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 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).

First: the MassHealth Prerequisite

Before either of the two paid-caregiving pathways opens up, the person receiving care usually has 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.1 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 look at the VA options below, which don't require MassHealth.

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, and schedule your own attendants, and MassHealth pays them for helping with daily activities like bathing, dressing, and transfers.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 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.1

How the assessment works. A Personal Care Management (PCM) agency completes a functional evaluation of the member, decides how many PCA hours MassHealth will authorize, and helps set up the arrangement. A separate fiscal intermediary handles payroll, taxes, and the paperwork of being an employer, so the family isn't left to run a payroll on its own.1

How the pay works. PCAs are paid an hourly wage set under the program's statewide collective-bargaining agreement (negotiated between the Commonwealth and the PCA workforce union), and that wage rises with seniority, with an added pay differential for approved complex-care work. Because the rate is contract-set and changes as new agreement terms take effect, ask your PCM agency or fiscal intermediary for the current hourly rate that applies to you.1

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.2 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.2

How the assessment and pay work. An AFC agency assesses the member's clinical and daily-living needs and assigns a care level (Level I or the higher Level II). That care level, along with the AFC agency, determines the tax-free monthly stipend the caregiver receives; the more hands-on the member's daily care needs, the higher the level and the stipend. AFC pays for the personal care, not room and board, so the caregiver's own housing costs aren't part of it. Because stipends are set by rate schedules and by care level, ask the AFC agency what the current Level I and Level II rates are for your situation.2

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 worth up to $2,424 a month for a single veteran with no dependents, and more with dependents, for example up to $2,874 a month for a veteran with one dependent. A surviving spouse with no dependents can receive up to $1,558 a month.3 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 an eligible veteran a monthly budget to hire their own caregivers, often including a spouse, and a separate caregiver-support program for veterans with a qualifying service-connected condition. 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 provides most Massachusetts workers job-protected, partially paid leave 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, and it isn't tied to MassHealth. 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, and Massachusetts sets both rates through processes that change over time, so this guide points you to how the number is set rather than quoting a figure that may already be out of date:

• PCA program: an hourly wage set by the statewide collective-bargaining agreement, rising with seniority and with an added differential for approved complex-care tasks. Your PCM agency or fiscal intermediary can tell you the current rate and how many hours are authorized.1
• Adult Foster Care: a tax-free monthly stipend that scales with the member's assessed care level (Level I or the higher Level II) and is set by the AFC agency under state rate schedules. Ask the AFC agency for the current Level I and Level II amounts.2
• VA Aid and Attendance: in 2026, up to $2,424 a month for a single veteran and up to $2,874 for a veteran with one dependent, paid to the veteran, who then pays the caregiver.3

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.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

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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.