Serving as a caregiver for a family member is an extremely rewarding experience. Not only do you get to spend time with your loved one, you also have the opportunity to ensure they receive the best quality care possible. As primary caregiver, you don’t have to worry about outside help that may not be sympathetic or attentive in caring for your loved one.
Unfortunately, being a caregiver for a family member comes at a cost. Caregivers often have to significantly reduce their number of hours working outside the home or leave their jobs entirely in order to provide quality care for their loved one. This means that caregivers are spending hours assisting loved ones with daily tasks, cooking meals, taking them to appointments, ensuring their safety and well-being, and providing companionship, but are not being compensated for their time.
The Caregiving in the U.S. 2020 AARP Research Report highlighted that 1 in 5 caregivers report high financial strain as a result of caregiving. 3 in 10 have stopped saving, and 1 in 4 have taken on more debt.
Caregivers can lose a great deal of income as they care for their loved ones, yet they often have to pay for caregiving expenses out of their own pockets. According to the AARP report, family caregivers spend about 20% of their income on costs associated with caregiving.
Family caregivers need to know their options for financial assistance while taking care of their loved ones. Here are a few steps you can take to be compensated for caregiving:
If you need to become a paid caregiver, look into the following possibilities for caregiver compensation.
Step 1: Determine Your Eligibility for Medicaid’s Self-Directed Services Programs
If your loved one is eligible for Medicaid, you may be able to receive financial aid from the Self-Directed Medicaid Services programs. According to Medicaid.gov, states have several options for providing Medicaid enrollees with the option to self-direct Medicaid services under the state plan and waiver programs. This option is available in some form in most states. It is important to note that the names of self-directed services programs vary from state to state. Self-directed services programs provide people with disabilities, including older adult citizens, the option to manage a budget and determine how to use their money to pay for goods and services directly relating to their personal care needs. When enrolled in one of these waiver programs or other self-directed options, program participants may use their allotted budget to hire and pay for caregivers. To determine your family member’s eligibility for self-directed services available in your state, contact your local Medicaid office.
Step 2: Opt into a Home and Community-Based Services Program
Many older adults are eligible to opt into a home and community-based services program (HCBS). HCBS programs, such as services provided by Caregiver Homes, deliver ongoing support and care oversight to assist caregivers while providing them with a tax-free daily stipend to make the financial burden of caregiving easier to bear.
These programs are typically available to Medicaid beneficiaries who receive in-home care. They often are available to people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses as well as older adults. The guidance and financial assistance HCBS programs reduce the financial burden on caregivers and while enabling them to learn and improve at providing quality care.
Step 3: Determine Whether Your Loved One Is Eligible for Veterans Aid
In the United States, some veterans can enroll in a Veteran Directed Care Program (previously known as Veteran-Directed Home and Community Based Services programs). This program empowers veterans to manage their own care, which may include hiring and paying for in-home caregivers. Another option for veterans who require in-home care is a benefit known as Aid and Attendance. This benefit may be used to cover assisted living, nursing home, and in-home care costs including paying family caregivers.
In many cases, your loved one must need assistance with activities of daily living and fall in line with income and asset guidelines. If you need more assistance in determining your loved one’s eligibility for these veterans benefits, contact your local Veterans Affairs office or your local veterans service organization.
Step 4: Determine Whether Your Loved One Has a Long-Term Care Insurance Policy That Provides for Caregiver Compensation
According to the Family Caregiver Alliance, some long-term care insurance policies do include provisions for paying a family member who provides care. If you can determine whether your loved one has such a policy, you need to find out if caregiver payment is among the benefits. If you need clarification about your loved one’s long-term health insurance policy, contact the agent or the insurance company and ask about the caregiver payment benefit.
Step 5: Determine Whether Your Company Offers Paid Leave for Caregivers
As more families require at least one member to serve as a caregiver for aging parents, companies are realizing the need to assist employees with paid leave. If you find yourself serving as a caregiver to a family member while you are employed, your company may offer an elder care program or benefit. Companies like Intel and Sun Life are allowing up to 8-16 weeks of paid leave for caregiving employees. However, the Bureau of Labor Statistics found in 2018 that just 16% of private-industry employees had access to paid family leave through their employers, and 88% had access to unpaid family leave.
Step 6: Determine Whether Your Family is Willing to Pay You for Your Caregiving Time
Considering the amount of money you are saving your loved one and the rest of the family by serving as the primary caregiver, you are well within your rights to ask your loved one or other family members if they will compensate you for your time. Chances are, the family would be paying out of pocket for a home health aide, which the Genworth Cost of Care Survey reports carries a monthly median cost of $4,576 per month. To protect yourself and your family, meet with an attorney to draft a contract to explicitly state your work and payment schedule. This contract may be used later in the event your loved one needs to apply for Medicaid or enter an assisted living facility or nursing home.
