You can be paid to care for a parent or other relative who lives with you in Massachusetts, through the state's Medicaid program. MassHealth's Adult Foster Care (AFC) program pays a live-in caregiver, who can be an adult child or other relative, to give daily personal care with nursing oversight from an AFC agency. Massachusetts Adult Foster Care family caregiver pay is a daily stipend, and MassHealth set its minimum at $25 a day (Level I) or $49 a day (Level II) in April 2024.

In This Guide

Who Massachusetts Adult Foster Care Pays as a Family Caregiver

The MassHealth AFC provider agency selects, supervises and pays the caregiver.,

130 CMR 408.434 bars a "family member" from being the AFC caregiver; 130 CMR 408.402 defines one as a spouse, a parent of a minor member (including an adoptive parent) or any legally responsible relative. MassHealth's AFC fact sheet also excludes legal guardians.

Your relationship to the member Can you be the paid AFC caregiver?
Adult child Yes, if not a guardian or legally responsible relative
Sibling or other relative Yes, if not a guardian or legally responsible relative
Someone not related to the member Yes
Spouse No
Parent of a member under 18 No
Legally responsible relative No
Legal guardian No, per MassHealth's fact sheet
The member's AFC care manager No, one person can't hold both roles

If you're your parent's court-appointed guardian, plan on no, and ask the AFC agency before you give up other work or income. Our guardian-as-caregiver guide explains why. Spouses can look at other Massachusetts options for paid spousal care.

Does Your Parent Qualify for Adult Foster Care?

Under 130 CMR 408.000, the AFC member must be 16 or older, have AFC ordered by their primary care provider, and have a medical or mental condition that requires daily hands-on (physical) help, or cueing and supervision throughout the entire activity, with at least one of these:

  • Bathing
  • Dressing
  • Toileting
  • Transferring
  • Mobility
  • Eating

Needing help with one activity is enough for MassHealth AFC, so a parent you help bathe or dress daily may meet its clinical test.

MassHealth's fact sheet adds that AFC members qualify for MassHealth Standard or CommonHealth, or are enrolled in One Care, Senior Care Options (SCO) or the Program of All-Inclusive Care for the Elderly (PACE), and can live safely at home with a caregiver's support. It calls itself a summary; the full rules are in 130 CMR 408.000.

What You Need to Be the Paid Caregiver

Under 130 CMR 408.434, every AFC caregiver must:

  • Be a responsible person at least 18 years old, able to make mature and accurate judgments, with no mental, physical or other impairment that would interfere with the caregiver's duties
  • Not have an alcohol or substance use disorder
  • Be able to devote the time needed to keep the member safe and well at all times
  • Not be a family member as the regulation defines it, or hold another role on the member's care team, such as their AFC care manager
  • Meet every other requirement the AFC provider sets (ask the agency for its full list before you apply)

What Massachusetts Adult Foster Care Pays a Family Caregiver

MassHealth AFC pays caregivers a daily stipend, not an hourly wage, and the AFC agency, not MassHealth, pays it.

MassHealth AFC Bulletin 32, issued in April 2024, set the minimum per diem caregiver compensation at $25 a day for AFC Level I and $49 a day for AFC Level II, and every AFC provider had to meet it by July 1, 2024. That's a floor; an agency may pay more.

Bulletin 32's minimums run concurrently with the AFC rates under 101 CMR 351.00, which changed on November 1, 2025, and we found no later caregiver-compensation bulletin, so we can't confirm the 2024 minimums still apply.

Before leaving a job or cutting hours, ask the agency its current rate and your level, then weigh a month of it against the income you'd lose.

How to Start Getting Paid Through Adult Foster Care

1
Step 1

Make sure your parent has MassHealth

People 65 or older, and anyone needing long-term-care services to live at home, generally apply for MassHealth with its Application for Health Coverage for Seniors and People Needing Long-Term-Care Services (SACA-2). Our guide on how to apply for MassHealth has MassHealth's phone line.

2
Step 2

Ask your parent's primary care provider to order AFC

, which the program requires.

3
Step 3

Work with an AFC provider agency

The AFC agency must get MassHealth's prior authorization before the first day of service, again every year, and whenever your parent's needs change significantly.

4
Step 4

Meet the agency's caregiver requirements

The AFC provider agency's approval is what makes you the paid caregiver.

Frequently Asked Questions

Do we have to live in my home, or can I move into my parent's?

Either works: MassHealth's AFC fact sheet says the member and caregiver live together in the member's home or the caregiver's.

Why does MassHealth's AFC rate look higher than the caregiver stipend?

For care on or after November 1, 2025, MassHealth pays the AFC agency $54.37 a day for Level I and $91.31 a day for Level II. That's the agency's rate, not your stipend.

Does Adult Foster Care pay for my parent's room and board?

No. MassHealth's AFC rates don't include any amount for room and board, so settle your parent's share of household costs separately.

What's the difference between Adult Foster Care and Group Adult Foster Care?

Group Adult Foster Care (GAFC) is a related MassHealth benefit for members 22 or older. GAFC services come from the provider's multidisciplinary team and a qualified GAFC direct care aide, and the GAFC provider must be a certified assisted living residence serving its own residents or a nationally accredited organization.

Learn More

CaregiverHow to Get Paid to Care for a Family Member in MassachusettsYes, you can be paid to care for a family member in Massachusetts. How the MassHealth PCA program and Adult Foster Care pay family caregivers, and who can't be. CaregiverHow to Get Paid to Care for Your Spouse in MassachusettsIn Massachusetts, MassHealth's PCA and Adult Foster Care won't pay a spouse, but the VA can. How PCAFC, Veteran-Directed Care, and Aid and Attendance work. CaregiverMassachusetts Caregiver ProgramsMassachusetts caregiver programs in 2026: which ones pay a family member (PCA, Adult Foster Care), which give respite to unpaid caregivers, and where to start. MedicaidHow to Apply for MassHealthHow to apply for MassHealth (Massachusetts Medicaid) in 2026: which of its two applications fits you, the ACA-3 or the SACA-2 for seniors and long-term care. CaregiverStructured Family Caregiving: How It Works and Which States Offer ItStructured family caregiving lets Medicaid pay a relative who lives with a parent for daily care, through an agency. See which states offer it and what it pays. CaregiverLive-In Caregiver for an Elderly ParentA live-in caregiver is usually owed minimum wage for every hour worked; room and board is only a capped credit. The rules, agency vs. private hire, who pays.

Find personalized help getting paid as a live-in Adult Foster Care caregiver in Massachusetts at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.