Paid Medical Leave in Massachusetts: Eligibility, Benefits, and Applying

Paid medical leave in Massachusetts, run by the state’s Department of Family and Medical Leave (DFML), replaces part of your wages when a serious health condition keeps you from working. For 2026, eligible workers can receive up to 20 weeks of benefits per benefit year, with a maximum weekly payment of $1,230.39.¹ Your job is protected while you’re out, and your employer must keep contributing to your health insurance on the same terms as if you were still working.

Who Qualifies

Most W-2 employees working in Massachusetts are covered, regardless of the size of the employer or how long you’ve been on the job.¹ Some 1099-MISC contractors are covered too, but only when they make up at least 50% of a business’s workforce on average over the past year.²

You also have to meet an earnings test. During your base period — the last four completed calendar quarters before your benefit year — you must have earned a minimum the state sets each year. In 2025, that floor was $6,300. On top of that, your total base period wages must be at least 30 times the weekly benefit you’d receive. Both tests filter for people with an established work history in Massachusetts.

What Counts as a Serious Health Condition

The law defines a serious health condition as a physical or mental condition involving either an overnight stay in a medical facility or continuing treatment by a healthcare provider.³ DFML interprets this broadly and the program is designed to presume in favor of granting leave.

Under the continuing treatment path, the condition generally has to keep you from your job for more than three consecutive days and require either two provider visits within 30 days, or one visit with an ongoing plan of care such as a prescription.⁴ Pregnancy-related conditions and recovery from childbirth qualify when certified by a provider. Chronic conditions such as asthma or diabetes count when they periodically keep you from working and require doctor visits at least twice a year. Hospitalization is not required.

How Much You’ll Get Per Week

Your weekly benefit is calculated from your individual average weekly wage measured against the statewide average weekly wage (SAWW). For 2026 the SAWW is $1,922.48, and the maximum weekly PFML benefit is $1,230.39.⁵ The formula has two tiers:

The portion of your wages up to 50% of the SAWW ($961.24 per week) is replaced at 80%.
Wages above that threshold are replaced at 50%.

Lower-wage workers therefore get a higher share of their normal pay. A worker earning $800 a week receives about $640. Higher earners get a blended rate, and no one is paid more than the $1,230.39 cap.⁵

Medical leave is capped at 20 weeks per benefit year. If you also take family leave (to care for a relative or bond with a new child) in the same benefit year, the combined total cannot exceed 26 weeks.¹

The Seven-Day Waiting Period

Benefits don’t start on day one. Every PFML leave includes a seven-calendar-day waiting period during which no PFML is paid.⁶ Those seven days still count against your 20-week total, so a full medical leave effectively includes one unpaid week at the front. You can use accrued sick time, vacation, or other PTO during that week, and your job protection is already in place.

For intermittent leave, the waiting period runs as seven consecutive calendar days from the start of leave, whether or not you actually miss work on each of those days. One exception applies: if you take medical leave for pregnancy or childbirth recovery and roll straight into bonding leave, the waiting period is waived for the family leave portion.

How to Apply

Give Your Employer Notice

Massachusetts law requires 30 days’ notice before your leave starts, including the anticipated start date, length, and expected return.⁷ If a medical emergency or other circumstance outside your control makes that impossible, notify your employer as soon as practicable. If your employer never gave you written notice of your PFML rights in the first place, your notice obligation is waived.

Get Your Certification Form Completed

The key document is the Certification of Your Serious Health Condition form. You complete the personal section; your healthcare provider fills in the clinical section confirming your condition, when it began, how long it’s expected to last, and whether your leave will be continuous, reduced, or intermittent.⁸ A generic doctor’s note is not enough. The state uses this specific form to confirm all the legal criteria are met.

