Yes, a family member can get paid as a caregiver in Massachusetts, most commonly through the MassHealth Personal Care Attendant (PCA) Program or the MassHealth Adult Foster Care (AFC) Program. Veterans have two additional options through the U.S. Department of Veterans Affairs. The catch that trips up most families: spouses, parents of minor children, and legally responsible relatives are excluded from being paid under both MassHealth programs, so who you are to the person you’re caring for decides which door is open to you.
Which Relatives Can Be Paid, and Which Cannot
Under the PCA regulations, the paid attendant cannot be a “family member” as the program defines that term, which specifically means a spouse, the parent of a minor member (including an adoptive parent), or any legally responsible relative.1Mass.gov. Personal Care Attendant Services Regulations – 130 CMR 422.000 The attendant also cannot be the person’s surrogate, meaning the individual who manages care decisions on their behalf.
The exclusion is narrower than it first sounds. Adult children caring for aging parents, siblings helping a brother or sister, grandchildren, nieces, nephews, and in-laws generally qualify. A daughter caring for her mother is eligible. A wife caring for her husband is not. A father caring for his 10-year-old son is not, but a father caring for his 30-year-old son is.
The AFC Program uses the same basic exclusion: spouses and legal guardians cannot be paid AFC caregivers.2Mass.gov. MassHealth Adult Foster Care Program Fact Sheet Other relatives who are at least 18 and willing to share a household with the care recipient can qualify, subject to a background check.
The PCA Program
The PCA Program is the most widely used route. It funds hands-on personal care for people with permanent or chronic disabilities so they can remain at home, and it is consumer-directed: the care recipient (or a surrogate acting for them) hires, trains, schedules, and manages the attendant.3Mass.gov. MassHealth Personal Care Attendant Program
Who Qualifies for PCA Services
The care recipient must be a Massachusetts resident enrolled in MassHealth with a permanent or chronic disability, and must need physical assistance with at least two Activities of Daily Living such as bathing, dressing, eating, or transferring.4Legal Information Institute. 130 CMR 422.403 – Eligible Members A physician or nurse practitioner has to confirm that PCA services are medically necessary.
MassHealth Standard eligibility generally requires income at or below 133% of the Federal Poverty Level. For 2026, that Federal Poverty Level for a single person is $15,960 per year ($1,330 per month), putting the 133% threshold around $1,769 per month.5HHS ASPE. 2026 Poverty Guidelines – 48 Contiguous States The asset limit for a single applicant is $2,000.6Mass.gov. Program Financial Guidelines for Certain MassHealth Applicants and Members
What PCAs Are Paid and How Hours Work
PCA attendants were paid $19.50 per hour as of early 2025. Massachusetts adjusts the PCA rate periodically through administrative bulletins, and a rate update took effect in January 2026 for certain service categories. Confirm the current rate with your fiscal intermediary.
A PCA cannot bill more than 66 hours per week across all consumers they serve. Hours above that limit are not covered by MassHealth, and billing for excess hours violates program rules.7Mass.gov. MassHealth Educational Trainings for the Personal Care Attendant Weekly Hour Limit The specific number of hours authorized for each care recipient depends on the Personal Care Management (PCM) agency’s assessment of their needs.
All PCA payroll runs through a fiscal intermediary, which withholds taxes and issues paychecks. In Massachusetts, the three fiscal intermediaries are Tempus Unlimited, Stavros, and Northeast ARC.8Mass.gov. MassHealth Personal Care Attendant (PCA) Fiscal Intermediary – Tempus
The Adult Foster Care Program
AFC pays a live-in caregiver to support a MassHealth member who cannot safely live alone. Unlike PCA, an AFC provider agency oversees the arrangement and continues to supervise it after approval.
