How to Get Paid as a Family Caregiver Through Medicaid

Being a caregiver for a parent, spouse, child or other relative can feel like a full-time job — because it often is. In some situations, Medicaid can pay a family member for providing approved care at home.

The payment is not an automatic caregiver allowance. The person receiving care must qualify for Medicaid-funded long-term services, enroll in a program that permits participant direction and formally hire the relative as a caregiver. The rules — including whether spouses or parents can be paid — vary by state and program.

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How Medicaid caregiver pay works

Medicaid’s home and community-based services (HCBS) help older adults and people with disabilities receive care at home instead of in an institution. Many HCBS programs offer “self-directed,” “consumer-directed” or “participant-directed” services. That means the person receiving care can help choose, schedule and supervise the worker.

Most self-directed Medicaid programs allow at least some relatives to be paid. Adult children, siblings and other relatives are often easier to approve than a spouse, the parent of a minor child or a legal guardian. Those “legally responsible” relatives may be allowed only under certain Medicaid programs or when the state determines that extraordinary care is needed.

The caregiver may be paid hourly or receive a daily payment through a structured family-caregiving program. Medicaid pays only for authorized tasks and hours, not every hour a relative spends helping.

Who qualifies?

The person needing care generally must:

• Be enrolled in Medicaid or financially eligible for it
• Need help with activities such as bathing, dressing, eating, toileting or moving safely
• Complete a medical or functional assessment
• Qualify for personal care, attendant care or an HCBS waiver
• Live at home or in another approved community setting

The caregiver may need to be at least 18, pass a background check, complete training, enroll as a provider and use electronic visit verification. A fiscal-management company may process payroll, taxes and timesheets.

How to apply

Start with the care recipient’s state Medicaid agency, managed-care plan, Area Agency on Aging or Aging and Disability Resource Center.

Ask this exact question:

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Then:

1. Apply for Medicaid if the person is not already enrolled.
2. Request an assessment of the person’s daily care needs.
3. Ask about every self-directed option, not just one waiver.
4. Confirm whether the specific relative can be paid.
5. Complete caregiver enrollment, training and payroll paperwork.
6. Submit accurate timesheets only for approved services.

Some waiver programs have enrollment caps or waiting lists. Ask whether a state-plan personal-care program is available while you wait.

State-by-state starting points

Program names and eligibility rules change. These are the main terms to ask your Medicaid agency about; being listed does not mean every relative can be paid.

• Alabama: Personal Choices
• Alaska: Consumer-Directed Personal Care Services or Community First Choice
• Arizona: Self-Directed Attendant Care through ALTCS
• Arkansas: Independent Choices
• California: In-Home Supportive Services or Self-Determination Program
• Colorado: Consumer-Directed Attendant Support Services or In-Home Support Services
• Connecticut: Community First Choice or Connecticut Home Care Program for Elders
• Delaware: Diamond State Health Plan Plus self-directed services
• District of Columbia: Services My Way
• Florida: Consumer-Directed Care Plus or Long-Term Care Waiver
• Georgia: Participant direction through CCSP, ICWP, NOW or COMP waivers
• Hawaii: QUEST Integration consumer-directed services
• Idaho: Family Directed Supports or self-directed waiver services
• Illinois: Home Services Program
• Indiana: PathWays for Aging or Health and Wellness waiver services
• Iowa: Consumer Choices Option or Consumer-Directed Attendant Care
• Kansas: Self-directed services through KanCare HCBS waivers
• Kentucky: Participant-Directed Services
• Louisiana: Self-direction through Community Choices Waiver
• Maine: Consumer-Directed Personal Assistance Services
• Maryland: Community First Choice or Developmental Disabilities Administration self-direction
• Massachusetts: MassHealth Personal Care Attendant Program
• Michigan: Home Help or Self-Determination Initiative
• Minnesota: Community First Services and Supports or Consumer Directed Community Supports
• Mississippi: Participant-directed services through applicable HCBS waivers
• Missouri: Consumer-Directed Services or Structured Family Caregiving
• Montana: Community First Choice or Big Sky Waiver
• Nebraska: Personal Assistance Services or developmental-disability waiver self-direction
• Nevada: State Plan Personal Care Services or Self-Directed Family Support Services
• New Hampshire: Choices for Independence or state-plan personal care
• New Jersey: Personal Preference Program
• New Mexico: Mi Via Waiver or Self-Directed Community Benefit
• New York: Consumer Directed Personal Assistance Program
• North Carolina: CAP/DA, CAP/C or NC Innovations consumer direction
• North Dakota: Home and Community Based Services
• Ohio: PASSPORT, SELF, Individual Options or Level One waivers
• Oklahoma: ADvantage, In-Home Supports or Community Waiver
• Oregon: Independent Choices, K Plan or State Plan Personal Care
• Pennsylvania: Community HealthChoices or participant-directed services
• Rhode Island: Personal Choice or Independent Provider Program
• South Carolina: Community Choices Waiver
• South Dakota: Assistive Daily Living Services or Family Support 360
• Tennessee: CHOICES consumer direction or Employment and Community First CHOICES
• Texas: Consumer Directed Services through STAR+PLUS, CFC, CLASS, HCS, or TxHmL
• Utah: Self-direction through Aging, Physical Disabilities or New Choices waivers
• Vermont: Choices for Care, Flexible Choices or Adult Family Care
• Virginia: Consumer-directed services through CCC Plus or DD waivers
• Washington: Community First Choice, Medicaid Personal Care or New Freedom
• West Virginia: Personal Options through applicable HCBS waivers
• Wisconsin: IRIS Program or Family Care
• Wyoming: Community Choices, Supports or Comprehensive waiver participant direction

How much can you earn?

There is no national pay rate. Earnings depend on the state, program, local wage rules, approved tasks and number of authorized hours. Ask for the hourly or daily rate before enrolling and whether overtime is allowed.

Some payments to a live-in caregiver under a qualifying Medicaid HCBS waiver may be excluded from federal income under IRS Notice 2014-7. The rule does not apply to every caregiver payment, so confirm the program with the payroll provider or a tax professional.

Before you apply

Do not pay a private company a large fee to “unlock” caregiver benefits. No one can guarantee approval. Verify the program through Medicaid and never report hours you did not work.

The best first step is simple: Request a care-needs assessment and ask which self-directed programs allow the person to hire your specific family relationship.