Key takeaway
Massachusetts pays family caregivers primarily through MassHealth PCA and Adult Foster Care, with PFML for short-term wage replacement and VA/local programs as complements.
- PCA: Pays most family members (not spouses/legal guardians) for ADLs; ~ $18–$20/hr.
- Adult Foster Care: Tax-free monthly stipend for live-in caregivers (excludes spouses/legal guardians).
- PFML: Up to 12 weeks of partial wages for caregiving leave.
- HCBS waivers (e.g., Frail Elder, ABI, MFP, DDS) can add services and supports.
- Local ASAP/AAA programs can offer respite, training, and small grants.
Overview
Becoming a paid caregiver for a family member in Massachusetts is possible via state, federal, and private programs. PCA and Adult Foster Care are core options under MassHealth, while PFML can replace wages during time off work.
Programs that pay family caregivers in Massachusetts
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| MassHealth Personal Care Attendant (PCA) (MassHealth) | MassHealth member who needs hands-on help with at least one ADL; assessment and medical certification required. | Pays most family caregivers (not spouses or legal guardians) ~ $18–$20/hr for ADLs/IADLs authorized by assessment. |
| Adult Foster Care (AFC) (MassHealth) | MassHealth, age 16+, daily help with ≥1 ADL, live-in caregiver arrangement. | $750–$1,500/month (tax-free) stipend to the caregiver depending on care level; spouses/legal guardians excluded. |
| HCBS Waivers (e.g., Frail Elder, ABI, MFP, DDS) (MassHealth) | MassHealth eligibility and level-of-care criteria per waiver; serves older adults, people with disabilities or brain injury. | Provides in-home services; some waivers support caregiver arrangements and additional supports via ASAPs/providers. |
| Paid Family and Medical Leave (PFML) (State wage benefit) | Workers paying into PFML who meet earnings tests; caring for a seriously ill family member. | Up to 12 weeks of partial wage replacement; complements PCA/AFC but is not a caregiving service. |
| VA Programs (Aid & Attendance, PCAFC, Veteran-Directed Care) (Federal) | Eligible veterans; program-specific criteria and clinical needs apply. | A&A increases pension; PCAFC provides monthly stipend/training; Veteran-Directed Care allows hiring family caregivers. |
| Local Caregiver Support (ASAP/AAA, MassOptions) (State/Local) | Varies by county and program funding. | Resources include respite, counseling, training, and occasional small grants; no direct salary in most cases. |
| Long-Term Care Insurance / Private Pay (Private) | Policy coverage or private agreement; varies by insurer/contract. | Some LTC policies allow family caregiving; otherwise create a written caregiver agreement for private pay. |
MassHealth programs: PCA, AFC, and HCBS waivers
MassHealth supports in-home care through PCA, Adult Foster Care, and several HCBS waivers. PCA pays hourly for authorized tasks; AFC provides a monthly tax-free stipend for live-in caregivers; waivers add services and supports.
Personal Care Attendant (PCA)
Pays most family caregivers (excluding spouses/legal guardians) to assist with ADLs/IADLs for MassHealth members who qualify through assessment and medical certification.
- Hourly pay typically about $18–$20 depending on contracts and updates.
- Tasks include bathing, dressing, meal prep, housekeeping, and medical appointment transportation.
- Enroll via a PCM agency and fiscal intermediary; member or surrogate directs the care.
Adult Foster Care (AFC)
Provides a monthly stipend ($750–$1,500 tax-free) to a live-in caregiver for a MassHealth member needing daily assistance with ADLs.
- Caregiver cannot be a spouse or legal guardian.
- Coordinated through approved AFC provider agencies; levels set by assessed need.
HCBS Waivers (Frail Elder, ABI, MFP, DDS)
Expand in-home supports for eligible populations and can complement PCA/AFC. Access is through ASAPs, DDS, or specialized providers depending on the waiver.
- Eligibility varies by waiver and may require nursing-home level of care.
- Services can include homemaker, adult day health, respite, and care management.
Family caregiver supports (ASAP/AAA, MassOptions)
Massachusetts provides caregiver support resources via ASAPs/AAAs and MassOptions, including respite, education, counseling, and connections to programs.
Short-term relief for caregivers and skill-building resources.
Navigation help and occasional small grants where available.
Who qualifies
- Family caregivers of older adults or people with disabilities; criteria vary by program and county.
- Contact your local ASAP/AAA for current availability.
Veterans’ programs
Veterans can leverage federal programs to fund family caregiving support in the home.
Aid & Attendance Pension
Adds to a qualifying veteran’s pension to offset in-home care costs, which can include family-provided care.
- Requires ADL need and income/asset criteria; payments help cover caregiver costs.
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Provides a monthly stipend, training, and support to a primary family caregiver of an eligible veteran.
- Eligibility and stipend tier depend on clinical needs and service era; apply via VA Caregiver Support.
Veteran-Directed Care
Gives veterans a flexible budget to hire caregivers of their choice, including family, where available.
Private pay and long‑term care insurance
If public programs do not apply, families can use private caregiver agreements or long-term care insurance to fund in-home care.
What to check in the policy
- Verify if the LTC policy covers in-home personal care and allows payment to the policyholder.
- Private agreements should outline duties, hours, and pay for clarity.
How to apply in Massachusetts (step-by-step)
- Choose the path: PCA, Adult Foster Care, HCBS waivers, PFML, VA programs, or local supports.
- Gather documents: ID, MassHealth status, proof of residency, earnings (for PFML), and medical certification as needed.
- Start with the right agency:
- PCA: contact a Personal Care Management (PCM) agency for assessment and enrollment with a fiscal intermediary.
- AFC: contact an approved AFC provider agency or your local ASAP.
- HCBS waivers: contact your local ASAP/DDS or program administrator to screen for waiver eligibility.
- PFML: apply through Massachusetts DFML (Paid Family and Medical Leave).
- Veterans: contact the VA Caregiver Support Program.
- Local supports: use MassOptions to find your ASAP/AAA.
- Complete functional and financial assessments as required by the program.
- If applicable, designate the family caregiver; complete enrollment/orientation and timesheet setup.
- Begin services and track hours/claims; keep documentation for renewals and audits.
Massachusetts paid caregiver FAQs
Can a spouse be paid as a caregiver in Massachusetts?
Generally no for PCA and AFC. Most other family members can be paid if eligible.
How much does PCA pay?
About $18–$20 per hour depending on contracts and updates.
Do I have to live with my family member to be paid?
AFC requires a live-in caregiver arrangement; PCA does not require live-in status.
Can I use PFML and PCA together?
Yes. PFML replaces wages during leave from your job; PCA pays for authorized caregiving hours. They serve different purposes.
How do I find my local ASAP?
Use MassOptions to locate the Aging Services Access Point in your area.
