What the two programs are
Adult Foster Care (AFC): a MassHealth program that pays a live-in family caregiver a tax-free monthly stipend, delivered through approved agencies who provide training and support.
PCA Program: a MassHealth program that pays an hourly wage to a caregiver the care recipient chooses, interviews, and schedules themselves.
Who qualifies — the care recipient
- Must be enrolled in MassHealth
- For AFC: eligibility based on income thresholds and a look-back asset review; open to individuals 16+, with possible additional requirements for those 65+
- For PCA: must need support with Activities of Daily Living
- As of January 1, 2026, the relevant HCBS waiver income limit increased to $2,982/month
Who qualifies — the caregiver
- Both AFC and PCA exclude spouses and legal guardians — consistent and firm across both programs
- Other family members and friends can generally qualify for either program
- Must complete required training (particularly for AFC)
How pay works
- AFC: figures cited range from roughly $1,470 to $1,600 per month, tax-free, depending on the source and arrangement
- PCA: paid hourly, with the rate set by the program
How to apply
- Confirm the care recipient's MassHealth eligibility
- Call MassOptions (1-800-243-4636) to reach your local Aging Services Access Point
- For AFC: contact an approved AFC agency to begin enrollment and training
- For PCA: contact the MassHealth Customer Service Center or an approved agency
If you're a spouse
Since both AFC and PCA exclude spouses, a spousal caregiver would need to look at other options — such as VA programs if the care recipient is a veteran, or a private personal care agreement.
What you'll need to keep track of once approved
- Training completion and ongoing education records (AFC)
- Hours worked and scheduling documentation (PCA)
- Ongoing MassHealth eligibility documentation
Keeping this organized
Whichever program applies, keeping your documentation current is an ongoing task. FeatherKeep organizes this automatically as you go.
Related guides: US pillar page
Disclaimer
General information only, not legal or financial advice. Massachusetts's income limits, stipend amounts, and program rules change — confirm current details with MassHealth or your local Aging Services Access Point before applying.