NEED HELP WITH PCA?
WLS Insurance Agency is your Massachusetts Insurance Broker, making the process simple and convenient for individuals, families, small groups, and Medicare clients.
Massachusetts’ Personal Care Attendant (PCA) Program will pay for up to 50 hours/week of in-home care and supervision for MassHealth Standard (Massachusetts ABD Medicaid) beneficiaries who live in their own home or the home of a loved one and require hands-on assistance with two of the seven following activities: mobility, bathing, dressing, eating, toileting, taking medication and passive range of motion exercises. To determine if that level of assistance is required in Massachusetts, a functional assessment is done by an occupational therapist or skilled nurse and signed by the applicant’s physician.
MassHealth Standard beneficiaries interested in the PCA program can contact a local personal care management agency to schedule an assessment. This assessment will also determine the number of hours of care the PCA Program will cover and which benefits will be offered. Available benefits include transportation, help with paperwork relevant to PCA services, and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) as well as essential household tasks (cooking, cleaning, laundry, shopping), medication administration and transportation to medical appointments.
Personal Care Attendant (PCA) Program participants can self-direct their care by choosing their own caregiver. This can include friends and certain relatives, like adult children and grandchildren, but not the beneficiary’s spouse. Program participants who are not capable of self-directing their own care can choose a surrogate to help manage their care. The surrogate can be anyone the PCA Program participant wants, including their spouse, but just not the person they hire as a caregiver. The state will provide a financial services company to manage some of financial aspects of being an employer, such as withholding taxes and issuing paychecks.
The PCA Program, like MassHealth Standard itself, is an entitlement. This means that all eligible PCA applicants are guaranteed by law to receive benefits.
WHAT YOU MAY NEED
To apply for MassHealth, you’ll need to provide documentation related to your income, assets, and citizenship/immigration status, along with any other health insurance information. Specifically, you’ll likely need to submit proof of income (like pay stubs, tax returns, or benefit award letters), bank statements or other asset information, and documentation verifying your citizenship or immigration status. Additionally, you’ll need to provide details about any other health insurance coverage you have.
Here’s a more detailed breakdown:
Income:
Proof of Income:
This could include pay stubs, tax returns (1040, 1040A, 1040EZ), Social Security benefit award letters or annual statements, or 1099/W2 forms.
All the family members who live with you, even if they aren’t applying for health insurance. The people you include on your federal income tax return, if you file taxes, are the people in your tax household.
Types of Income:
Be prepared to provide information on various income sources like pensions, retirement income, rental income, and more.
Assets:
✅Bank Statements: You’ll need to provide recent bank statements (within the last 45 days).
✅Vehicle Information: If applicable, you’ll need your vehicle registration or title.
✅Real Estate: If you own real estate, you’ll need deeds and mortgage statements or tax bills.
✅Other Assets: This could include life insurance policies, prepaid funeral contracts, and trust information.
Citizenship/Immigration Status:
✅Proof of Citizenship: A passport or other acceptable documentation may be needed.
✅Immigration Status: If you are not a U.S. citizen, you’ll need to provide documentation related to your immigration status.
Other Health Insurance:
✅Insurance Cards: You’ll need to provide information about any other health, dental, or vision insurance you have.
✅Premium Bills: Copies of your health insurance premium bills may also be required.
Other Important Information:
✅Social Security Numbers: You’ll need to provide Social Security numbers for everyone in your household applying for MassHealth.
✅Massachusetts Application for Health and Dental Coverage and Help Paying Costs (ACA-3): You’ll need to complete this application form.
✅MassHealth Child Disability Supplement: If applicable, you’ll need to complete this supplement and potentially medical records release forms.
Important Considerations:
Electronic Verification:
MassHealth may attempt to verify some information electronically, but you may still need to provide documentation.
Speeding up the process:
Providing the requested documentation with your application can help speed up the process, according to Mass.gov.
Accuracy:
Ensure all information provided is accurate, as estimates may not be sufficient
WHAT ARE OPEN ENROLLMENT DATES TO KNOW?
ConnectorCare Plans: Open enrollment is November 1 through January 23.
