Massachusetts Home Care Program Consumer Directed Care: Family Pay

Massachusetts Home Care Program consumer directed care (CDC) lets an older adult hire their own paid worker, and the state's letter to CDC consumers refers to CDC workers who are also family members.1 CDC serves Massachusetts adults 60 or older, or younger with a documented dementia diagnosis, and covers homemaking, personal care, chore and companion help.2,1 Massachusetts' CDC statute bars the consumer's surrogate, such as a legal guardian, from being that consumer's paid CDC worker, and it neither names nor bars relatives.3 Start by calling MassOptions at 1-800-243-4636.4

In This Guide

• Who Qualifies for Massachusetts Home Care Program Consumer Directed Care
• Which Family Members Can Be Paid Through Consumer Directed Care
• How Consumer Directed Care Pay and Hours Work
• What the Home Care Program Costs Your Family
• How to Start Massachusetts Home Care Program Consumer Directed Care

Who Qualifies for Massachusetts Home Care Program Consumer Directed Care

The Home Care Program is run by the Executive Office of Aging & Independence (AGE) through regional Aging Services Access Points (ASAPs). To qualify for the Massachusetts Home Care Program under 651 CMR 3.04, the person you care for must:2

• Be 60 or older, or under 60 with a physician's documented diagnosis of Alzheimer's disease, a related disorder or other dementia.
• Live at home in Massachusetts, not in a nursing facility, hospital or assisted living residence.
• Meet the state's Financial Eligibility Guidelines, which set an income-based co-pay rather than an income cap.
• Need help, confirmed by an ASAP assessment with a home visit: at least one activity of daily living (ADL) or six or more instrumental activities (IADLs), plus a critical unmet need, meaning unmet help with an ADL, meal preparation, grocery shopping, medication management, rides to medical treatment, respite or home health services.2

Someone who meets every other Massachusetts Home Care Program requirement but not the needs standard may still qualify (AGE's slides say with 4 IADLs) if at risk of being unable to stay in the community, living in Congregate Housing, or eligible for the Frail Elder Waiver. Under the same exception rule, elders receiving or eligible for Protective Services are eligible. MassHealth members who meet the criteria can use the Home Care Program if its services don't duplicate their other MassHealth services, but people in an all-inclusive MassHealth program can't.2 CDC itself is for Home Care consumers not enrolled in the Frail Elder Waiver.3

Which Family Members Can Be Paid Through Consumer Directed Care

State law, M.G.L. c. 19A, section 4E, bars a surrogate (the consumer's legal guardian or a person named in a signed agreement to manage CDC workers) from being the CDC worker for that same consumer, and neither names nor bars other relatives.3

AGE's letter to Massachusetts Home Care CDC consumers says a CDC worker can't sit on the CDC Workforce Council "even if that worker is also your family member," which assumes some CDC workers are relatives.1 If you're the spouse or adult child already doing this care, the Massachusetts CDC statute doesn't rule you out unless you are your parent's surrogate. Ask the ASAP whether you can be hired and whether you're being named surrogate.3

How Consumer Directed Care Pay and Hours Work

The older adult (or their surrogate) is the employer and recruits, hires, trains, manages and fires the CDC worker.1

Published rate: $19.50 an hour is the Massachusetts Home Care CDC wage in the sample care plans in AGE's May 18, 2026 slides, which the slides label as illustrative. The $21.72 an hour that AGE's May 2026 Massachusetts Home Care slides list as consumer cost is what each CDC hour costs the care plan, not the wage. In AGE's illustrative 2026 example, 3 CDC hours a week is $282.00 of a $501.50 monthly Massachusetts Home Care plan, and the consumer's co-pay, set by a financial assessment, is $125.00 a month.1

Hours: the ASAP assesses need and authorizes an average number of hours a week within Home Care Program limits. Training for Massachusetts Home Care CDC workers is optional.1

What the Home Care Program Costs Your Family

The Massachusetts Home Care Program has no income cap, and at the lowest incomes its co-pay is voluntary. Massachusetts Home Care Program monthly co-pays, effective March 31, 2026:5

MassHealth members of any coverage type (AGE's slides include members of a Medicare Savings Program) with income at or below $2,982 a month ($35,784 a year) in 2026 owe no Massachusetts Home Care Program co-pay, voluntary or otherwise. If a Home Care co-pay would be a hardship, ask the ASAP to waive or reduce it. Reverse mortgage proceeds and war reparations don't count as income for the Home Care Program co-pay; AGE's slides list some VA benefits and pooled trusts as exceptions. A Home Care Program co-pay two or more months overdue after collection efforts can lead to a notice ending services unless it is paid or a payment plan is set up within 14 days.5

How to Start Massachusetts Home Care Program Consumer Directed Care

If the ASAP Says No or Cuts Services

If the ASAP denies, reduces or ends Massachusetts Home Care Program services, you can request a Review, then appeal the Review decision to a state Hearings Officer. To keep your parent's care in place, get the Review request to the ASAP within 14 calendar days of your parent receiving a notice ending services (30 on the Frail Elder Waiver); services then continue, or stay on hold, until the Review and appeal are decided. If services were paused while your parent was away, telling the ASAP within that same 14-day (or 30-day) window that they're home also stops the termination, and the ASAP then reassesses their need for services. Miss both deadlines and restarting Home Care services counts as a new application.2

Learn More

Find personalized help with Massachusetts Home Care consumer directed care 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.