It’s vital that you know your loved one’s eligibility for various government programs, insurance policy benefits, employee benefits, and family payment options if you hope to become a paid caregiver for a family member. To help you navigate the options available to you, we’ve put together a step-by-step, state-by-state guide to help you obtain financial assistance for caregiving services.
The programs that compensate family caregivers differ by state, and in some cases, from county to county.
Note that not all states make this option available, and some have restrictions on the family members that may be hired as caregivers. We included helpful resources to find your local Aging and Disability Resource Center or local Area Agency on Aging to get in touch with local experts for further guidance. We’ve also provided information on the states that offer Veteran Directed Care (VDC) well as links to the state Veterans Administration to make it easy for you to get in touch with the right representatives for the help you need. Click on a state below to go directly to the information for your state:
Alabama offers the Alabama Cares Program, which is administered under the Alabama Department of Older adult Services (ADSS) through the 13 Area Agencies on Aging (AAA). This program offers assistance to caregivers including training, individual advice, information, and support (such as personal care, limited homemaker services, and adult day care. Based on the county you live in, you will need to contact your local area agency on aging for more information and eligibility requirements.
A number of Medicaid Waiver Programs are offered that aim to help prevent nursing home placements where possible. Each has its own eligibility criteria, including income and asset qualifications. Below are some general details about Medicaid Waiver Programs that may be relevant to your situation:
The Alabama Medicaid Waiver for the Older adult and Disabled (E&D Waiver) Program is designed to provide support services to older adults and persons with disabilities that enable them to live safely in their own homes. Services may include case management, personal care, homemaker services, respite care, companion services, adult day care, and home-delivered frozen meals.
The Personal Choices program enables Alabama older adults to select and manage their own care providers and is available to individuals enrolled in a Home and Community Based Waiver Services program such as the State of Alabama Independent Program (SAIL).
The Alabama Community Transition (ACT) Program provides individuals with disabilities or long term illnesses living in a nursing facility and who wish to transition back to a home or community setting the opportunity to do so by providing Plan of Care and Case Management services. To qualify, the individual must have been in the nursing facility for 90 days or more. They must also move into the community within 180 days.
The Technical Assisted Waiver (TAW) Program provides Plan of Care and Case Management services to enable ventilator-dependent adults or those with a tracheostomy who would otherwise need institutional care to remain in the community.
If you would like more information about any of the Medicaid Waiver Programs, you can contact your local Area Agency on Aging (AAA) and Aging & Disability Resource Center (ADRC) at 1-800-AGE-LINE (1-800-243-5463).
Under the Veteran Directed Care Program (VDC), eligible veterans manage a flexible budget and determine the mix of goods and services that meet their needs to enable them to continue living in their homes and engage in their communities rather than risk placement in a long term care facility. Under this program, veterans hire and supervise their own workers, while receiving assessment and care planning assistance, help securing financial management services, and ongoing counseling support for themselves, their family members, and their caregivers from an options counselor.
Summary: How to obtain financial assistance for caregivers in Alabama
The Alaska Commission on Aging (ACoA), under the Alaska Department of Health and Social Services, engages in planning, advocacy, and interagency collaboration on issues impacting older Alaskans. The ACoA collaborates with the Division of Older adult and Disabilities Services and the Alaska Mental Health Trust Authority on program development, grand fund allocation, and more.
The state of Alaska offers a Personal Care Services (PCS) program, which provides assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, and eating, as well as instrumental activities of daily living (IADLs) such as shopping, laundry, and light housework, for eligible older adults. The program operates in two primary ways:
The Community First Choice Program (CFC) is a new program under the Medicaid reform initiative, 1915(k). The CFC program offers personal care services and other supportive services to enable eligible recipients to receive services in their homes as an alternative to institutional care. Recipients may receive a personal emergency response system (PERS) as part of the program, and as well as skills training to help them learn to perform activities with greater independence. The number of hours of personal care services a recipient is eligible to receive each week is determined by an assessment conducted by the Older adult Division of Older adult and Disabilities Services.