Who Qualifies for AFC
The care recipient must be 16 or older, enrolled in MassHealth Standard, CommonHealth, or an integrated care plan (One Care, Senior Care Options, or PACE), and need hands-on help or cueing and supervision with at least one ADL.2Mass.gov. MassHealth Adult Foster Care Program Fact Sheet That one-ADL threshold is lower than PCA’s two-ADL requirement, so some people who don’t meet PCA criteria still qualify for AFC. The same MassHealth income and asset rules apply, including the $2,000 asset cap for a single individual.6Mass.gov. Program Financial Guidelines for Certain MassHealth Applicants and Members
What AFC Caregivers Are Paid
AFC caregivers receive a tax-advantaged monthly stipend rather than an hourly wage. The amount varies with the care recipient’s level of need. No single official source publishes a fixed rate schedule, but stipends generally fall in the range of $1,000 to $1,500 per month.
The live-in rule is the practical dividing line between the two MassHealth programs. Under PCA, the attendant comes to the recipient’s home for scheduled hours. Under AFC, the caregiver and care recipient share a household full time.
Options for Veteran Families
If the person needing care is a veteran, two VA programs may apply regardless of MassHealth enrollment.
The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to a primary family caregiver of an eligible veteran.9Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers The stipend is tied to the Office of Personnel Management’s General Schedule pay scale for the veteran’s geographic area, with two tiers based on the veteran’s level of need.10Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Eligibility Criteria Fact Sheet
The Veteran Directed Care Program gives the veteran a flexible budget and, with counselor support, lets them hire their own workers, which can include family members or neighbors.11Veterans Affairs. Veteran-Directed Care It works much like PCA in that the veteran or their representative controls the spending plan.
How to Start the Application
For PCA, contact a Personal Care Management agency in your area. The PCM agency schedules a home visit by a nurse and an occupational therapist who assess how much physical help is needed, then submits a prior authorization request to MassHealth for a specific number of weekly hours.3Mass.gov. MassHealth Personal Care Attendant Program If the care recipient is not yet enrolled in MassHealth, apply for long-term care coverage first, with financial documents and medical records ready.12Mass.gov. Apply for MassHealth Coverage for Seniors and People Needing Long-Term Care Services
For AFC, contact an adult foster care provider agency. The provider handles the application, arranges a medical evaluation by a healthcare professional, and conducts a home assessment to confirm the living situation is safe.2Mass.gov. MassHealth Adult Foster Care Program Fact Sheet
If MassHealth Denies or Reduces Services
If MassHealth denies or cuts PCA or AFC services, the care recipient can request a fair hearing. The request has to be filed within 60 calendar days of receiving the denial notice, or within 120 days if no written notice was provided, and can be submitted by mail, fax, phone, or email to the Board of Hearings.13Mass.gov. Fair Hearing Request Form MassHealth also offers a prehearing resolution option for eligibility disputes. Federal rules generally require a fair hearing decision within 90 days.
How Being Paid Affects Taxes and Benefits
Under IRS Notice 2014-7, Medicaid waiver payments to a caregiver who lives with the care recipient are treated as “difficulty of care” payments and can be excluded from gross income. The shared-residence requirement is strict: if the caregiver keeps a separate home where they conduct their private life, the exclusion does not apply.14Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
In practice, AFC caregivers are usually positioned to exclude their stipend because the program requires them to live with the care recipient. PCA attendants who commute to the recipient’s home generally cannot use the exclusion unless they also share a household. A tax professional can confirm whether a specific arrangement qualifies.
Caregiver earnings that are not excluded count toward Social Security work credits. In 2026, you earn one credit for every $1,890 in covered earnings, with a maximum of four credits per year at $7,560 total.15Social Security Administration. Social Security Credits and Benefit Eligibility Excluding the income under Notice 2014-7 means no Social Security credits accrue on those dollars, though the caregiver still has the option to count those payments as earned income for purposes of claiming the Earned Income Tax Credit.
For a caregiver on Supplemental Security Income (SSI), in-home supportive services payments made to an ineligible spouse or parent for caring for an SSI-eligible family member in the same household are excluded from income for SSI deeming purposes.16Social Security Administration. SI 01320.175 – Deeming – In-Home Supportive Services Payments Caregiver income received for caring for anyone else counts as income under normal SSI rules.