Get Paid to Care for a Family Member in Massachusetts

In Massachusetts, you can often get paid to care for a family member, whether that's an aging parent or a disabled relative you're already helping. The work is real, and asking to be paid for it is reasonable.

Massachusetts has two main MassHealth-funded ways for a family member to be paid, plus options for veteran families. This guide walks through each pathway, who qualifies, how the pay actually works, and the one rule that disappoints people most: a spouse usually can't be the paid caregiver, but an adult child or other relative often can.

In This Guide

• The 60-second version
• First: the MassHealth prerequisite
• Pathway 1: get paid through the MassHealth PCA program
• Pathway 2: Adult Foster Care
• Pathway 3: VA benefits for veteran families
• Massachusetts Paid Family and Medical Leave
• How much a family caregiver gets paid
• Who can and can't be paid
• How to start getting paid to care for a family member
• Where to get help

The 60-Second Version

In Massachusetts, the two ways a family member gets paid to provide care both run through MassHealth. If you come and go and help with daily tasks, the PCA program is usually the fit: the person receiving care hires you as their personal care attendant, and MassHealth provides the funds for hiring PCAs. If you live with the person and provide daily care, Adult Foster Care pays you a stipend through an AFC provider agency. In both, a spouse can't be the paid caregiver, but many other relatives can. Veteran families have additional options, and Massachusetts Paid Family and Medical Leave can cover time off (though it's leave, not an ongoing caregiver wage).

First: the MassHealth Prerequisite

Before either of the two paid-caregiving pathways opens up, the person receiving care needs to be a MassHealth member. MassHealth is Massachusetts' Medicaid program, and both the PCA program and Adult Foster Care are MassHealth benefits, so the care recipient's eligibility is what unlocks them, not the caregiver's.3 If your loved one isn't enrolled yet, that's the first step; if they're close to but over the income or asset limits, ask about a spend-down or other eligibility pathways rather than assuming the door is closed. Veteran families can also look at the VA options below.

Pathway 1: Get Paid Through the MassHealth PCA Program

The Personal Care Attendant (PCA) program is self-directed, which is the part families like. The MassHealth member is the employer: you recruit, hire, train, schedule, and manage your own attendants, and MassHealth provides the funds for hiring PCAs to help with activities of daily living.1 Because you choose your attendants, you can hire a relative the rules allow, often the adult child or sibling already doing the work. The limits to remember: your paid PCA can't be your spouse, the parent of a minor member, any other legally responsible relative, your surrogate or administrative proxy, or your foster parent. A PCA must also be at least 16, have a current and valid PCA provider number, and sign a PCA provider agreement.1

How to get started. To get more information or enroll, the member contacts a Personal Care Management (PCM) agency in their area.3

How the pay works. MassHealth provides the funds, and the member, as the PCA consumer-employer, hires the attendant. One rule to know: a PCA can't be receiving compensation from any other person or entity for the same activity time.1 For more information, the member can contact a PCM agency in their area.3

Pathway 2: MassHealth Adult Foster Care

Adult Foster Care (AFC) fits when a caregiver and the person they care for live together. The caregiver provides daily personal care, an AFC provider agency provides nursing oversight and care management, and the AFC provider pays the caregiver a stipend.2 The caregiver can be related or unrelated, and you can live in either person's home. A relative can be the paid caregiver, with these exceptions: not a spouse, not the parent of a member who's a minor, and not any other legally responsible relative. MassHealth's AFC fact sheet also excludes legal guardians, so a relative who is the member's court-appointed guardian should confirm with the AFC provider before counting on being paid. The caregiver must be at least 18.2

How eligibility and pay work. To qualify, the member must be 16 or older, have AFC ordered by their primary care provider, and need daily hands-on help or cueing and supervision with at least one of six activities: bathing, dressing, toileting, transferring, mobility, or eating. The AFC provider must get MassHealth's prior authorization before the first date of service and again each year. The provider pays the caregiver a stipend at compensation levels for which MassHealth may set a minimum, and AFC rates don't include any amount for room and board. Ask the AFC provider what stipend would apply to your situation.2 Our guide to structured family caregiving compares Adult Foster Care with similar live-in programs in other states.

Pathway 3: VA Benefits for Veteran Families

If the person needing care is a wartime veteran or a veteran's surviving spouse, VA Aid and Attendance adds money to their monthly pension that can be used to pay for care, including care a family member provides. In 2026 (rates effective December 1, 2025 through November 30, 2026), Aid and Attendance is capped at $29,093 a year for a single veteran with no dependents, and the ceiling is higher with dependents, for example $34,488 a year for a veteran with one dependent. For a surviving spouse with no dependents, the ceiling is $18,697 a year. Each figure is a ceiling rather than a flat award: VA bases the payment on the difference between the claimant's income for VA purposes and the applicable maximum, so a veteran or surviving spouse with other income receives less than the amount shown. Some expenses, like non-reimbursable medical expenses, may reduce income for VA purposes. These are annual amounts; VA figures the monthly payment by subtracting countable income from the annual maximum and dividing by 12.4 The pension goes to the veteran or surviving spouse, who can then pay a family caregiver, ideally under a simple written caregiver agreement.

The VA also runs Veteran-Directed Care, which gives veterans a flexible budget for services that can be managed by the veteran or the family caregiver, and lets them hire their own personal care aides, which VA says "might include their own family member or neighbor." All enrolled veterans are eligible if they meet the clinical need for the service and it is available, but the program is only available in certain locations, so talk with the veteran's VA social worker about whether it's offered near you.5 Help applying for VA benefits is free through accredited Veterans Service Officers, so no one should charge you to file.

Massachusetts Paid Family and Medical Leave

Massachusetts Paid Family and Medical Leave (PFML) is different from the programs above: it gives most Massachusetts workers up to 12 weeks of job-protected, partially paid family leave in a benefit year to care for a family member with a serious health condition, run by the Department of Family and Medical Leave. It's time off from your job with partial wage replacement, not an ongoing wage for being a caregiver. One catch: work performed for your own son, daughter, or spouse is excluded from PFML, so a job working for them isn't covered.6 For a working family member who needs to step back during a crisis, it's worth knowing about alongside the MassHealth pathways.

How Much a Family Caregiver Gets Paid

The honest answer is that it depends on the pathway. For the two MassHealth programs, this guide points you to who to contact rather than quoting a figure that may already be out of date:

• PCA program: MassHealth provides the funds for hiring PCAs, and the member is the employer.1 For more information, contact a PCM agency in your area.3
• Adult Foster Care: a stipend the AFC provider pays, at compensation levels for which MassHealth may set a minimum; AFC rates don't cover room and board. Ask the AFC provider for the current amount.2
• VA Aid and Attendance: in 2026, a ceiling of $29,093 a year for a single veteran and $34,488 for a veteran with one dependent, reduced by the veteran's income for VA purposes and paid to the veteran, who can then pay the caregiver.4

Who Can and Can't Be Paid

The rule that trips up the most families is about spouses. In both the PCA program and Adult Foster Care, a husband or wife cannot be the paid caregiver, and neither can a legally responsible relative or the parent of a member who is a minor.1,2 The PCA program also bars the member's surrogate, administrative proxy, or foster parent, and MassHealth's AFC fact sheet excludes legal guardians.1,2 But an adult child, a sibling, a grandchild, a niece or nephew, or even a friend usually can be paid. So the daughter caring for her mother can often get paid; the wife caring for her husband usually can't through these programs, though VA benefits or PFML may still help.

How to Start Getting Paid to Care for a Family Member

Where to Get Help

Learn More

Find personalized help figuring out how to get paid as a 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.