MassHealth PCA Program Family Member Pay, Hours and Rules (2026)

An adult child can be paid to care for a parent at home through the MassHealth Personal Care Attendant program, which funds members with permanent or chronic disabilities to hire help.1 MassHealth, the state's Medicaid program, won't pay the member's spouse or a relative who is their legal guardian as a Personal Care Attendant (PCA).2 For work on or after July 1, 2025, the MassHealth PCA program pays a family member the published PCA wage of $20.00 to $22.40 an hour, by seniority step.2

In This Guide

• Which Family Members the MassHealth PCA Program Will Pay
• If You Live With the Person You Care For
• How Many Hours a Family PCA Can Work
• What the MassHealth PCA Program Pays a Family Member
• How to Get Hired as Your Family Member's PCA
• Frequently Asked Questions

Which Family Members the MassHealth PCA Program Will Pay

The MassHealth PCA program is self-directed: the member recruits, hires, trains, schedules and manages their own PCA, who assists with activities of daily living.1

MassHealth regulation 130 CMR 422.404 bars a PCA who is a "family member" as 130 CMR 422.402 defines it: only the member's spouse, the parent of a minor member (including an adoptive parent), and any legally responsible relative. Adult children aren't in that definition, so they can be paid MassHealth PCAs. A 2009 Massachusetts State Auditor report records MassHealth changed the definition, effective March 1, 2006, to let an adult child, a parent of an adult child, a son-in-law or a daughter-in-law be paid as a PCA.1

130 CMR 422.404 also bars the member's surrogate: their legal guardian, family member or another adult named in the service agreement who handles PCA management tasks the member can't or won't do.1 Siblings, grandchildren and other relatives not on that list should ask the Personal Care Management (PCM) agency before counting on the income.

If You Live With the Person You Care For

MassHealth PCAs who live permanently with the member aren't required to use Electronic Visit Verification (EVV), though the live-in exemption must be renewed every year.1 See how EVV works.

When the PCM agency sets PCA hours for instrumental activities of daily living (IADLs), it must assume that family members living with the member will provide most of that help, such as routine laundry, housekeeping, shopping, and meal preparation and clean-up.1 Expect the paid hours to go mostly to your parent's personal care, not the shared household.

How Many Hours a Family PCA Can Work

A member can schedule one PCA for no more than 50 hours a week, counting hours that PCA works for other members; more takes authorization from MassHealth or its designee. MassHealth doesn't cover PCA services above 60 hours a week in the aggregate.1 Those are caps, not promises: ask the PCM agency what your parent's evaluation allows.

What the MassHealth PCA Program Pays a Family Member

Under MassHealth Administrative Bulletin 25-13, for work on or after July 1, 2025, the PCA wage is $20.00 an hour at Seniority Step 1 (0 to 3,640 hours worked as a PCA since 2008), then $20.60, $21.20 and $21.80, up to $22.40 at Step 5 (18,201 or more hours). For work on or after July 1, 2025, a MassHealth PCA who hasn't completed, and isn't exempt from, New Hire Orientation (NHO) gets $19.50 an hour.2

Starting January 1, 2026, a PCA working for a member who meets MassHealth's clinical criteria for complex care, with the complex care modifier in their prior authorization, earns a complex care differential: $23.25 an hour at Step 1 up to $25.65 at Step 5. A MassHealth PCA must complete NHO to receive either the seniority rates or the complex care differential.2

Don't mistake the billing rate for your wage: for work on or after July 1, 2025, MassHealth's total hourly PCA rates ($22.24 at Step 1 up to $24.92 at Step 5) add an 11.20% employer expense component for employer-required taxes and workers' compensation insurance; that extra isn't paid to the PCA. The wage is set under the collective bargaining agreement between 1199SEIU, the PCAs' union, and the PCA Quality Home Care Workforce Council.2

How to Get Hired as Your Family Member's PCA

A MassHealth PCA must be at least 16, physically able to do the tasks, understand and carry out the member's or surrogate's directions, and be willing to receive training and supervision. A PCA also can't be on the HHS Office of Inspector General list of excluded individuals or other lists barring them from MassHealth, and can't be paid by anyone else for the same activity time.1

Learn More

Find personalized help getting hired as a MassHealth PCA for your parent or relative 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.