MassHealth work group flags rapid growth in PCA program, recommends overtime cap and fraud controls

Leslie Darcy, chief of MassHealth’s Long Term Services and Supports, told the Mass. Commission on the Status of Persons with Disabilities’ Long Term Services and Supports and Health Equity Subcommittee that a legislative work group met five times between October and February to examine the Personal Care Attendant (PCA) program and reached three consensus recommendations. “The group was able to reach three consensus recommendations,” Darcy said, listing enforcement of an overtime cap, addressing fraudulent activity and removing certain PCA administrative paperwork for members required to use electronic visit verification (EVV).

The recommendations came as work‑group members reviewed data showing rapid spending and utilization growth in the PCA program. Darcy said the program served about 56,000 members in state fiscal year 2024, with roughly 26,000 of those members enrolled in managed care plans. She said PCA program costs rose from about $1.2 billion in fiscal 2020 to $1.6 billion in fiscal 2024 and are projected to reach $2.0 billion by 2027.

Charlie Carr, a commission member who led parts of the discussion, said the group’s charge from the legislature was to “try to see if we could find some level of savings in the PCA program.” Carr said…