Health insurance through work: Enrollment periods are set by your employer (typically in fall)
Medicare: Annual Enrollment Period (AEP) is October 15 to December 7 every year. Initial Enrollment Period (IEP) is around age 65
Medicare Advantage: Annual Enrollment Period (AEP) is January 1 to March 31 every year.
MassHealth: Enroll anytime
Dual Eligible Special Needs Plans (DSNP): Enroll anytime
WHAT IF I MISSED THE DEADLINE FOR OPEN ENROLLMENT?
If you need coverage during a time when annual open enrollment isn’t available and you have not experienced a Qualifying Life Event, you can buy short term health insurance. Short term health insurance can fill health care needs for short amounts of time.
INDIVIDUAL SHORT-TERM HEALTH INSURANCE
RESOURCES & USEFUL LINKS
MassHealth For Seniors
SNAP
WIC
CSMP
Travel
TAFDC
MassGrant
FAFSA
MASFA
MBTA
Auto
Home
Small Business
HEAP
Flood
You apply for both MassHealth and ConnectorCare at the same time, through one application.
The application form and the way you apply are different, based on whether you are over or under the age of 65.
- For most people under 65, MassHealth is based on income alone.
- For most people 65 and over, MassHealth is based on income and assets.
Get help with applying
For many people, the best way to apply is with help from an “enrollment assister,” “certified application counselor” “navigator” or licensed insurance agents. These are people who are trained and certified by MassHealth and the Health Connector.
If you are under 65, or the primary caretaker of a child
If you are under 65, or the primary caretaker of a child under 19, you can:
in English, Spanish or Portuguese. You may get a decision in real-time. Learn how to create an online account
- Apply over the phone at 800-841-2900. A MassHealth worker will ask you questions needed to complete the online application and get your electronic signature.
- Apply in person at a MassHealth Enrollment Center or Health Connector Walk-In Center. MassHealth encourages you to schedule an appointment in advance
- Apply by mail or fax. Find out more information and get the paper application in English and other languages
If you are 65 or older
See more information about application options for people 65 and older
. You can:
- Apply by completing a paper application called a SACA-2. Return it by mail or fax, or drop it off at a MassHealth Enrollment Center.
- Complete the SACA-2 as a fillable form online. You sign it and submit it electronically. You must complete the form in one sitting.
- Apply by telephone at 800-841-2900. A MassHealth worker will ask you questions needed to complete the SACA-2 and get your electronic signature.
- Apply in person at a MassHealth Enrollment Center
. MassHealth encourages you to schedule an appointment in advance
If you are on Medicare
If you only want help with your Medicare premiums, copayments and deductibles, but do not want to apply for full MassHealth coverage, there is a 1-page application for MassHealth Medicare Savings Programs that only help with Medicare costs.
You will get a written notice in the mail telling you if your application was:
- approved,
- denied,
- or if MassHealth needs more information to make a decision.
If you applied online or by phone, you may find out right away if you qualify or not or whether more information is needed.
If you are approved, the notice tells you what program you qualify for and when your coverage will begin.
If you are denied, the notice will tell you the reason and include information about your right to appeal.
Sometimes the notice will tell you that more information is needed before MassHealth can decide if you qualify. Sometimes the notice will say that you are qualified but only temporarily, to give you time to submit more information. A second letter will tell you what other information you need to send.
If MassHealth finds you qualify, you are covered by MassHealth right away. Usually it will also cover you for a period before you submit the application. This is called a “retroactive” coverage period. If you were charged for any medical expenses during the retroactive period, let your providers know so they can bill MassHealth for those expenses.
MassHealth will send you a blue card with your unique MassHealth ID number. The number will be on the notice from MassHealth too. Be sure to always show your card or have your MassHealth ID number when you see your health care providers.
Most people under 65 also need to pick a managed care plan soon after they qualify for MassHealth. If this applies to you, MassHealth will mail you information about your plan options. If you do not pick a plan for yourself, MassHealth will assign a plan for you. Your managed care plan will send you a plan card that will also have your MassHealth ID on it, and information about your plan benefits.
