MASSACHUSETTS · PROGRAM GUIDE
Massachusetts:
MassHealth Personal Care Attendant (PCA) Program
Massachusetts offers several kinds of home support, but a search for family caregiver pay often leads to the Personal Care Attendant program. PCA is a consumer-employer arrangement: the person receiving care manages the worker. A Personal Care Management agency helps with assessment and program skills, while Tempus handles fiscal administration. These organizations have different jobs, so identifying the right contact can prevent a payroll question from becoming a delayed care request.
Official sources checked: 2026-11-15. View references
Program at a glance
- Program
- MassHealth Personal Care Attendant (PCA) Program
- State agency
- MassHealth, Massachusetts Executive Office of Health and Human Services
- Payroll or employer arrangement
- Tempus Unlimited is the fiscal intermediary for the MassHealth PCA program.
- Payment arrangement
- Pay for authorized PCA service hours, processed through Tempus; Adult Foster Care uses a different arrangement.
- Spouses
- The consumer’s legal spouse cannot be their paid PCA.
- Parents of minors
- A parent or foster parent cannot be the paid PCA of their minor child; other prohibited roles also apply.
PCA and Adult Foster Care serve different arrangements
PCA supports self-directed assistance with approved daily tasks. Adult Foster Care, or AFC, instead involves a caregiver living with the member and an AFC provider supplying oversight and support. The AFC fact sheet also excludes spouses and legal guardians as caregivers. Do not substitute an AFC stipend advertisement for the PCA wage, or assume that living together changes PCA family restrictions. Ask which service matches the person’s actual care and living arrangements.
Describe hands-on assistance, not just a diagnosis
MassHealth’s PCA fact sheet identifies Standard or CommonHealth coverage, a chronic or permanent disability, and physical assistance with at least two activities of daily living as core requirements. The member must manage the service or receive permitted surrogate or administrative-proxy support. For assessment, prepare concrete examples: who helps with transfers, what happens during bathing, and how frequently assistance is necessary. Separate household tasks from hands-on personal assistance so the evaluator can understand the request.
Follow each authorization stage
A request to a Personal Care Management agency is not a payroll start date. Track the assessment, the submission to MassHealth, the authorization decision and worker onboarding as separate items. If approved hours do not match the request, read the notice and discuss the difference with the agency. Keep the notice and its instructions rather than relying on a verbal estimate. This guide does not promise reimbursement for work performed before the required authorization and enrollment are complete.
Resolve incompatible roles before hiring
The July 2026 consumer-employer handbook excludes the legal spouse, a parent or foster parent of a minor consumer, and people holding specified guardian, surrogate or proxy roles. An adult child should therefore disclose any additional decision-making role, not merely say that they are a relative. Ask the management agency to check the proposed arrangement. Complete the current Tempus hiring packet and confirm acceptance before placing the worker on the paid schedule.
Keep authorization, activity records and payroll aligned
MassHealth uses Electronic Visit Verification for consumer-directed services. Follow Tempus instructions for recording and correcting PCA activity; do not assume a shared address creates an exemption. Compare authorized hours, submitted activity and the pay statement each period. The consumer also manages scheduling and overtime requests, so an overtime discussion belongs before extra shifts are worked. Maintain a backup-care plan for absences and ask the management agency how to request reassessment when needs change.
Your next steps
- Check Standard or CommonHealth coverage.
- Contact a Personal Care Management agency for PCA assessment.
- Disclose the caregiver’s relationship and any representative role.
- Complete Tempus enrollment and confirm authorized service dates.
- Review activity records and pay statements together.
Explore a pay scenario
The table uses a hypothetical amount of $18.00 per hour. This is not a rate verified for this state. Approved units depend on the assessment and written plan; the table does not establish a maximum or entitlement.
| Hours/week | Weekly | Monthly average |
|---|---|---|
| 20 | $360.00 | $1,560.00 |
| 30 | $540.00 | $2,340.00 |
| 40 | $720.00 | $3,120.00 |
Monthly average = weekly × 52 ÷ 12. Overtime and taxes are not calculated.
Edit this example in the calculator →Does caregiver pay qualify for IRS Notice 2014-7?
IRS Notice 2014-7 can exclude certain qualifying Medicaid waiver payments from federal gross income when the care recipient lives in the provider’s home. Sharing a home alone is not enough: the payment and program must qualify. This is not an exemption for all caregiver wages, all taxes or all state programs. Ask payroll which payments are covered and check the IRS guidance or a qualified tax adviser. Our calculator does not apply a tax exemption.
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Questions families ask
Can my spouse be my PCA?
No. The PCA consumer handbook excludes a legal spouse.
Who processes PCA payroll?
MassHealth identifies Tempus Unlimited as its PCA fiscal intermediary.
Is AFC the same as PCA?
No. AFC is a separate service involving a live-in caregiver and provider oversight.
Is needing help with shopping sufficient by itself?
PCA eligibility requires physical help with at least two daily living activities; discuss the complete situation with a management agency.
Official sources and review notes
- MassHealth PCA program
- PCA eligibility fact sheet
- Consumer-employer handbook, July 2026
- MassHealth PCA fiscal intermediary: Tempus
- EVV for consumer-directed programs
- Adult Foster Care fact sheet
Sources describe the named programs; they do not endorse this website. Rules and provider arrangements can change. Check the linked agency before making a financial decision.
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