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The Heritage Law Center, LLC Blog

Can Family Caregivers Get Paid in Massachusetts?

POSTED ON: November 2, 2022

About 48 million Americans provide care without pay to an adult family member or friend, and they do so for an average of nearly 24 hours per week according to the research Caregiving in the U.S. 2020 done by the National Alliance for Caregiving (NAC) and AARP. 1 in 6 Americans are caregivers for someone 50 years old and older. So, how can family caregivers get paid in Massachusetts?

MassHealth’s Adult Foster Care Program

One way for family caregivers to get paid in Massachusetts is the Adult Foster Care Program. This program isn’t just for older adults but seniors are the focus of this article. When a senior is eligible for nursing home care, they can move into a caregiver’s home or have the caregiver move into their home. Most often the caregivers are family members or friends of the senior.

The caregivers are supported by a team of MassHealth professionals who provide regular home visits and counseling, and the caregivers receive training in best practices and help connecting seniors to other resources.

This program pays the caregivers for the 24-hour personal care they provide, which includes activities of daily living (ADLs) like, bathing, toileting, maintaining continence, dressing, eating, and walking and transferring (moving from bed to wheelchair). It also includes instrumental activities of daily living (IADLs) like meal preparation, housekeeping, laundry, managing medications, shopping, handling transportation, managing finances, and telephone use. Caregivers are paid monthly via the program; the specific amount depends on the level of care the person needs.

Family members who can be paid caregivers include siblings, adult children, and other relatives; however, the care recipient’s spouse or anyone who is the legal guardian of the care recipient isn’t eligible to be paid by this program.

If the care recipient is living in the caregiver’s home, the caregiver can charge a monthly fee for room and board. This offers one way in which a senior can pass assets to a family caregiver without violating MassHealth asset transfer rules. The program doesn’t cover room and board.


The elder participant must be on MassHealth and need assistance with at least three ADLs. Qualifying for MassHealth is a complicated process involving a review of a family’s income, assets, and asset transfers as far back as 5 years. Rules change frequently and there are many exemptions, but typically “countable asset” limits, excluding the car and home, can’t exceed $2,000. Here’s more information about MassHealth eligibility.

The MassHealth application can be confusing, and if it’s not done correctly then it will take more time to become eligible for MassHealth. A Massachusetts elder law attorney should be consulted to ensure families have the best chance of acceptance into the MassHealth program.

Personal Care Contracts

Another way for family caregivers to get paid in Massachusetts is the personal care contract. This option is primarily for those who don’t yet qualify for MassHealth, but who want to plan ahead for MassHealth eligibility. Without a personal care contract in place, MassHealth may consider any payments made by a senior to a family caregiver as a disqualifying transfer. By establishing an employer/employee relationship through a personal care contract, a senior can pay a family caregiver for their efforts without causing an issue with the MassHealth 5-year-look -back policy. Personal care contracts must observe strict formalities in order to be considered legitimate, so contacting an elder law attorney to assist you is highly recommended.

For more information about the Adult Foster Care, you can call the MassHealth Customer Service Center at 1-800-841-2900. For help with applying for MassHealth or creating a personal care contract, please contact us today for your free, no-obligation consultation.