If you're caring for an aging parent or a disabled relative in Massachusetts, you can often be paid for it. 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, 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
- Pathway 1: the MassHealth PCA program
- Pathway 2: Adult Foster Care
- Pathway 3: VA benefits for veteran families
- Massachusetts Paid Family and Medical Leave
- Who can and can't be paid
- How to start
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 pays you an hourly wage. If you live with the person and provide daily care, Adult Foster Care pays you a tax-free monthly stipend. 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).
| Pathway | How you're paid | Best fit | Can a spouse be paid? |
|---|---|---|---|
| MassHealth PCA program | Hourly wage; you hire/direct your own attendant | Part-time, come-and-go help | No |
| MassHealth Adult Foster Care | Tax-free monthly stipend to a live-in caregiver | Living together, daily care | No |
| VA Aid and Attendance | Added monthly income to a veteran, usable for care | Wartime veteran or surviving spouse | Income can pay most family caregivers |
| MA Paid Family and Medical Leave | Job-protected partially paid leave | A working caregiver needing time off | Yes (it's leave, not caregiver pay) |
Pathway 1: 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, and schedule your own attendants, and MassHealth pays them for helping with daily activities like bathing, dressing, and transfers. Because you choose your attendants, you can hire a relative the rules allow, often the adult child or sibling already doing the work. The program is an entitlement, so qualifying members don't wait on a list. The one limit to remember: your spouse and any legally responsible relative can't be your paid PCA. Pay is an hourly wage set under the PCA program's collective-bargaining agreement; a Personal Care Management agency sets your approved hours and a fiscal intermediary handles payroll. Ask your agency for the current hourly rate.
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 agency provides nursing oversight and care management, and the caregiver receives a monthly stipend that's generally tax-free under IRS difficulty-of-care rules. The caregiver can be related or unrelated, and you can live in either person's home. Under the program's higher care level, a relative can serve as the paid caregiver, with the same exceptions everywhere: not a spouse, not the parent of a member who's a minor child, and not another legally responsible relative. The stipend amount depends on the member's assessed care level and the AFC agency; ask the agency what the current rate is for your situation.
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 can add up to $2,424 a month to a veteran's income in 2026, which can be used to pay for care, including care a family member provides. The VA also runs Veteran-Directed Care and a caregiver-support program for eligible veterans. Help applying for VA benefits is free through accredited veterans service officers, so no one should charge to file.
Massachusetts Paid Family and Medical Leave
Massachusetts Paid Family and Medical Leave (PFML) is different from the programs above: it provides job-protected, partially paid leave to care for a family member with a serious health condition, funded through a state payroll contribution. It's time off from your job with wage replacement, not an ongoing wage for being a caregiver, but for a working family member who needs to step back during a crisis, it's worth knowing about alongside the MassHealth pathways.
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 child. 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
- For the PCA program, ask your MassHealth provider or call MassHealth to be connected with a Personal Care Management agency that runs the evaluation.
- For Adult Foster Care, contact an AFC provider agency in your area; they enroll the member and the caregiver.
- For VA benefits, contact a veterans service officer (free) to apply for Aid and Attendance.
- For PFML, apply through the Massachusetts Department of Family and Medical Leave when you need leave from a job.
- If you're not sure which fits, your local Aging Services Access Point (ASAP) can help; call MassOptions at 1-800-243-4636.
Frequently Asked Questions
Often, yes. If your parent has MassHealth, you can usually be paid as their Personal Care Attendant, or as their Adult Foster Care caregiver if you live together. Adult children are among the relatives the rules allow.
Generally no. In both the PCA program and Adult Foster Care, a spouse can't be the paid caregiver. Veteran families may be able to use VA Aid and Attendance, and Massachusetts Paid Family and Medical Leave can cover time off from a job.
It depends on the program. The PCA program pays an hourly wage set under its collective-bargaining agreement, and Adult Foster Care pays a tax-free monthly stipend that varies by the member's care level. Ask the PCM or AFC agency for the current rate.
The PCA program is an entitlement, so there's no waitlist for members who qualify. Adult Foster Care and other programs can vary by agency, so call early.
For the PCA program and Adult Foster Care, yes, the person receiving care must be a MassHealth member. Veteran families have VA pathways that don't require MassHealth, and PFML is tied to employment, not MassHealth.
Learn More
- Caregiving in Massachusetts
- Massachusetts Medicaid (MassHealth): the full guide
- How to Apply for MassHealth
- Nursing Homes in Massachusetts
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.