East Taunton resident John Mariani has cerebral palsy and uses a power wheelchair. He relies on personal care attendants funded through MassHealth to help him live independently.
“They help get me dressed. They help get me in the shower. They go food shopping for me. They do cooking for me, everything,” he said. “They’re my hands, they’re my arms, they’re my legs.”
But recent administrative problems with a third-party company that manages the program has led to a reduction in the hours of support for Mariani, affecting his independence and state of mind.
Mariani is not alone. Several people who depend on state-funded personal care attendants, also known as PCAs, told GBH News that they have faced delays and lapses in care over the last several months. They say their helpers have gone without pay, or have not been able to work at all.
For Tiffany Rasmussen of Westwood, the delays are debilitating. Rasmussen, 33, has cerebral palsy and uses a power wheelchair to get around. When her workers didn’t come, she said, she had to sleep in her wheelchair for four days, curtailing her food routine and limiting movement around her home.
“I have had a nightmare with it,” she said. “It has never been this bad.”
The problems appear to be due to a combination of new state requirements and lagging administrative changes.
Officials from MassHealth told GBH News this week that they are aware of delays and are working to fix them. They say the delays stem from challenges with a Stoughton-based company, Tempus Unlimited Inc., which is responsible for administering the program and making sure PCAs get paid.
“MassHealth recently became aware that Tempus, a personal care management (PCM) agency responsible for conducting clinical evaluations and reevaluations for MassHealth-covered personal care attendant (PCA) services, is experiencing administrative issues that has delayed the timeliness of some of its clinical reevaluations, which is affecting payments to some PCAs,” the statement read.
“We are doing everything we can, including clearly communicating with MassHealth provider networks, to minimize disruptions and ensure hard-working PCAs are paid in a timely manner,” the statement continued.
Tempus President Larry Spencer also acknowledged in a prepared statement that “there are many consumers who are facing this particular problem.”
He attributed the delays in part to new paperwork rules required by MassHealth. For example, he said a consumer’s primary care physician needs to sign off on care forms filed by attendants, which can lead to lengthy delays.
“As of January 1, 2026, this is a requirement in the program,'' he wrote in an email. ”Many physicians ignore our faxes and calls to their office to get this signed resulting in delays.”
The PCA program is part of MassHealth and serves more than 50,000 people across the state. Attendants help people with disabilities with daily living tasks like getting out of bed, bathing and eating. They are paid through an agency as an intermediary, but are hired and managed by the disabled person, known as the “consumer.”
The PCA program has grown in recent years and has faced yearly budget cuts from the state to certain parts of the program; low wages have contributed to a worker shortage. Pending Medicaid cuts at the federal level have put more pressure on the cost of the program.
Chris Hoeh, a disability advocate and PCA user who lives in Boston, says some of the recent interruptions are a result of attempts to reign in the growing program and avoid fraud.
“There have been a number of incredibly significant changes to the way the PCA program functions, some of which end up requiring Tempus quickly responding,” Hoeh said.
For example, every year, PCA customers have to go through a prior authorization process with their doctor to certify the number of hours they will get support each week — but they say they have noticed the process is different this year.
November Allard, who lives in Rehoboth, says she has been a PCA for more than 30 years and cares for an elderly woman who needs 24-hour service. Allard says she recently went a month without getting paid, but kept working.
“A lot of us [PCAs] live paycheck to paycheck,” she said. “I went just about four weeks with my account being in the negative.”
If their pay is disrupted again, Allard worries that other attendants caring for her client will have no choice but to stop working.
“She’s like my mom, I love her. And I didn’t want her to go to a nursing home,'' she said. ”But if this happens again, I know one of her workers will leave.”
Rasmussen of Westwood has limited mobility in her arms and legs. She says without PCAs, she can’t get to bed, use the bathroom or prepare food.
This year, there was a new form that needed to be sent to her primary care physician. But Rasmussen says Tempus was delayed in sending the new form, and “everything got pushed back.” Her prior authorization was not approved, meaning she ran out of PCA hours a few months ago.
Since then she’s had to get an extension five times from Tempus to send to MassHealth and pay her attendants, which she says is a stop-gap, cumbersome solution.
“My current status is jumping from extension to extension, waiting for MassHealth to approve my prior authorization for the year,” she said. “Meanwhile, I run the risk of losing PCAs because if PCAs are not getting paid, they’re not going to want to work.”
