Understanding the main pathways to paid family caregiving
Becoming a paid family caregiver in Massachusetts is primarily facilitated through programs funded by MassHealth, the state's Medicaid program. The two most common and structured pathways are the Adult Foster Care (AFC) Program and the Personal Care Attendant (PCA) Program. Additionally, Veterans' benefits and Paid Family and Medical Leave (PFML) can offer compensation under specific circumstances.
MassHealth Adult Foster Care (AFC) Program
This program provides a tax-free monthly stipend to a non-spousal family member or friend who lives with and provides 24/7 care for an adult with disabilities or a senior. Eligibility requires the caregiver to be 18 or older, live with the care recipient, and pass background checks. The care recipient must be at least 16, have MassHealth Standard or CommonHealth, and need daily help with at least one Activity of Daily Living (ADL). Application is through a MassHealth-approved AFC provider agency which offers ongoing support.
MassHealth Personal Care Attendant (PCA) Program
This program allows the care recipient (consumer) to hire, train, and manage their own PCA, who can be a non-spousal family member. The consumer is the employer. Caregivers must follow the consumer's directions. Care recipients need MassHealth, a permanent or chronic disability, and require physical assistance with ADLs. The process involves working with a Personal Care Management (PCM) agency for evaluation and authorized hours, and a Fiscal Intermediary (FI) for payroll.
Veteran-Directed Home and Community Based Care (VDC) program
Eligible veterans needing help with daily activities can use this program for a budget to manage their care and hire family members. Eligibility is based on the veteran's needs and VA healthcare eligibility. This program gives veterans control over who provides their care.
Comparison of Massachusetts Paid Caregiving Programs
| Feature | Adult Foster Care (AFC) Program | Personal Care Attendant (PCA) Program | Veteran-Directed Care (VDC) Program |
|---|---|---|---|
| Funding Source | MassHealth (Medicaid) | MassHealth (Medicaid) | U.S. Department of Veterans Affairs |
| Caregiver Relationship | Non-spouse family member or friend (must live-in) | Non-spouse family member (can be non-resident) | Any family member chosen by the veteran |
| Care Recipient Eligibility | Ages 16+, MassHealth Standard, requires help with 1+ ADLs, unable to live alone | Permanent or chronic disability, MassHealth, needs physical help with ADLs | Veteran requiring assistance with daily activities |
| Control over Care | Structured through AFC provider agency with oversight from a care team | Self-directed by the care recipient, who acts as the employer | Self-directed by the veteran, who manages a personal budget |
| Compensation | Tax-free monthly stipend (up to ~$1,600) | Hourly wage based on authorized hours | Hourly wage based on veteran's budget allocation |
| Application Process | Contact a certified AFC provider agency | Contact a Personal Care Management (PCM) agency | Contact the local VA Medical Center |
The process to become a paid family caregiver
Regardless of the program, the general process involves several key steps:
Step 1: Check eligibility for MassHealth
Confirm the family member needing care is eligible for MassHealth, a prerequisite for most state programs. MassHealth has income and asset limits, with some waiver exceptions. A Medically Needy program may help those over the income limit qualify. Provider agencies can assist with applications.
Step 2: Choose the appropriate program
Select between AFC (for live-in, 24/7 care) or PCA (for those who can self-direct care). Veterans should explore the VDC program.
Step 3: Contact a provider agency
Contact a state-certified agency: an AFC provider agency for AFC, or a Personal Care Management (PCM) agency for PCA.
Step 4: Complete the assessment and paperwork
An agency representative will conduct an in-home assessment and gather documentation like MassHealth coverage, medical records, and the caregiver's background check.
Step 5: Fulfill caregiver training requirements
Some programs, like AFC, require agency-provided training. Becoming a Home Health Aide might require 75 hours of training for pediatric care in some programs.
Step 6: Receive approval and begin care
Upon MassHealth approval, the caregiver can receive payments. A care team will provide ongoing support and visits.
Conclusion
Becoming a paid family caregiver in Massachusetts is a realistic and necessary path for many. The state offers several structured programs, primarily through MassHealth, to provide financial compensation and support for families. The most common routes are the Adult Foster Care (AFC) and Personal Care Attendant (PCA) programs, which differ in their structure, eligibility, and the level of recipient control. For veterans, additional benefits exist. Understanding the specific requirements for each program, particularly regarding eligibility for MassHealth and the non-spousal rule in AFC and PCA, is crucial. By working with a state-approved provider agency, families can navigate the application process to secure the compensation and resources they need to continue providing quality, at-home care for their loved ones.
Helpful Resources
- Massachusetts Executive Office of Elder Affairs: The central state resource for aging and independence programs.(https://www.mass.gov/orgs/executive-office-of-aging-independence-age)
