How to Become a Paid Caregiver for an Elderly Parent

Medicaid services for elder- and long-term care are available for Medicaid-eligible citizens in all 50 states of the U.S. and the District of Columbia. While traditional Medicaid benefits pay for nursing home care, there are newer programs that pay for individualized, self-directed care. The difference between self-directed and traditional programs is that self-directed programs allow individuals to choose their own at-home eldercare services instead of these services being directed by an agency or facility.

According to AARP, applying for self-directed care via Medicaid involves the following four steps.

• Assessment: Your loved one is assessed for capacities, need, preferences, risks and strength
• Planning: Your family member creates a written service plan detailing the daily living assistance required, including contingency plans
• Budgeting: If the assessment demonstrates need, a budget for goods and services is provided
• Selection: Once the care plan is set, the care recipient chooses a caregiver. In some states, that can include hiring a family member to provide care. Some programs pay family caregivers but exclude spouses and legal guardians. Others will pay care providers only if they do not live in the same house as the care recipient.

Source: AARP

Self-directed Medicaid programs vary from state to state in terms of eligibility, restrictions, and details about benefits and coverage amounts. There are four basic types of programs under the Medicaid umbrella: HCBS and 1915(c) Waivers, Medicaid Personal Care Services, Medicaid Caregiver Exemption, and Adult Foster Care. Not all of these four types are available in all fifty states, but at least one is available in each state.

1. Medicaid HCBS (Home and Community Based Services) or 1915(c) are the most common option, allowing states to pay for in-home personal caregiving and assistance with activities of daily living (ADLs). For these waivers, in-home can mean individuals “aging in place” in their own homes, or in the homes of loved ones. Medicaid Waivers have an option commonly called “Consumer Direction” in the majority of states. Consumer direction allows the individual receiving care (the “consumer”) to choose or direct who will provide their care. They can choose a family member, who will then be paid by Medicaid. The pay rate is the Medicaid hourly rate for home care in the individual’s state of residence. Not all states use the term “consumer direction.” It may also be known as Participant Directed Services, Self-Directed Care, Cash and Counseling, Choice Programs, or Self-Administered Services.
2. Medicaid State Plan Personal Care also allows individuals receiving care to choose their own caregiver, including family members. The person receiving care is assessed as part of the enrollment process to determine how many hours of care they need per week and, as with Waivers, the family caregivers are paid the Medicaid-approved hourly rate for their state. Certain states offer personal care services through an option in their state plan called Community First Choice (CFC), although the names of these programs vary greatly from state to state. A program may be called Consumer Directed Care in one state, and Participant-Directed Services, In-Home Supportive Services or Cash and Counseling in another.
3. The Medicaid Caregiver Exemption, or Child Caregiver Exception, is fairly complicated, as it doesn’t directly pay an hourly rate for caregiving. Instead, it compensates indirectly, based on the value of the home owned by the elderly person receiving care. The exemption allows an adult child who cares for their elderly parent in the parent’s home to inherit the home, instead of the state seizing the home or some of its value when the elderly parent passes away. In order to qualify for the exemption, the caregiver, most often an adult offspring, must also live in the home with their parent and provide care for at least two years. They must also be able to provide medical documentation that their caregiving enables their parent to age in place instead of in a nursing home.
4. Adult Foster Care is a Medicaid program that allows adult offspring to become adult foster care providers for elderly parents. The parent receives care in their caregiver’s/adult child’s home, with the caregiver becoming legally responsible for providing help with ADLs, mobility and transportation, and any other personal care needed. Medicaid pays for caregiving services (based on the amount of care needed), medical treatment and expenses, including prescriptions, but does not give any compensation for room and board. However, this is often supplemented through financial compensation from state funds, varying from state to state.