How to Become a Caregiver in Massachusetts: HHA, PCA, and Pay

To become a caregiver in Massachusetts, you choose one of three roles, clear a criminal background check, complete the training or orientation that role requires, and submit a hiring packet to either a home health agency or the state’s Fiscal Intermediary. The role you pick drives everything else, so start there.

Choose Your Role First

Massachusetts treats three caregiver positions as distinct jobs with different rules:

A Home Health Aide (HHA) works through a Medicare-certified home health agency under a registered nurse’s supervision. HHAs provide hands-on medical assistance such as taking vital signs, wound care, and help with prescribed exercises. Federal certification standards apply.
A Personal Care Attendant (PCA) is hired directly by a MassHealth consumer through the state’s PCA program. PCAs help with daily activities like bathing, dressing, meal preparation, and mobility. The consumer is the employer and directs the care.
A Homemaker or Personal Care Homemaker provides non-medical support such as housekeeping, errands, and light personal assistance. The state offers free online training for these roles.

The HHA and PCA tracks carry the most regulatory requirements, so most of what follows focuses on those two.

Background Check and Basic Eligibility

You must be at least 18 to work in most professional care settings, and every applicant has to clear a Criminal Offender Record Information (CORI) check before entering a client’s home. The state maintains this criminal history database under M.G.L. c. 6, § 172, and health and human services employers are required to run it when screening applicants.¹

Convictions for violent felonies, sexual offenses, and abuse of elderly or disabled individuals are generally permanent bars. Other offenses may trigger a review process or a waiting period before you can reapply. The specific categories and timelines depend on the type of position and the regulatory framework the employer operates under. Agencies risk losing their licensure if they skip screening, so expect the check to be thorough.

Becoming a Home Health Aide

To work as an HHA through a Medicare-certified agency, you need at least 75 hours of combined classroom and supervised practical training.² Federal regulations under 42 CFR 484.80 require at least 16 hours of classroom instruction before at least 16 hours of hands-on clinical training. The curriculum covers vital signs, infection control, basic body mechanics, emergency procedures, documentation, and communication with patients and families.

After the training program, you must pass a competency evaluation that tests both written knowledge and practical skills. Once certified, you work under the supervision of a registered nurse. There is one catch worth flagging: if you go 24 consecutive months without providing compensated home health aide services, your certification lapses, and you must complete a full training program again before returning to work.²

Training programs typically cost between $120 and $2,800 depending on the provider, though some agencies cover the cost for employees they plan to hire. Massachusetts also keeps a Nurse Aide Registry, and HHAs who completed a state-approved nurse aide program and appear on the registry in good standing can qualify without repeating a separate HHA course.

Becoming a Personal Care Attendant

PCAs follow a different path. Instead of clinical certification, you complete a four-hour New Hire Orientation covering employment rights, the consumer-employer model, and how to recognize fraud, abuse, and neglect.³ You can attend a group session (virtual or in person) or begin with a consumer-employer led orientation and then finish the group session component.

The deadline to complete this orientation is three months from your hire date.⁴ Missing it does not remove you from the program automatically, but it blocks every pay increase, including seniority steps and the complex care differential, until you finish. That can mean leaving thousands of dollars behind over a year, so treat the three-month window seriously.

Enrolling Through Tempus

The MassHealth PCA program is governed by 130 CMR 422.000 and uses a consumer-directed model. The person receiving care is your employer, and a Fiscal Intermediary handles payroll and tax administration. Tempus Unlimited, Inc. is the sole Fiscal Intermediary.⁵

Before you can start working, you need to gather a New Hire packet that includes:

A completed federal Form I-9, which means producing either one List A document such as a U.S. passport, or a combination of a List B document (such as a state driver’s license) and a List C document (such as a Social Security card).⁶
Your Social Security number and proof of Massachusetts residency.
Federal and state tax withholding forms (W-4 and state equivalent) and a direct deposit authorization with your bank account and routing numbers.

