Self-Direction and FMS in Massachusetts

All states: self-direction map

Massachusetts self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Massachusetts offer self-direction?

Massachusetts offers Medicaid self-direction through two agencies. MassHealth runs the Personal Care Attendant (PCA) Program and the self-directed option in the Acquired Brain Injury (ABI) and Moving Forward Plan (MFP) waivers. The Department of Developmental Services (DDS) runs two self-direction models for adults with intellectual disabilities: the Participant Directed Program and Agency with Choice. There is no single state self-direction office, so the rules and the FMS vendor depend on the program.

• MassHealth Personal Care Attendant (PCA) Program: serves MassHealth Standard or CommonHealth members with a permanent or chronic disability who need physical help with two or more activities of daily living. MassHealth runs it under its PCA regulations (130 CMR 422.000), with Personal Care Management (PCM) agencies handling intake, skills training and authorizations. The consumer has employer authority. Hours are approved by prior authorization, and we did not find a page that describes budget authority.
• Self-direction in the ABI and MFP waivers: four 1915(c) waivers (ABI-N, ABI-RH, MFP-CL and MFP-RS) that serve adults with an acquired brain injury, and adults with disabilities or seniors, who are moving from a nursing facility or a chronic disease, rehabilitation or psychiatric hospital to the community. MassHealth runs them, with MassAbility operating ABI-N and MFP-CL and DDS operating ABI-RH and MFP-RS. The participant has employer authority over the direct care worker (DCW). We did not find a statement on budget authority, and we did not confirm which services can be self-directed in each waiver, so ask the waiver case manager or service coordinator.
• DDS Participant Directed Program (PDP): serves adults age 22 and older with intellectual disabilities in the Adult Supports, Community Living and Intensive Supports waivers, and also some people DDS funds outside the waivers. DDS runs it. The participant or family hires staff and manages an individual DDS budget, so the program has both employer authority and budget authority.
• DDS Agency with Choice (AWC): a second option in the same three DDS adult waivers, delivered through provider agencies that DDS has qualified. DDS calls it a co-employment model: the agency serves as the employer, and the participant or family selects, trains and supervises the staff. The participant has a budget allocation and gets a monthly financial report from the agency. Service options are Service Navigation, Individualized Home Supports, Individualized Day Supports and Flexible Funding.

Employer authority means the person recruits, hires, schedules and supervises the workers. Budget authority means the person also manages a set amount of money for services. DDS says on its waiver information page that each of its three adult waivers offers both. For the DDS options, start at the DDS Self Directed Services page, which also lists the regional self-direction managers.

Who handles financial management services (FMS) in Massachusetts?

Massachusetts has one FMS vendor per program. Tempus Unlimited, Inc. is the fiscal intermediary for the MassHealth PCA Program and for self-direction in the ABI and MFP waivers. Acumen Fiscal Agent is the financial management service for the DDS Participant Directed Program. In PCA and ABI/MFP the consumer or participant is the employer, and in DDS Agency with Choice the agency is.

A fiscal intermediary (FI) is the organization that handles the paperwork side of being an employer. In the PCA Program the consumer is the employer, listed on the worker's I-9 and W-4, and the FI does payroll, taxes, workers' compensation and W-2s. MassHealth states on its fiscal intermediary page that Tempus Unlimited, Inc. is the FI for the PCA Program.

• PCA Program: Tempus Unlimited, Inc. is the FI. The consumer is the employer. PCM agencies are separate organizations that help with intake, skills training and authorizations.
• ABI and MFP waivers: Tempus Unlimited is the FI. The waiver participant becomes the employer of the direct care worker, and the FI carries out the tasks an employer is required to do.
• DDS Participant Directed Program: Acumen Fiscal Agent is the FMS. It processes payroll, taxes, workers' compensation, background checks and vendor payments. DDS says the FMS "assumes employer fiscal responsibility" while the participant or family hires the staff. DDS's FMS transition page says Acumen replaced Public Partnerships (PPL), and that since August 5, 2026 assigned Acumen agents use a new phone number, (617) 275-2684, and email, MA-PDP@acumen2.net.
• DDS Agency with Choice: a qualified provider agency serves as the employer. DDS publishes a getting started page for the option and a list of qualified agencies. We did not review that list, so no agency names appear here.

Because each program has a single FI or FMS, participants in PCA, ABI/MFP and the Participant Directed Program do not pick among competing vendors. For questions, Tempus publishes a PCA line at (877) 479-7577, and Acumen publishes a Massachusetts PDP customer service line at (866) 427-1739.

Who can be a paid caregiver under self-direction in Massachusetts?

Relatives can be hired in the MassHealth programs, but not every relative. A PCA cannot be the consumer's spouse, the parent or foster parent of a minor consumer, the consumer's surrogate, or a legally responsible relative such as a legal guardian. The ABI and MFP waivers apply the same exclusions to direct care workers. We did not find a published family rule for the DDS programs.

