Getting paid as a family caregiver through Medicaid

Caring for an ailing family member is difficult work, but it doesn’t necessarily have to be unpaid work. There are programs available that allow Medicaid recipients to hire family members as caregivers.

All 50 states have programs that provide pay to family caregivers. The programs vary by state, but are generally available to Medicaid recipients, although there are also some non-Medicaid programs.

Medicaid’s program began as “cash and counseling,” but is now often called “self-directed,” “consumer-directed” or “participant-directed” care. The first step is to apply for Medicaid through a home-based Medicaid program. Medicaid is available only to low-income seniors, and each state has different eligibility requirements. The Medicaid application approval can take months, and there may be a waiting list for benefits.

The state Medicaid agency usually conducts an assessment to determine the recipient’s care needs, e.g., how much help the Medicaid recipient needs with activities of daily living, such as bathing, dressing, eating and moving. Once the assessment is complete, the state draws up a budget and the recipient can use the allotted funds for goods or services related to care, for example by paying a caregiver. Each state offers different benefits coverage.

Recipients can choose to pay a family member as a caregiver, but states vary on which family members are allowed. For example, most states prevent caregivers from hiring a spouse, and some states do not allow recipients to hire a caregiver who lives with them. Most programs allow ex-spouses, in-laws, children and grandchildren to serve as paid caregivers, but states typically require family caregivers to be paid less than the market rate, to prevent fraud.

In addition to Medicaid programs, some states have non-Medicaid programs that allow self-directed care. These programs may have different eligibility requirements than Medicaid, and they are different in each state. Family caregivers can also be paid using a “caregiver contract,” increasingly part of Medicaid planning.

In some states, veterans who need long-term care also have the option of paying family caregivers. In 37 states, veterans who receive the standard medical benefits package from the Veterans Administration and who require nursing home-level care may apply for Veteran-Directed Care. The program provides veterans with a flexible budget for at-home services that can be managed by the veteran or the family caregiver. In addition, if a veteran or surviving spouse of a veteran qualifies for Aid & Attendance benefits, he or she can receive a supplement to their pension to help pay a caregiver, who can be a family member.

Contact your attorney to find out what is available in your state.