Can Medicaid pay a family member to give care?

How Medicaid can pay a family caregiver

Many families care for a loved one at home without being paid. Medicaid can change that in some places, and Medicaid.gov explains that many people can get care at home instead of in a facility. These programs are called home and community-based services, and they include help with daily tasks such as bathing and making meals.

Some of these programs let the person getting care choose who gives it. The name for this on Medicaid.gov is self-directed services. The person getting care, or a helper they choose, decides who to hire. That person also trains the worker and sets the schedule, and in some states the worker can be a relative or a friend.

The government's long-term care site backs this up. It says these programs let you choose who provides your services, and the people you choose can include family and friends. It adds that many public programs, such as Medicaid, now work this way.

What self-directed care means

Medicaid gives the person a care plan and a budget. The person then decides how to use that budget to get the help they need.

Medicaid.gov names two kinds of control, and the first is employer authority. It means the person can hire the workers, train them and supervise their work. Budget authority means the person has a say in how the money in the budget is spent.

Nobody has to handle the paperwork alone, because Medicaid.gov says a supports broker must be available to anyone who picks this option. A supports broker is a helper who explains how the program works and takes direction from the person. A payroll helper handles the money side, which Medicaid calls financial management services. This helper runs the payroll and files the taxes, and it collects the timesheets. A family caregiver is usually paid through the payroll helper, and the person getting care does not pay the worker directly.

Why the rules differ by state

States can offer self-directed services through more than one Medicaid option, and Medicaid.gov lists four of them. Three are choices a state can add to its regular Medicaid plan, and one of those is called Community First Choice. The fourth is the home and community-based services waiver. A waiver is a permission from the federal government that lets a state try a program with its own rules. Each of these options comes with its own set of rules.

That is why the answer changes from place to place. Medicaid.gov says one option lets a state decide whether people can hire relatives who are legally responsible for them. A parent or a spouse is an example. For children with major disabilities, our Katie Beckett Medicaid guide explains a separate state option. Some programs allow it, and others leave out spouses or legal guardians.

This page does not list state rules, because they change and each program has its own. The safest way to learn what applies to you is to ask the state directly, using the steps in the section below.

What the person needing care must have first

A family member cannot be paid unless the person receiving care is already in the program. That usually takes three things, which are listed here.

• First, the person must qualify for Medicaid itself. Our guide on who qualifies for Medicaid explains the groups and income rules, and the how to apply for Medicaid guide covers the steps.
• Second, the person usually has to show that care is needed. For a waiver, Medicaid.gov says people must need the level of care that a nursing home or similar facility would give.
• Third, the person needs a spot in the program. Medicaid.gov says states choose the most people a waiver will serve. A federal rule also makes states report on waiting lists for waiver programs, so some programs have lines to join.

If the program has a waiting list, ask to be added right away. Ask the office how people are chosen and whether other services can start in the meantime.

How to ask your state

A short phone call can answer most of these questions, and there are two good offices to start with.

• Call your state Medicaid office, which you can find in the directory on Medicaid.gov. Ask if your state has a self-directed or consumer-directed program, and ask if a family member can be hired.
• Next, call your local Area Agency on Aging. The Eldercare Locator, a public service of the Administration for Community Living, can connect you at 1-800-677-1116. These agencies know the programs near you, and they can explain family caregiver services such as respite care, which gives caregivers time off.

A few questions are worth asking on every call. Ask whether your state allows a relative to be paid. Ask whether the rule changes if the relative is a spouse, a parent or a legal guardian. Find out if there is a waiting list and who handles the payroll. Write down the date of each call and the name of the person you spoke with.

If you are told no, a legal aid office can explain your rights for free. The Legal Services Corporation lists a local legal aid group for every state.

If you are the caregiver and need coverage yourself

Many family caregivers worry about their own health insurance. Caregiving can limit how much a person works, and that can affect coverage from a job. Medicaid may be an option if your income is low enough, and our Medicaid eligibility guide shows how to check.

A new federal work rule starts by January 1, 2027 for many adults in the expansion group. The federal government says some caregivers are exempt, such as a parent or family caregiver of a child 13 or younger or of a person with a disability. Our Medicaid work requirements guide explains the rule, and our health insurance without a job guide lists other choices.

You can also search for a cash-pay doctor for your own care. This page is general information and not medical, legal or financial advice. If you think you are having an emergency, call 911 or go to the nearest emergency room.