MassHealth PCA working group recommends tighter overtime cap and meal‑prep limit to contain costs

Leslie Darcy, chief of Long‑Term Services and Supports at MassHealth, told the Massachusetts Commission on the Status of Persons with Disabilities subcommittee that a legislatively‑mandated PCA working group recommended several targeted limits to curb rapid program growth.

Darcy said the group earlier implemented three recommendations effective Jan. 1, 2026: re‑enforcing a 66‑hour overtime cap for individual PCA workers, tightening program‑integrity steps, and eliminating hours authorized for paperwork where electronic visit verification (EVV) replaces paper timesheets. MassHealth estimates those measures will save about $7.4 million.

The group later recommended further limits, Darcy said: lowering the overtime cap for a single worker from 66 to 60 hours (estimated savings $3.9 million) and creating a 7‑hour weekly cap for meal‑prep support (about one hour per day), which the agency estimates could save roughly $28 million. “We are once again enforcing that [66‑hour] cap,” Darcy said, and described the 60‑hour proposal as a targeted approach rather than a change to members’ authorized hours.

The PCA program has grown rapidly, Darcy said, from roughly $1.6 billion to about $2.0 billion over the past decade; the working group also reviewed several benchmark options but “was not able to come to consensus” on a single benchmark to guide long‑term spending limits. Darcy said experts including John Gruber (MIT) and Mark Cohen (UMass) provided input to the group and the full report is posted online for review.

Commissioner Charlie Carr praised the working group’s deliberative process, noting the group “met many times” and reached consensus on these limited measures despite the difficulty of recommending cuts that affect constituents. Darcy told the subcommittee the 60‑hour cap would likely be implemented July 1, 2026, and stressed that the cap restricts a single worker’s overtime rather than the number of hours a MassHealth member may receive.

Darcy also said MassHealth intends to use work groups to evaluate similar targeted measures across other long‑term services and supports programs as the agency prepares for fiscal challenges in coming years.