.

Effective January 1, 2026, MassHealth will require any PCA seeking the EVV Live-In Exemption to permanently live, work, and sleep at the same home as the Consumer-employer. PCAs living in the same home as the Consumer-employer for an “extended period of time” (120 hours a week or more) will no longer qualify for an EVV exemption. All Live-In Exemptions in place prior to January 1, 2026, will remain in effect until the Exemption Renewal date.

Additionally, documentation that supports this permanent “Live-In” status must be furnished upon request.

MassHealth will be releasing an updated Consumer Handbook on January 1, 2026. This version of the consumer handbook will include new information regarding program changes and updates, as well as provide clarity on existing program rules.

In Spring 2026, all new hire paperwork must be completed before a PCA Unique Identification (PCA ID) number is created for a PCA. For new Consumer/PCA employment relationships, a PCA will only be able to provide PCA services and be paid for providing those services for dates on or after the date that their PCA ID was created.

The new hire process will also require that Consumer-employers submit copies of their PCA’s employment authorization documentation (EADs) when submitting the Form I-9, which is currently already required.

Newly hired PCAs’ identity and employment eligibility will be verified using E-Verify. E-Verify is an Internet-based system operated by the U.S. Department of Homeland Security that allows employers to electronically verify the identity and employment eligibility of new hires by submitting information from the employee’s Form I-9. PCA employment eligibility verification will be managed by Tempus Unlimited Fiscal Intermediary (Tempus FI).