You can get help to decide which managed care plan you want or change your plan. For help, call MassHealth Customer Service at 1-800-841-2900. Or call one of the certified enrollment assistance organizations that help people apply.
Get notices in the mail
If you qualify for ConnectorCare, you will get 2 notices in the mail: 1 from MassHealth and 1 from the Health Connector.
The MassHealth notice will tell you:
- that you do not qualify for full MassHealth,
- explain the reasons why, and
- tell you your appeal rights.
- The notice may also tell you about other benefits that you qualify for besides ConnectorCare.
Some people who qualify for ConnectorCare may also qualify for a kind of MassHealth called MassHealth Limited that only covers emergencies. Some people who qualify for ConnectorCare may qualify for the Health Safety Net temporarily to give them time to enroll in ConnectorCare.
If you apply online or over the phone, you may find out right away if you were denied MassHealth but qualify for ConnectorCare.
If you qualify for ConnectorCare, the notice in the mail will tell you:
- that you qualify for ConnectorCare Plan Type 1, 2 or 3;
- how much your copayments will be are based on whether you are in Plan Type 1, 2 or 3;
- how much help you will get with your premium costs; and
- How to enroll in a health plan.*
* Some people may have no premium contribution and may be automatically enrolled into a plan.
Enroll in a plan
If you qualify for ConnectorCare, you first have to choose and enroll in a health plan to:
- know what your premium contribution will be, and
- have health coverage.
To enroll, you have to select a health plan and pay the first month’s premium (if any) by the 23rd of the month to have coverage on the 1st of the next month.
If your income is low, you may not have to pay a premium and will just have to select a plan by the 23rd. If you do not have to pay a premium and you selected the option to let the Connector automatically enroll you into a plan, you may be automatically enrolled into ConnectorCare.
After enrolling, you will get a card and information in the mail from your plan.
Important
You can apply for coverage from the Connector at any time, but there are deadlines about when you can enroll. You must enroll within 60 days from the date you get a letter that says you can enroll in ConnectorCare or other coverage, unless there is a special reason for you to enroll later.
Pay the first month’s premium
To make a premium payment:
If you do not have login information,
If MassHealth or the Health Connector deny your application because they say you do not qualify or didn’t return information on time, you have the right to appeal.
If an enrollment assister helped you to apply or renew, ask them about your denial. They should be able to explain the reasons for the denial, your right to appeal, and refer you to legal help. Also, sometimes a denial is based on missing or wrong information that an enrollment assister can help you send in.
In person
MassHealth Enrollment offices in Chelsea, Charlestown, Tewksbury, Springfield, Quincy, Worcester, and Taunton are open for limited walk-in visitors. Office locations are listed here.
MassHealth encourages people to schedule phone or video appointments instead of visiting a MassHealth Enrollment Center. Click here to schedule an appointment.The Health Connector walk-in centers in Worcester, Boston, and Springfield are open. See Locations and offices hours
By phone
Call MassHealth Customer Service: 1-800-841-2900. Monday-Friday 8 a.m. to 5 p.m. If you are deaf, hard of hearing, or speech disabled, call TTY: 711
Call the Health Connector’s Customer Service: 1-877-623-6765. Monday-Friday 8 a.m. to 6 p.m. If you are deaf, hard of hearing, or speech disabled, call TTY: 1-877-623-7773.
In a language other than English
For free translation of MassHealth notices and forms, and to get an interpreter to talk to MassHealth over the phone, call MassHealth Customer Service: 1-800-841-2900. If you are deaf, hard of hearing, or speech disabled, call TTY: 711.
MassHealth’s customer service phone line has options to select a language in English, Spanish, Brazilian Portuguese, Vietnamese, Mandarin, and Haitian Creole.
You can also get an interpreter for any other language, but to do that, after listening to the messages in different languages, select 0 and stay on the line until a person answers. If the person who answers the phone is speaking English, be prepared to say the name of your language in English and the MassHealth worker should arrange an interpreter. Use the TTY to arrange for an ASL interpreter.
To learn more, see MassHealth’s Language Assistance page.