Immigrants dropped from state’s care workforce over work permit issues
Just days before undergoing major spinal fusion surgery, Hassan Elzeneiny lost the person he depended on most.
"She's my first good PCA," Elzeneiny said of Marie, a Haitian refugee and trained nurse who had been helping him at home since February. "She actually moved towns in order to get closer to me."
Personal care attendants, or PCAs, support people with disabilities and chronic health conditions with daily tasks like bathing, dressing, using the bathroom, preparing meals, administering medications, and cleaning. They enable people to continue living at home and potentially avoid or delay costly institutional care.
But earlier this month, Marie was abruptly terminated from her job after the Executive Office of Health and Human Services determined her work permit had lapsed — not because she failed to apply for a renewal, but because a typo in her immigration paperwork left her stuck in a bureaucratic limbo for 10 months, she said.
She is one of 185 PCAs who have received termination notices from MassHealth, the Massachusetts Medicaid program. Many, like Marie, are immigrants caught in the ever-shifting currents of federal immigration policy.
"I can't work anymore because I don't have my permit," Marie said. State House News Service agreed not to use her full name due to her ongoing immigration process.
While Gov. Maura Healey has publicly criticized federal immigration law enforcement under President Donald Trump, her administration has moved to align the state's program with federal requirements — citing the need to protect the PCA program from possible scrutiny or penalties.
The notices requesting information about work permit statuses began arriving this spring, triggered by an effort by the Healey administration to ensure all PCAs have up-to-date work authorization.
The push comes as Trump's administration ends a Biden-era immigration policy that allowed vetted immigrants from Cuba, Haiti, Nicaragua, and Venezuela (CHNV) to enter the U.S. legally under humanitarian parole.
The CHNV program brought thousands of immigrants to Massachusetts between 2022 and 2024, many of whom filled critical roles in health care, especially as PCAs, a workforce long dominated by women of color and immigrants. According to a 2018 state report , 38% of PCAs were foreign-born, a number that has only grown.
But now, hundreds are in legal limbo.
Termination letters sent out
A June notice to consumer-employers like Elzeneiny, sent by Tempus Unlimited — the state's fiscal intermediary — stated that Marie's employment could only continue if updated work authorization documents were received within 30 days.
Despite Marie having applied for an extension to her work permit last fall, her case stalled because her lawyer misspelled her name on the application.
"Look, I can't make the State Department move faster. I can't meet the 30-day deadline, and I got a lot of misinformation along the way," Elzeneiny said. "I'm on the phone with Tempus on July 1, July 3, on August 9, on August 15. I sent them faxes. And every time they come back with a different person giving me a different instruction."
He described the information he and Marie received from the state, Tempus and U.S. immigration department as contradictory and difficult to understand. They cannot meet the state's timeline until the State Department processes her paperwork, he said.
"[Being a PCA] is a really low-paying job. It doesn't require a lot of English. But damn it, negotiating with the United States Department of State does," he said. "Imagine trying to get through to your lawyer who made the mistake and them saying, 'I'm sorry. My workload is overwhelming. I don't have time to correct spelling mistakes.'"
Marie's termination letter, signed by MassHealth's PCA employment manager Geralyn Smith Coryat, reads: "Specifically, you were terminated because you did not provide valid employment authorization documentation that demonstrates you are authorized to work in the United States." It's dated Aug. 12, 10 days before Elzeneiny's surgery.
A similar letter was sent to the PCA of Dianna Hu, a software engineer and chair of the Boston Center for Independent Living. Hu's PCA has valid work authorization through 2029, but still received the notice of sanction and termination in August.
The letter, bearing the names of Healey, former Health and Human Services Secretary Kate Walsh and Assistant Secretary for MassHealth Mike Levine, stated: "EOHHS has determined... that your continued participation in MassHealth during the pendency of any appeal could reasonably be expected to compromise the integrity of MassHealth."
Hu told State House News Service she didn't know why she and her PCA got the letters in the first place, as Tempus had documentation showing that the work authorization was valid until 2029.
She had previously sent the documentation via email, which she said was an accepted way to send documentation. She guesses that Tempus changed course and now requires a mailed version of the same information.
"My guessed reason does not feel acceptable to me as a reason to terminate her employment or my care. It also does not feel acceptable to me that despite mailing the documentation ten days before the deadline, we still received the 'Initial Notice of Sanction and Termination' letter - resulting in no small amount of panic and frustration for both my PCA and me," she told the News Service.
When Hu told her story at a PCA workforce Council meeting last Tuesday, Rebecca Gutman of 1199 SEIU — which represents many of the PCAs — expressed alarm.
"Does that not cause concern to other people?" she asked. She said it was "incredibly concerning to me."
MassHealth's Smith Coryat, who was at the council meeting to discuss this issue, responded, "We can't make the assumption, we understand that the documentation that they submitted may have been valid, but there may have been a request for something else... I would have to research."
Tempus did not respond to questions about how many consumers and PCAs are affected, what kinds of problems they are hearing on their hotline, and specific steps they are advising callers to take.