Home and Community Based Waiver programs are also available in Alaska. These programs aim to “support the independence of Alaskans who experience physical or developmental disabilities by providing services in their homes and in the community rather than in an institution such as a nursing home.” You can find more information here. There are also grant programs for those who are waiting or don’t qualify for Home and Community Based services under the Medicaid Waiver program, or for those who only require minimal support offered by grant services. Grant funds provide support for “families and individuals experiencing Developmental Disabilities (DD), Alzheimer's Disease and related Disorders (ADRD), family caregivers of older adults aged 60 and over, grandparents raising grandchildren aged 55 or over, older adults aged 60 and over, and/or frail or disable older adults who need assistance in the home.”
Alaska’s Veteran Directed Care Program is offered through the Alaska VA Health System.
Summary: How to obtain financial assistance for caregivers in Alaska
Arizona’s Department of Economic Security (DES) Division of Aging and Adult Services (DAAS) provides non-medical home and community-based services and Family Caregiver Support for qualified individuals. These services are offered through local Area Agencies on Aging (AAA), and the AAA may also provide caregiver support services. However, the DES Division of Aging and Adult Services doesn’t offer programs that enable family caregivers to be paid for providing care for a loved one.
The Arizona Long Term Care System (ALTCS), Arizona’s Health Care Cost Containment System (AHCCCS) (the state’s Medicaid program) is the only agency that offers such a program. ALTCS is “health insurance for individuals who are age 65 or older, or who have a disability, and who require nursing facility level of care.”
In order to be eligible for ALTCS, individuals must a) be in need of a nursing home level of care as determined by AHCCCS, b) be a citizen or qualified immigrant, c) have a Social Security Number (SSN) or apply for one, d) be an Arizona resident, e) apply for all cash benefits that you may be entitled to, such as Pensions or VA benefits, and f) live in an approved living arrangement. There are also certain financial eligibility requirements that must be met.
ALTCS offers ‘Member-Directed Options,’ which empower members who qualify with more control over how certain services are provided, such as attendant care, personal care, and homemaker services. One notable Member-Directed option is ‘Self Directed Attendant Care (SDAC).’ Under SDAC, the member’s legal guardian serves as the legal employer of the paid caregiver. In this role, they assume all employer-based responsibilities and are supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding, and paychecks for the caregiver.
Arizona’s Agency with Choice (AWC) program allows ALTCS members to share employer-based responsibilities for paid caregivers in relationship with a provider agency. Under this program, the provider agency maintains hiring and firing authority over caregivers and arranges for required minimum training for caregivers. Members may choose to recruit and select their own caregivers, dismiss caregivers, manage caregivers, including their duties and schedules, supervise caregivers, and identify special training needs and conduct caregiver training.
Arizona’s Veteran Directed Care Program is offered through the Southern Arizona VA Health Care System.
Summary: How to obtain financial assistance for caregivers in Arizona
The Arkansas Department of Human Services, Division of Aging, Adult & Behavioral Health Services, administers the ARChoices in Homecare Medicaid waiver program. Under the ARChoices program, eligible recipients can receive services that provide help with activities of daily living and instrumental activities of daily living such as bathing, dressing, meal preparation, and household chores. Benefits also include adult day care services, respite care, and home modifications. ARChoices represents a combination of two prior Medicaid waivers: Alternatives for Adults with Physical Disabilities (AAPD) and ElderChoices.
The Living Choices Assisted Living Waiver (ALW) is another Arkansas Medicaid waiver program. This program covers the cost of services received at an assisted living facility but does not cover the cost of room and board. Services may include medication monitoring, attendant care, and nursing evaluation, among others.
Arkansas also offers the Arkansas Independent Choices (IC) program. This is a member-directed option that allows the client to be in charge of “hiring, training, and supervising his or her in-home workers from Medicaid funds the client or his/her representative control.”
The Program of All Inclusive Care for the Older adult (PACE) is a joint Medicare-Medicaid program for people age 55 and older that also emphasizes consumer-directed care. You can find a PACE Plan near you by searching here.
Summary: How to obtain financial assistance for caregivers in Arkansas
California’s Department of Aging offers a Family Caregiver Services Program with funding from the U.S. Administration on Aging through the state’s 33 Area Agencies on Aging (AAAs). The AAAs coordinate local programs to assist family caregivers who are caring for an older adult. Services include information for caregivers, help with gaining access to services, training, counseling, respite care, and limited supplemental services aiming to complement the care provided by a family caregiver. These services are provided either directly by AAA staff or through partnerships with public or private agencies.
Additionally, California’s Medicaid program offers an In-Home Supportive Services (IHSS) program that pays for services provided to qualifying older adults to enable them to remain in their own homes, such as housekeeping, meal preparation, laundry, grocery shopping, and personal care services. The recipient is responsible for hiring, training, and supervising their individual provider. The IHSS program consists of four programs: IHSS-Residual (IHSS-R), Personal Care Services Program (PCSP), IHSS Plus Option (IPO), and Community First Choice Option (CFCO). Spouses may receive compensation for providing caregiving services under the program in some situations.
