How to Become a PCA for a Family Member in Massachusetts

To become a Personal Care Attendant for a family member in Massachusetts, you need to be an eligible relative (not a spouse, not the parent of a minor child receiving care, not a legal guardian), your family member has to qualify for the MassHealth PCA program, and the two of you must work through a Personal Care Management agency to get hours authorized and enroll you with the state’s Fiscal Intermediary as a paid employee. The program is consumer-directed, which means your relative is legally your employer — they hire you, schedule you, and approve your hours — while MassHealth funds the wages and a contractor handles payroll.

Which Relatives Can Be Paid, and Which Can’t

Most adult family members can serve as a paid PCA. Adult children, siblings, grandchildren, aunts, uncles, cousins, and in-laws are all generally eligible. Under 130 CMR 422.404, three relationships are prohibited:¹

Spouses cannot be paid as a PCA for their husband or wife.
Parents, adoptive parents, and foster parents cannot be paid as a PCA for their own child under 18.
Anyone with legal guardianship or other court-ordered responsibility for the consumer is excluded.

The consumer’s surrogate and administrative proxy also can’t serve as PCA. A surrogate helps manage the program on the consumer’s behalf, so letting the same person also be the paid caregiver would remove the program’s built-in check on how hours get used.²

Beyond the relationship rules, you have to meet basic caregiver qualifications: at least 16 years old, legally authorized to work in the United States with a Social Security number, physically able to do the tasks the consumer needs, and able to understand and follow the consumer’s directions.³

CORI background checks aren’t required by the program, but consumers are encouraged to request one. Starting in Spring 2026, MassHealth is rolling out a formal process through the Fiscal Intermediary that lets consumer-employers request optional CORI and SORI checks on prospective or current PCAs.

Does Your Family Member Qualify for the Program?

You can’t be hired until your relative is approved as a PCA consumer. They must be enrolled in MassHealth Standard or CommonHealth and have a chronic or permanent disability that keeps them from handling their own personal care.² Specifically, they need hands-on physical help with at least two of seven Activities of Daily Living:

Mobility
Bathing and grooming
Dressing and undressing
Passive range-of-motion exercises
Taking medications
Eating
Toileting

Once that two-ADL threshold is met, MassHealth may also authorize hours for Instrumental Activities of Daily Living like laundry, meal preparation, shopping, housekeeping, and transportation to medical appointments. IADL hours alone won’t qualify someone; the physical-help requirement comes first.

If your relative’s income sits slightly above MassHealth’s limit, they may still qualify by meeting a deductible (a “spend-down”) based on six months of medical expenses. A MassHealth caseworker can walk through that math.

How to Get Hired and Authorized: Step by Step

1. Gather Documents

The consumer needs their MassHealth ID number and a valid state ID. You need your Social Security number and proof of work authorization — a passport, or a driver’s license plus birth certificate.²

The critical medical document is the Physician Summary Form. A licensed physician, nurse practitioner, or physician assistant who has examined your relative must complete and sign it, listing diagnoses, physical limitations, medications, and the types of daily help needed.⁴ MassHealth cannot authorize any hours without it.

2. Choose a Personal Care Management Agency

The consumer picks a Personal Care Management (PCM) agency from those under contract with MassHealth. That agency runs the evaluation, submits the paperwork to MassHealth, and serves as the ongoing point of contact.⁵

3. In-Home Evaluation

The PCM agency sends an evaluation team, typically a registered nurse and an occupational therapist, to the consumer’s home. They watch how the consumer manages daily tasks and recommend a specific number of weekly PCA hours.

4. Prior Authorization From MassHealth

The PCM agency compiles the evaluation into a Prior Authorization request and submits it to MassHealth. Regulations require the agency to submit the initial request within 45 calendar days of the consumer’s first inquiry about PCA services.⁶ MassHealth reviews the clinical file and issues an authorization letter with the approved weekly hours and the start and end dates. The full process from home visit to approval usually takes several weeks. If MassHealth denies services or approves fewer hours than requested, the consumer has 60 calendar days to file a Fair Hearing appeal.⁷

5. Enroll With the Fiscal Intermediary

Once hours are authorized, the consumer formally hires you and you enroll with the Fiscal Intermediary that runs payroll. Tempus Unlimited serves as the FI as of 2026.⁸ Tempus withholds state and federal taxes, handles unemployment and workers’ compensation, and issues your paychecks.

Complete New Hire Orientation Right Away

Every newly hired PCA must attend a four-hour New Hire Orientation covering wages, benefits, fraud prevention, neglect reporting, and workers’ rights.⁹ Register by calling the Homecare Training Benefit at 877-409-8283 or signing up online.

