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Home care programs · Massachusetts

Massachusetts home care programs

Massachusetts pays for care at home through 6 programs. Consumer-directed care is available through MassHealth Personal Care Attendant Program. Family members can be paid caregivers in 2 of them.

Verified Oct 9, 2026Sources: official state and federal agencies

Every state
Programs
6
Consumer-directed
Yes
Family can be paid
Yes
Structured family caregiving
No
On this page
Programs

Every way Massachusetts pays for care at home

Massachusetts pays for care at home through 6 programs. Consumer-directed care is available through MassHealth Personal Care Attendant Program. Family members can be paid caregivers in 2 of them.

ProgramTypeCan family be paidHow it differs
Home Health Services (MassHealth)State Plan home health (42 CFR 440.70)Home healthNoSkilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.
MassHealth Personal Care Attendant ProgramState Plan personal care (130 CMR 422.000; rates 101 CMR 309.00)Consumer-directedYesConsumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.
Frail Elder Waiver (FEW)1915(c) waiver MA.0059Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Adult Foster Care (AFC)State Plan (130 CMR 408.000)Adult family careYesAdult family care: care in a family or foster home that is paid to house and help the person; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.
Program of All-Inclusive Care for the Elderly (PACE)Medicare/Medicaid PACE (42 CFR 460)PACENot statedPACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.
Home Care Programstate-funded (651 CMR 3.00)State-fundedNot statedState-funded home care: paid outside Medicaid, usually for people who do not qualify for it; run as state funds outside Medicaid, paid fee-for-service.
Guide

Home health vs home care vs consumer-directed care in Massachusetts

What each kind of program is, who employs the caregiver and when a family member can be paid.

Home health: the medical benefit

In Massachusetts, skilled home health is Home Health Services (MassHealth). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Massachusetts Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating and household tasks is "home care" or personal care. In Massachusetts it is paid through the programs below rather than a separate agency personal care benefit.

Consumer-directed care: the person hires their own aide

Massachusetts's consumer-directed option is MassHealth Personal Care Attendant Program. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: MassHealth Personal Care Attendant Program allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Massachusetts has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (MassHealth Personal Care Attendant Program), by the hour, as the participant's chosen aide.

Other ways Massachusetts pays for care at home

Waiver in-home services: Frail Elder Waiver (FEW). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

Adult family care: Adult Foster Care (AFC). The person lives in a family or foster home that is paid to provide housing and daily care.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: Home Care Program. Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Which one fits

  • Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (MassHealth)).
  • Wants to choose the aide, including a relative where allowed: MassHealth Personal Care Attendant Program.
  • Meets nursing-home level of care and needs more than personal care: Frail Elder Waiver (FEW).
In the workspace

Massachusetts program rules, side by side

Eligibility, the family caregiver rules (spouses, parents, live-in caregivers), employer of record, fiscal intermediary, caregiver training, provider requirements, how to enroll, published pay, EVV and waiting lists: 69 details across 6 programs.

ProgramFamily rulesEmployerEligibilityPay
See Massachusetts's program rules — start free

Who can be paid, who employs the caregiver, what each program requires of agencies and caregivers, how to become a provider and what it pays, for all 6 programs.

  • Family caregiver rules
  • Provider requirements
  • CSV export
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Program by program

Massachusetts's programs

What each program is and how it differs from the others. Locked details open in the workspace.

Home Health Services (MassHealth)

Home health

State Plan home health (42 CFR 440.70) · MassHealth (Executive Office of Health and Human Services)

Skilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.

Can family be paid?No
How to get set up
Provider track · 8 steps
  1. Form the business and get an NPI
  2. 7 more steps: forms, fees, timelines and links
Family / participant track · 5 steps
  1. Have MassHealth coverage
  2. 4 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredFamily caregiver rulesEmployer of recordCaregiver requirementsProvider requirementsHow to become a providerEVVWaiting list or capManaged-care plansHow it differs, in detailSetup checklistUnlock the details →

MassHealth Personal Care Attendant Program

Consumer-directed

State Plan personal care (130 CMR 422.000; rates 101 CMR 309.00) · MassHealth (EOHHS); Personal Care Management (PCM) agencies evaluate and support consumers

Consumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.

Can family be paid?Yes
How to get set up
Provider track · 3 steps
  1. Fiscal intermediary is a single state contractor
  2. 2 more steps: forms, fees, timelines and links
Family / participant track · 10 steps
  1. Contact a PCM agency
  2. 9 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryCaregiver requirementsProvider requirementsHow to become a providerPay rateEVVWaiting list or capManaged-care plansRecent changesHow it differs, in detailSetup checklistUnlock the details →

Frail Elder Waiver (FEW)

Waiver in-home

1915(c) waiver MA.0059 · MassHealth with the Executive Office of Aging & Independence; ASAPs do assessment and care management

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 8 steps
  1. Form the business
  2. 7 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Request a clinical eligibility assessment
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordProvider requirementsHow to become a providerEVVRecent changesHow it differs, in detailSetup checklistUnlock the details →

Adult Foster Care (AFC)

Adult family care

State Plan (130 CMR 408.000) · MassHealth (EOHHS)

Adult family care: care in a family or foster home that is paid to house and help the person; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.

Can family be paid?Yes
How to get set up
Provider track · 9 steps
  1. Check the enrollment moratorium
  2. 8 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Ask for AFC
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordCaregiver requirementsProvider requirementsHow to become a providerPay rateWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Program of All-Inclusive Care for the Elderly (PACE)

PACE

Medicare/Medicaid PACE (42 CFR 460) · MassHealth with CMS

PACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.

Can family be paid?Not stated
How to get set up
Provider track · 4 steps
  1. Decide to apply as a PACE organization or contract with one
  2. 3 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Contact a PACE organization in your area
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredEmployer of recordProvider requirementsHow to become a providerHow it differs, in detailSetup checklistUnlock the details →

Home Care Program

State-funded

state-funded (651 CMR 3.00) · Executive Office of Aging & Independence through Aging Services Access Points (ASAPs)

State-funded home care: paid outside Medicaid, usually for people who do not qualify for it; run as state funds outside Medicaid, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 5 steps
  1. Pass the EOEA Notice of Intent (homemaker/personal care)
  2. 4 more steps: forms, fees, timelines and links
Family / participant track · 5 steps
  1. Call MassOptions or the local ASAP
  2. 4 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordProvider requirementsHow to become a providerEVVWaiting list or capRecent changesHow it differs, in detailSetup checklistUnlock the details →
FAQ

Frequently asked questions

Can family members get paid to be caregivers in Massachusetts?

Yes. MassHealth Personal Care Attendant Program and Adult Foster Care (AFC) let a family member be the paid caregiver. Which relatives qualify, including spouses and parents of minor children, is set program by program.

Does Massachusetts have consumer-directed care?

Yes: MassHealth Personal Care Attendant Program. The person receiving care hires and directs their own aide, and a fiscal intermediary handles payroll.

Does Massachusetts have structured family caregiving?

No. Massachusetts does not run a structured family caregiving program. Family caregivers are paid through consumer-directed care instead.

What is the difference between home health and home care in Massachusetts?

Home health (Home Health Services (MassHealth)) is medical: nursing, therapy and aide visits ordered by a practitioner and delivered by a licensed home health agency. Home care is non-medical help with daily activities, based on functional need.

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