California’s Veteran Directed Care program is offered through the San Diego VA Health Center.
Summary: How to obtain financial assistance for caregivers in California
The Colorado State Unit on Aging is part of the Department of Human Services, overseeing a variety of programs and services for older adults including caregiver support, nutrition services, legal services, and aging and disability resources. The National Family Caregiver Support Program (NFCSP) provides information, respite care, counseling, assistance for caregivers who need help gaining access to available services, and limited supplemental services such as home modifications, assistive technologies, emergency response systems, and other equipment and supplies.
Colorado’s AAAs also provide supportive services including transportation, outreach, care coordination, in-home services, home health care, and other services aimed at helping older adults remain in their homes independently. Alongside the AAAs, Aging and Disability Resources for Colorado (ADRC) aids individuals in planning for their long-term care needs, provides personalized assistance to empower older adults and their caregivers to make informed decisions, and more.
In-Home Support Services (IHSS) are available in the Elderly, Blind, and Disabled (EBD) waiver program, which enables recipients to direct their own care with the added support of an agency. The program is an added benefit offered by Health First Colorado, Colorado’s Medicaid program, for qualified individuals. Other waiver programs IHSS offers include the Spinal Cord Injury Waiver (SCI) and the Children's Home and Community-Based Services Waiver (CHCBS).
The Consumer Directed Attendant Support Services (CDASS) program allows eligible recipients to hire, train, and manage their own personal care providers, including adult children and spouses. It’s not technically a waiver program, but it is available for older adults residing in Colorado who are receiving services under the EBD waiver program or are qualified to receive services under the EBD program and other Colorado waiver programs. Under the CDASS program, recipients can manage their own Health First Colorado funds and use the funds to pay their chosen personal care provider.
Summary: How to obtain financial assistance for caregivers in Colorado
The state of Connecticut has five Area Agencies on Aging (AAAs) under the Department of Aging and Disability Services. AAAs receive funding from the Federal Older Americans Act (Title III) and state funds which are then allocated to older adult service providers through a request for proposal (RFP) process. These services are offered through the National Family Caregiver Support Program (NFCSP). Connecticut’s Medicaid program is also called HUSKY Health.
Community First Choice is a program provided by the Department of Social Services as part of the Affordable Care Act. It enables participants to receive support and services in their home while giving them control over what services they obtain and the responsibility of managing those services. Participants are permitted to hire certain family members and friends.
Various Home and Community Based Services Medicaid waivers are available in the state of Connecticut. The Personal Care Assistance (PCA) Waiver Program allows individuals with a physical disability who require hands-on help with at least two activities of daily living (ADLs) to receive a personal care assistant. Examples of activities of daily living include bathing, dressing, eating, incontinence, transferring, and toileting. Under this program, a Personal Care Assistant is an employee of the participant, and the participant is responsible for hiring, training, supervising, and terminating them. Wages that the Personal Care Assistant receives are based on negotiation with the participant. Anyone who meets the program requirements may be a Personal Care Assistant; however, a conservator may not be a Personal Care Assistant. More information is available here.
The Connecticut Home Care Program for Elders (CHCPE) is a program offered by the Connecticut Department of Social Services (DSS). This program helps older adults over the age of 65 employ personal care attendants to help with activities of daily living (ADLs) and other needs such as housekeeping and meal preparation. Family members are not eligible to be paid as caregivers, except under rare circumstances, through this program. However, the Adult Family Living (AFL) program is offered as an option (under ‘Assisted Living Services’) in the CHCPE program. The AFL program, provided by Caregiver Homes of Connecticut, allows a family member or friend living in the same house as the participant (or willing to move into the same house) to be compensated for their services as a care provider. The program also includes caregiver coaching and support from a professional care team.
For veterans, the VDC program in Connecticut is offered through VA Connecticut Health Care System West Haven Campus.
Summary: How to obtain financial assistance for caregivers in Connecticut
The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) within the Delaware Aging and Disability Resource Center (DADRC) offers a number of services to provide help for caregivers, including adult day services, Alzheimer’s day treatment, respite care, and more. The Lifespan Respite program provides vouchers to eligible caregivers to pay for care for their care recipient to allow them to take a break from their caregiving responsibilities. Ten Caregiver Resource Centers are located throughout the state of Delaware to provide information, assistance, and support to family caregivers.