You’ll also need your Social Security Number or ITIN and your employer’s Federal Employer Identification Number, which appears on your W-2.⁹

Submit and Wait for a Decision

Applications go through paidleave.mass.gov, where you can upload your certification and ID directly.⁹ You can also apply by phone through the DFML Contact Center at (833) 344-7365. Once you submit, DFML notifies your employer, who has 10 business days to respond. If the employer doesn’t respond in time, DFML decides based on what you filed.¹⁰

Job Protection and Anti-Retaliation

Your employer must hold your position and restore you to the same job (or one with similar duties and pay) when you return, and must keep paying its share of your health insurance while you’re out.¹¹

Anti-retaliation protections take effect the moment you tell your employer you plan to take leave. Firing, discipline, demotion, suspension, or threats tied to your PFML use are prohibited. Any negative job change during your leave or within six months after you return is legally presumed to be retaliation, and you can sue in Massachusetts Superior Court if it happens.¹²

How PFML Interacts with Other Benefits

If you’re already receiving other benefits, PFML may be reduced or coordinated:

Workers’ compensation runs concurrently with PFML. Workers’ comp pays first, and PFML covers the difference up to your full benefit amount. Weeks with a work-related injury count against your 26-week allotment even if you never apply for PFML.
Unemployment insurance generally cannot be collected at the same time. Unemployment requires you to be available for work, which a serious medical condition usually rules out. Stop certifying for unemployment when PFML starts and reopen that claim when you can work again.
Social Security Disability Insurance reduces PFML dollar for dollar for the same period. Because SSDI decisions often come later, you may owe DFML for an overlap.
Private short-term disability, by statute, doesn’t reduce PFML unless the combined total exceeds your average weekly wage. In practice, most STD policies require you to apply for PFML first and then pay the difference.

Tax Treatment Starting in 2026

Beginning in 2026, PFML tax treatment follows IRS Revenue Ruling 2025-4, and the rules split between family and medical leave.¹³ Family leave benefits are included in federal gross income but are not wages for employment tax purposes; DFML reports them on Form 1099-G.

Medical leave is more complicated. The share funded by your employer’s required contribution is taxable income and counts as wages for employment tax. The share funded by your own payroll contributions is excluded from gross income, under the same rule that exempts insurance proceeds you paid for yourself.¹³ At larger employers (25 or more workers), where the employer pays 60% of the medical contribution, roughly 60% of your medical leave benefit is taxable. At smaller employers, where employees pay 100% of the medical contribution, medical leave benefits are not subject to income or employment taxes.

If Your Claim Is Denied

You have 10 calendar days from the date you receive a denial to file an appeal.¹⁴ The window is tight. If you miss it for reasons beyond your control, you can still file late and explain why on the form.

DFML will first try to resolve the issue directly. If that doesn’t work, they schedule a virtual hearing, typically two to four weeks after your appeal, with at least 10 days’ notice.¹⁴ Keep copies of your medical certification, DFML correspondence, and your employer’s response ready. Those are the documents the hearing officer will focus on.

If Your Employer Uses a Private Plan

Not every Massachusetts employer participates in the state program. Employers can apply for an exemption if they offer a private plan whose benefits meet or exceed the state’s, including at least 20 weeks of paid medical leave, the same or higher weekly benefit, job protection, continued health insurance, and intermittent leave.¹⁵ Your out-of-pocket contribution under a private plan cannot exceed what you’d pay under the state plan. The anti-retaliation protections apply either way, but the application steps, tax treatment, and appeal process may differ, so ask your HR department how to file under the plan that covers you.

1
Mass.gov. Paid Family and Medical Leave (PFML) Overview and Benefits
2
Mass.gov. Who in Your Workforce Does the PFML Law Cover
3
General Court of Massachusetts. Massachusetts General Laws Part I, Title XXII, Chapter 175M, Section 1
4
Mass.gov. PFML – About Medical Leave to Manage Your Own Serious Health Condition
5
Mass.gov. How PFML Weekly Benefit Amounts Are Calculated and/or Changed
6
Mass.gov. Types of Paid Family and Medical Leave
7
General Court of Massachusetts. Massachusetts Session Laws, Acts of 2018, Chapter 121
8
Mass.gov. Filling Out the Certification of Your Serious Health Condition Form
9
Department of Family and Medical Leave. How to Apply for Paid Family and Medical Leave
10
Mass.gov. Paid Family and Medical Leave (PFML) Application Approval Timeline
11
Mass.gov. How PFML Is Different Than FMLA
12
Mass.gov. Notices, Appeals, and Employee Protections Under Paid Family and Medical Leave (PFML)
13
Internal Revenue Service. Revenue Ruling 2025-4
14
Mass.gov. Paid Family and Medical Leave (PFML) Appeals Timeline
15
Mass.gov. Benefit Requirements for Private Paid Leave Plan Exemptions