Tempus distributes and processes the packets. You can submit documents through its secure digital portals or by mail to 600 Technology Center Drive, Stoughton, MA 02072 (fax: 800-359-2884).⁵ Check every field before submitting. Missing signatures and tax form errors are the most common reasons packets get bounced back.

Expect roughly two to four weeks of processing after Tempus receives your packet. During that window your CORI results are verified and the state confirms you are not on any exclusion registries. You will receive a confirmation notice clearing you to begin working. Do not log any shifts before that authorization date, because you cannot bill for hours worked before it.

Clocking In With EVV

Federal law under the 21st Century Cures Act requires Electronic Visit Verification for personal care services.⁷ Massachusetts PCAs use an EVV App to clock in at the start of each shift and clock out at the end.⁸ The system records six data points per visit: the service type, who received it, the date, the location, who provided it, and start and end times. Consumers or their surrogates verify visits through a separate EVV Portal, and Tempus then processes the approved activity forms and issues payment. Forgetting to clock in or out is the quickest way to delay a paycheck.

Free Training for Homemaker Work

If you are interested in non-medical caregiving, the state’s Personal and Home Care Aide State Training (PHCAST) program offers free, self-paced online courses. The Homemaker track runs about 37 hours across ten modules; the Personal Care Homemaker track adds roughly 10 more hours over six modules. You need to score at least 80% on each module assessment to advance, and you receive a certificate of completion at the end.⁹ The courses are available in English, Spanish, Haitian Creole, Brazilian Portuguese, Mandarin, Cantonese, Russian, and Vietnamese.

What You Will Earn as a PCA

As of January 1, 2026, the base PCA wage in the MassHealth program is $19.50 per hour. PCAs who have completed New Hire Orientation and accumulated seniority earn more through a step system that ranges from $23.25 to $25.65 per hour. A complex care differential is also available for PCAs working with consumers who qualify, pushing the total hourly rate (including the employer expense component) as high as $28.56 at the top seniority step.¹⁰ Massachusetts caregivers are also entitled to time-and-a-half overtime for hours exceeding 40 in a workweek.¹¹

If a Family Wants to Hire You Directly

Some caregivers work outside the PCA program for a family that hires them privately. Make sure you receive a W-2 and not a 1099. The IRS decides your classification based on whether the family controls how you do your work (employee) or just specifies the result (contractor), and in most home care situations the family directs the schedule, tasks, and methods closely enough that the worker is a W-2 employee.¹² Getting this wrong creates tax problems on both sides and can cost you Social Security and unemployment credit later. Private hires are also covered by the Massachusetts Domestic Workers Bill of Rights, which adds protections around rest days, written employment agreements, and live-in arrangements.¹³

1
General Court of Massachusetts. Massachusetts General Laws Chapter 6 Section 172
2
eCFR. 42 CFR Part 484 – Home Health Services
3
Commonwealth of Massachusetts. Personal Care Attendant (PCA) New Hire Orientation
4
Commonwealth of Massachusetts. PCA New Hire Orientation Fact Sheet
5
Commonwealth of Massachusetts. MassHealth Personal Care Attendant (PCA) Fiscal Intermediary – Tempus
6
USCIS. Form I-9 Acceptable Documents
7
Medicaid.gov. EVV Requirements in the 21st Century Cures Act – Workshop
8
Commonwealth of Massachusetts. EVV Implementation in the MassHealth PCA Program
9
Commonwealth of Massachusetts. Personal and Home Care Aide State Training (PHCAST)
10
Commonwealth of Massachusetts. Administrative Bulletin 25-29 – 101 CMR 309.00 Rates for PCA Program
11
U.S. Department of Labor. Fact Sheet on Hours Worked Applicable to Domestic Service Employment Under the FLSA
12
Internal Revenue Service. Independent Contractor (Self-Employed) or Employee?
13
Commonwealth of Massachusetts. Domestic Workers