A quiet enforcement amid public opposition
As attorney general during Trump's first administration, Healey consistently challenged Trump's immigration agenda with lawsuits and strong words. But as governor, her rhetoric has softened, even saying this spring that "some" of the president's border policies made sense.
Behind the scenes, her administration is quietly enforcing those immigration policies to protect state programs from federal retaliation.
"We have to ensure that we are protecting the program and to ensure that we are able to continue to provide services for 50,000 consumers," Sherri Hannigan, director of the PCA program, told the PCA Workforce Council during their meeting last Tuesday.
On MSNBC in November, Healey addressed how Trump's immigration policies might affect states .
"I do think it is important that we all recognize that there is going to be a lot of pressure on states and state officials," she said on the nationally broadcast interview. "... I think the key here is that, you know, every tool in the toolbox has to be used to protect our citizens, to protect our residents."
Smith Coryat said a first batch of notices went out to 671 PCAs who were flagged for expired documentation to submit their documents within 30 days.
After that deadline, they received another 30-day initial notice of sanction and termination. Another wave targeted those whose authorizations are nearing expiration.
In all, MassHealth issued requests for work authorization information to 1,540 PCAs. MassHealth confirmed that as of Monday, they sent 185 termination notices.
"What I can tell you is that it was a small proportion of the full PCA workforce that was identified," she said during the Workforce Council meeting, when pressed on how many total PCAs were affected.
Hannigan told the council that EOHHS cannot "try and, you know, have our own extension policy" due to State Department delays in processing immigration paperwork. "Unfortunately, we're just not able to do that."
"We cannot be responsible for what the State Department does or does not do. And we have to ensure that the workforce is legally authorized to work in the country based upon the documentation that you have in hand," she said.
Elzeneiny, who attended the meeting, expressed frustration. "Health care needs to be managed with humanity and intelligence," he told the News Service in a later interview. "I was very disappointed when the manager of the program gets onto the screen and says to me, 'I have to preserve the program for the state.'"
"We are in a very tough spot making sure that we don't get penalized or give any excuse to mess with the program," said Workforce Council Vice Chair Justin Graceffa. The council is independent from the administration, though chaired by EOHHS Secretary of Health and Human Services Dr. Kiame Mahaniah.
In a statement to State House News Service, MassHealth spokesperson Stacey Nee pointed to the Trump administration's "constantly changing immigration policies" that she said were "causing immense uncertainty and disruption to our workforce."
"In an effort to minimize any disruption in services for MassHealth members, MassHealth conducted a review of PCA work authorizations to ensure work authorization information is up to date.
MassHealth must act to protect members and ensure compliance with federal law. MassHealth is committed to ensuring that our members have access to the services they need and are here to support our members in navigating this challenging time," Nee's statement said.
"The system is already stretched"
Chris Hoeh, a PCA Workforce Council member and a consumer-employer himself, said the documentation issue may not always be about expired work permits — but clerical errors by consumer-employers who have to file paperwork for their PCAs but may not be tech-savvy themselves.
"I think it's not necessarily that their paperwork wasn't up to date. It was that consumer employers had not checked the box. When we hire someone, we have to check their status," Hoeh said.
He noted that most PCAs hired through MassHealth are employed by people with disabilities who rely on Medicaid, and are often living in poverty. Many don't use computers or struggle with navigating bureaucratic systems, he said.
Gutman said 1199 SEIU has been trying to help workers connect with immigration support.
The state's push to enforce worker permit compliance in the PCA program comes at a time when the workforce is already critically short.
"The health care system in Massachusetts, our hospitals and home care, is so dependent on immigrants, including people who work in people's homes who came here with full work authorization from Haiti, in particular, and who were invited here to work," Hoeh said. "And I don't know how the system is going to work without those people. The system is already stretched."
Over 50,000 people across the state receive services from PCAs. Losing just a few hundred could significantly disrupt care for the elderly and people with disabilities.
"There's fear throughout all of our communities," Hoeh added, especially "people who rely on federal dollar Medicaid… and are in Massachusetts, which is a state that will be targeted, to make sure that nothing can be used as an excuse to further cut money or services."
"I help him to do everything ... That's why I would like to continue working."
For Elzeneiny, the loss of Marie is more than a bureaucratic issue — it's a devastating personal blow.
Marie had been working with him since February. "I help him to do everything. He will have an operation on Friday. That's why I would like to continue working, because he can't do some things by himself," she said in a phone interview before Elzeneiny's surgery.
Asked what kind of resolution she hopes for, she said, "I would like USCIS to process my case."
"I like [to] help people. I studied nursing in my country. I worked in the hospital in my country. I like my boss, Hassan; he is very nice with me," Marie said.
Following his spinal fusion at a Boston hospital, Elzeneiny told the News Service the surgery went well and he is hoping to relocate home to western Massachusetts soon.
Marie, no longer employed by Elzeneiny, visited him in the hospital at her own expense.
"With respect to not being worried about my surgery, [it's] because I have such a loyal PCA," Elzeneiny told State House News Service. "And because she's an immigrant, she knows what it's like to be abandoned by society and doesn't want that for her patients. I'm very lucky."
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