Get answers to all your questions

A list of program materials, including contact information, announcements, helpful guides and materials, and other PAO resources can be found at https://www.mass.gov/masshealth-ltss-programs-and-services.

MassHealth members who have MassHealth Standard or CommonHealth who are seeking Adult Day Health (ADH), Group Adult Foster Care (GAFC), or Personal Care Attendant (PCA) services have the choice of having their preferred provider or the PAO complete their assessment.

MassHealth members who have MassHealth Standard or CommonHealth who are seeking Adult Foster Care (AFC) must have the PAO complete their assessment.

MassHealth members who are authorized for services through MassHealth’s One Care, Senior Care Options (SCO), or Program for All-Inclusive Care for the Elderly (PACE) plans will be assessed through their plan. 

Yes. The PAO can do an assessment and explore with the individual what services they are eligible for, and then they can decide which service they would like to access.

There are a few options to request an assessment from the PAO.

The PAO will reach out using your preferred contact method (phone, text, or email) within two business days of receiving the request. Although text and email may be used, a phone call will typically be needed to gather some information to get your assessment scheduled. 

Note: If you contact the PAO by phone, you may be able to request an assessment live with Help Desk staff or any voicemails left will be returned promptly (within two business days). 

It can be very helpful to talk to your Primary Care Physician (PCP) about your interest in services before reaching out for an assessment. If you have not seen your PCP for a visit within the last 12 months, it is recommended that you do so as some services require this before you can start. You can also talk to your PCP to let them know that the PAO will need a form to be completed for you to be able to start services or in some cases, even to complete the assessment, so it will be important for them to complete this.

If you do not agree with the outcome of your assessment, you may appeal the decision within 60 calendar days of receiving the notice of the decision. You will get a copy of how to file an appeal with that notice. You can file an appeal with the MassHealth Board of Hearings by mail, fax, phone, in person, or online. More information about how to file an appeal can be found at https://www.mass.gov/how-to/how-to-appeal-a-masshealth-decision. 

Adult Day Health (ADH) programs provide nursing care, supervision, and health related support services in a structured group setting for people age 18 or older who have physical, cognitive, or behavioral health impairments. ADH is a community-based, nonresidential program that allows participants to attend during the day (5 days per week) while still living in their home.

More information about ADH can be found at MassHealth Adult Day Health Program Fact Sheet

MassHealth members age 18 or older who:

  • Have MassHealth Standard or CommonHealth or are authorized for ADH services through MassHealth’s One Care, SCO, or PACE
  • Have a medical, cognitive, or mental health condition that requires supervision and support by a nurse
  • Have at least one (1) skilled nursing service need or need help with one or more activity of daily living (ADL), such as bathing, toileting, transferring, mobility, and eating

Full eligibility requirements can be found at 130 CMR 404.0

The Adult Foster Care (AFC) program helps individuals to live in their own home with a qualified caregiver or in the qualified caregiver’s home. Caregivers can be a family member (except for spouses and legal guardians) or a certified foster caregiver.

More information about AFC can be found at MassHealth Adult Foster Care Program Fact Sheet. 

MassHealth members age 16 or older who:

  • Have MassHealth Standard or CommonHealth or are authorized for ADH services through MassHealth’s One Care, SCO, or PACE
  • Need physical assistance or cueing and supervision with at least one (1) ADL such as bathing, dressing, eating, or mobility
  • Can live safely in a home setting with a caregiver’s support

This is a summary of who may be eligible for AFC services. Full eligibility requirements can be found at 130 CMR 408.000.

 

The Group Adult Foster Care (GAFC) program provides personal care services in a home setting with other individuals who also need care, with services provided by direct care workers employed by a GAFC agency.

More information about GAFC can be found at MassHealth Group Adult Foster Care Program Fact Sheet.

MassHealth members age 22 or older who:

  • Qualify for MassHealth Standard or CommonHealth

  • Need physical assistance or cueing and supervision with at least one (1) ADL, such as bathing, dressing, eating, or mobility

In the PCA program, individuals with disabilities live independently by hiring personal care attendants to help them with daily tasks.

The PCA program is a self-directed program, meaning that the individuals receiving services are the employers of their personal care attendants, including being responsible for hiring and supervising them.

Personal care attendants help with things like ADLs, medication assistance, meal preparation and grocery shopping, light housekeeping, and providing transportation to appointments.

More information about PCA can be found at MassHealth Personal Care Attendant Program Fact Sheet. 

MassHealth members who:

  • Are eligible for MassHealth Standard or CommonHealth
  • Have a permanent or chronic disability
  • Need physical assistance with two (2) or more ADLs, such as bathing, dressing, eating, or mobility
  • Are able to manage their own PCA services or have someone else to manage them on their behalf (known as a Surrogate or Administrative Proxy)