• PCA Program: the fiscal intermediary lists who cannot be a PCA: a spouse, a parent of a minor child (adoptive and foster parents included), a surrogate, a legally responsible relative (legal guardian), and anyone under age 16. A surrogate is the person who acts for the consumer in running the PCA program.
• ABI and MFP waivers: a direct care worker cannot be the participant's spouse, surrogate, legally responsible relative, or the parent (adoptive or foster included) of a minor child.
• DDS Participant Directed Program and Agency with Choice: we did not find a published rule on paying family members, guardians or legally responsible individuals. Ask the DDS regional self-direction manager, or call Acumen's Massachusetts PDP line at (866) 427-1739.

Weekly hours are capped. Under the PCA overtime policy effective July 3, 2026, a PCA may work up to 50 hours a week without an overtime prior authorization, needs a prior authorization for 51 to 60 hours, and may never work more than 60 hours a week counted across all consumers. After a third overtime or weekly hour violation, the PCA and consumer can be referred for termination, and a terminated PCA is barred for 9 months.

ABI and MFP direct care workers are held to the same 60 hour weekly maximum across all waiver participants, and MassHealth's weekly hour limit training page says hours worked as a PCA count toward it. A participant needs an overtime authorization from the waiver case manager or service coordinator before a worker goes over 50 hours in a week. The fiscal intermediary also says PCAs earn 1 hour of paid time off for every 30 hours worked.

Does EVV apply to self-directed workers in Massachusetts?

Yes for the PCA Program. PCAs clock in and out on an electronic visit verification (EVV) app, and the consumer approves the time in an EVV Portal and sends it to the fiscal intermediary for payment. Two exemptions exist, one for live-in PCAs and one for safety. For the ABI and MFP waivers and for DDS self-direction, we did not find confirmation that EVV is in use.

• PCA Program: MassHealth's EVV page describes two parts: an EVV App the PCA uses to clock in and out, and an EVV Portal where the consumer, surrogate or administrative proxy reviews, approves and submits time to the FI. The fiscal intermediary names the app HHAeXchange+. MassHealth's pages do not name a vendor, and we did not find any other EVV system offered to consumers.
• Rollout: MassHealth and the FI began rolling out EVV for consumer-directed programs in January 2024, starting with PCA. Consumers who joined PCA after January 2024 use EVV as soon as they are active. We did not find a statement that the rollout to longer-standing consumers is finished.
• Exemptions: the live-in exemption covers a consumer and PCA who permanently live in the same home, and there is a separate safety exemption. The FI says exempt consumers may still submit eTimesheets or paper timesheets. The FI's EVV page also says new live-in exemption requirements began January 1, 2026. We did not review the details, so check with Tempus before relying on an older exemption.
• Pay: the FI says PCA time must be submitted through EVV unless the consumer has an approved exemption, and that EVV time approved by Monday at 4 pm is paid on Thursday.
• ABI and MFP waivers: MassHealth and the FI announced that self-directing participants would submit direct care worker time through EVV. We could not confirm that this has started. Ask Tempus at (877) 479-7577 or the waiver case manager.
• DDS programs: we did not find any state page that says whether EVV applies to the Participant Directed Program or Agency with Choice. Ask DDS or Acumen at (866) 427-1739.

What is changing next for self-direction in Massachusetts?

We did not find a firm, dated upcoming change to self-direction in Massachusetts as of October 13, 2026. Several changes took effect earlier in 2026 and are already in force. Two items are still open and worth watching: EVV for the ABI and MFP waivers, and a DDS support service that is not yet available.

• Already in force, July 3, 2026: revised PCA regulations at 130 CMR 422.000 took effect, bringing the 60 hour weekly limit and the overtime prior authorization rule described above.
• Already in force, September 1, 2026: the fiscal intermediary says a new PCA cannot begin work until the new hire paperwork is completed and approved by Tempus FI, and the updated 2026 PCA Consumer Agreement must be on file first.
• ABI and MFP new hires: the FI's program changes page says employers must submit copies of the worker's employment authorization documents with the Form I-9, and that Tempus FI runs E-Verify.
• To watch, EVV in the ABI and MFP waivers: the same page describes EVV for self-directing participants as planned for spring 2026, with an email address required for the participant and each worker. The page still words it as upcoming, an earlier target had already slipped, and we could not confirm that it went live. Treat the timing as unsettled until MassHealth or Tempus confirms it.
• To watch, DDS Independent Facilitator: DDS says on its Participant Directed Program page that this service is not currently available because the required training is still being developed. No date has been given.

Massachusetts self-direction sources

• MassHealth: Personal Care Attendant Program
• MassHealth: Personal Care Attendant (PCA) fiscal intermediary, Tempus
• MassHealth: Electronic Visit Verification (EVV)
• MassHealth: PCA overtime policy effective July 3, 2026
• MassHealth: Educational trainings for the direct care worker weekly hour limit
• Massachusetts DDS: Self Directed Services
• Massachusetts DDS: Financial management services transition for the Participant Directed Program
• Tempus Unlimited: Personal Care Attendant program
• Tempus Unlimited: Moving Forward Plan and ABI waivers

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Massachusetts EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.