Do this early. Until you complete the orientation, you’re paid $21.72 per hour (as of January 2026). Once you finish, your base rate rises to $22.24 per hour at the first seniority step.¹⁰ Every week you wait is money you don’t get back.

Pay Rates and Sick Time

Hourly pay increases with cumulative hours worked in the program. Standard rates for PCAs who have completed New Hire Orientation, effective January 1, 2026:¹⁰

Step 1 (0–3,640 hours): $22.24 per hour
Step 2 (3,641–7,280 hours): $22.92 per hour
Step 3 (7,281–12,740 hours): $23.60 per hour
Step 4 (12,741–18,200 hours): $24.28 per hour

If the consumer qualifies for a complex-care differential, the Step 1 rate starts at $25.88 per hour instead.

You also earn one hour of sick time for every 30 hours worked, up to 40 hours per calendar year. Unused sick time carries over to the next year, still capped at 40 hours. You can start using accrued sick leave 90 days after your first day of work.¹¹

Timesheets and Electronic Visit Verification

You report your hours through timesheets that the consumer must approve before payment. MassHealth is implementing Electronic Visit Verification, which requires you to clock in and clock out through a mobile app.¹² EVV checks your location only at clock-in and clock-out — whether you’re within 250 feet of the consumer’s home or in the community — and doesn’t track you during the shift. If you forget to clock in, or your phone dies, you or the consumer can enter the time manually through the EVV online portal.

Weekly Hour Limits

You can work up to 50 hours a week without additional approval. Working 51 to 66 hours in a single week requires a separate Prior Authorization from MassHealth. No PCA may work more than 66 hours in one week, and if you work for more than one consumer, those hours are added together.¹³

Tax Break for Live-In Family Caregivers

If you live in the same home as the relative you care for, your PCA wages may be fully excluded from both federal and Massachusetts state income tax. IRS Notice 2014-7 treats certain Medicaid-funded personal care payments as “difficulty of care” payments excludable under Section 131 of the Internal Revenue Code.¹⁴

As of January 1, 2026, this exclusion applies to the Massachusetts PCA program following an IRS Private Letter Ruling that extended the benefit to the state’s non-waiver personal care programs. If you live with the consumer, you can apply through the Fiscal Intermediary to have the exclusion reflected in your withholdings. The exclusion covers wages for personal care services only, not training time. If you don’t share a household with the consumer, your PCA wages are fully taxable and reported on a W-2.

Staying Authorized: Annual Reevaluation and a Backup Plan

PCA hours aren’t approved forever. The PCM agency must reevaluate the consumer at least once a year, and more often if their condition or living situation changes.¹⁵ Each reevaluation produces a new Prior Authorization that can raise, lower, or hold steady the weekly hours. Watch the expiration date on the current authorization and contact the PCM agency well before it lapses to avoid a gap in coverage — and in your pay.

MassHealth also expects every consumer to keep an emergency backup plan naming alternative caregivers who can step in on short notice. Even when you’re the primary PCA, help your relative line up one or two backups for illness, vacation, or emergencies. The PCM agency will review the plan periodically and record it in the service agreement.

1
Mass.gov. Personal Care Attendant Services Regulations – 130 CMR 422.404
2
Mass.gov. Personal Care Attendant Program – PCA Consumer Handbook
3
Mass.gov. Personal Care Attendant Services Regulations – 130 CMR 422.404Personal Care Attendant Program – PCA Consumer Handbook
4
Mass.gov. Physician Summary Form
5
Cornell Law School. 130 CMR 422.405 – Personal Care Management Agency and Fiscal Intermediary Functions
6
Cornell Law School. 130 CMR 422.416 – PCA Program: Prior Authorization for PCA Services
7
Mass.gov. How to Appeal a MassHealth Decision
8
Mass.gov. MassHealth Personal Care Attendant (PCA) Fiscal Intermediary – Tempus
9
Mass.gov. Personal Care Attendant (PCA) New Hire Orientation
10
Mass.gov. Administrative Bulletin 25-29 – Rates for Certain Services for the Personal Care Attendant Program Effective January 1, 2026
11
Mass.gov. Implementation of Personal Care Attendant Earned Sick Leave
12
Mass.gov. Public Information Session – EVV Implementation in the MassHealth PCA Program
13
Mass.gov. MassHealth PCA Overtime Policy Effective January 1, 2026
14
IRS. Notice 2014-7 – Difficulty of Care Payments
15
Cornell Law School. 130 CMR 422.422 – PCA Program: Personal Care Management Agency Operating Procedures