Summary
Seniors who are frail, disabled or suffer from dementia will likely need to move into a nursing home or assisted living unless they get help with the basic activities of living, like eating and bathing. The job of providing that help usually falls on spouses, family members or friends. These caregivers are rarely paid, but that doesn’t have to be the case. Family members and other loved ones can be compensated for their caregiving efforts through multiple Medicaid programs.
Getting Paid as CaregiverTypes of Medicaid that Pay CaregiversHome and Community Based Service WaiversAged, Blind and Disabled MedicaidChild Caregiver ExceptionMoney Follows the PersonAdult Foster CareWho May be Paid?How Much Are Caregivers Paid?How to Apply
Almost every state has a Medicaid-funded program with a benefit that allows for Consumer Directed Care, or something with a similar name, like Self Directed Care, Participant Directed Care, or Cash & Counseling. This type of benefit lets the Medicaid recipient direct their own care, primarily by hiring a caregiver of their choice, within certain parameters. These caregivers can be friends or family members in most states and programs, and Medicaid will actually pay them for their care, which many of them were already providing. Some Medicaid programs will even pay spouses to be caregivers.
The amount of money a loved one can be paid for caregiving under Medicaid Consumer Directed care programs is usually determined by two factors:
Medicaid recipients will be evaluated by their state of residence to determine their level of care of needs, and what specific long-term care services and supports their situation requires. If it requires personal care assistance, and it usually does with frail seniors who are living independently, the Medicaid beneficiary can use the Consumer Directed Care option to hire, and pay, a family member or loved one.
Medicaid is a state-run health insurance program, and in every state it provides an option for loved ones, meaning friends or relatives, to become paid caregivers. The specifics can vary quite a bit, however, as there is a lot of variance between how Medicaid works in each state. (Medicaid is even known by a different name in many states, like “Medi-Cal” in California and “MassHealth” in Massachusetts.)
Though the names and specific details will differ depending on the state, the following programs will help individuals get compensated for caring for aging loved ones:
Home and Community Based Service (HCBS) Waivers provide long-term care benefits to seniors who require some level of nursing care but choose to live at home or elsewhere in the community (like the home of a loved one) instead of moving into a nursing home. HCBS Waivers can provide a wide-range of benefits, including Consumer Directed personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, housekeeping, medication management, etc.). This means the Medicaid beneficiary can hire a personal caregiver of their choice, including family members and loved ones (in most states), and the HCBS Waiver will provide the funds to pay the caregiver. State Medicaid officials will also help HCBS Waiver beneficiaries who use the Consumer Directed option with the financial responsibilities that come with paying someone – tracking hours, calculating taxes, issuing paychecks, etc.
To be eligible for HCBS Waivers in most states, seniors must need a Nursing Facility Level of Care, which means they require the kind of care provided in a nursing home in order to survive. Some states only require applicants to be at risk of nursing home placement to be eligible for HCBS Waivers. To be clear, the word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care benefits for seniors who live in the community, which can include the beneficiary’s home, the home of a loved one, adult foster care, assisted living, or memory care facilities for people with Alzheimer’s disease and other related dementias. Other benefits of HCBS Waivers include adult day care, case management, meal delivery, home modifications (like adding a wheelchair ramp), and transportation. The type of benefits, and the settings where they can be provided, depend on the state, the waiver, and the individual.
HCBS Waivers have a limited number of enrollment spots. Once those spots are full, additional eligible applicants are placed on a waitlist. Most seniors come off HCBS Waiver waitlists and enroll in the program within two months, but it can take as long as two years. Some waitlists are prioritized on a first-come, first-serve basis, some are prioritized by need, and some use different methods. It all depends on the specific HCBS Waiver.
For a step-by-step guide to applying for Medicaid HCBS Waivers, click here.
Aged, Blind and Disabled (ABD) Medicaid provides health care for anyone over age 65 (or blind or disabled) of limited financial means. ABD Medicaid also provides long-term care services and supports for beneficiaries who might need them to avoid nursing home placement. These long-term care benefits can include Consumer Directed personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (shopping, cooking, housekeeping, medication management, etc.). Again, this means the Medicaid beneficiary can hire a personal caregiver of their choice, including loved ones (in most states). ABD Medicaid will provide the funds to pay the caregiver, and it will also provide help with the financial responsibilities that come with paying someone – tracking hours, calculating taxes, issuing paychecks, etc.