Delaware also offers both Personal Care and Personal Attendant Services Programs. Under the Personal Care program, various services are provided to enable a care recipient to live independently in the community, such as assistance with personal hygiene, light housekeeping, meal preparation, and similar activities. Under the Attendant Services Program, participants serve as employers of their own attendants, who provide services similar to those offered under the Personal Care program. Assistance may also be available for assistive devices, home modifications, and emergency response systems; more information on these services can be found here.
Delaware’s Diamond State Health Plan - Plus (DSHP-Plus) is Delaware Medicaid’s managed long-term care program , which includes a Long Term Care Community Services (LTCCS) Program that allows for certain consumer-directed services such as personal care assistance. Under this program, some family members can receive payments for providing caregiving services, including spouses and adult children.
Delaware does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in Delaware
Florida’s Department of Elder Affairs administers the National Family Caregiver Support Program, which provides information and assistance to caregivers of frail older adult relatives or other loved ones. Florida’s Home Care for the Older adult (HCE) program provides support for Florida residents age 60 and older who are living in family-type living arrangements as an alternative to nursing homes or other long-term care settings. In some cases, subsidies may be provided for services or supplies, although a basic subsidy (which averages $160 per month) is provided for all participants.
The Community Care for the Older adult (CCE) program “provides community-based services organized in a continuum of care to help functionally impaired older adults live in the least restrictive yet most cost-effective environment suitable to their needs.” Under this program, clients receive a range of services including adult day services, personal care, shopping assistance, respite care, and more. The Department of Elder Affairs also provides a number of other services for older adult Floridians.
Florida’s Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) includes a Participant Directed Option (PDO) that allows older adult Floridians or their designated representatives to hire, train, and manage care providers, and spouses and adult children may be hired and receive compensation for caregiving services under this program.
Summary: How to obtain financial assistance for caregivers in Florida
The Georgia Department of Human Services, Division of Aging Services is the entity that oversees and administers services provided for the aging population in Georgia. Georgia offers its two Medicaid-funded waiver services through the Older adult & Disabled Waiver Program. Structured Family Caregiving from Seniorlink is available through these waivers, and provides a tax-free stipend along with coaching and emotional support from a care team of registered nurses and social workers.
Non-Medicaid-funded services are offered through the Home and Community Based Services Program (HCBS). The Division of Aging Services contracts with Georgia’s 13 Area Agencies on Aging to administer the HCBS program, which consists of services such as home-delivered meals, older adult recreation, emergency response services, home modifications, personal care assistance, and more. HCBS also includes services for caregivers including education and support groups, adult day services, mobile day care, and kinship care programs.
Community Care Services Program (CCSP) is a Medicaid waiver program administered by the Department of Community Health (DCH) and includes services similar to those offered under the HCBS program, such as personal support services, adult day health, alternative living services, and others. Under this program, participants can choose their own caregivers. However, spouses cannot be hired and compensated as caregivers. Typically, family members are only hired as caregivers in rural areas or in unique conditions that make it difficult to find home care providers. Consequently, this program is not ideal for many seeking compensation to take care of a loved one. Several other waiver programs are offered under HCBS as well. You can find information on those programs in this downloadable pamphlet from the DCH, or the DCH’s website.
Georgia’s other Medicaid waiver program is called Service Options Using Resources, or SOURCE for short. This program supports “aged, blind and disabled Georgians who are Medicaid eligible” to pay for assisted living services they receive in a personal care home. However, the program does not include compensation for carers who provide caregiving services.
Georgia does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in Georgia
Under the Hawaii Department of Human Services, the State of Hawaii Med-QUEST Division (MQD) administers the state’s Medicaid program. The state does not offer any Medicaid waivers, as equivalent services are available through Med-QUEST, which centralizes administration of beneficiaries’ health and personal care services. Med-QUEST offers funding for home health care, adult day care, personal care, and respite care, although only personal care and respite care are eligible for consumer-directed care. Under the consumer-directed care model, some family members and friends can be compensated for providing caregiving services.
The State of Hawaii Department of Health, Executive Office of Aging administers the Family Caregiver Support Program, which provides caregiver support services to caregivers of eligible care recipients, with the goal of enabling recipients to remain in their home environment.
Four non-Medicaid-funded assistance programs are available. The Kupuna Caregivers Program, administered by the Older adult Affairs Division of the Hawaii Aging and Disability Resource Center, provides participants in the city and county of Honolulu with up to $210 per day to cover the adult day care services. Payments are made directly to the service provider. In order to qualify, a primary caregiver must be employed at least 30 hours per week.
The Kupuna Care Program is a state of Hawaii-funded program for older adults who do not qualify for other government programs, nor have the help of private assistance. The program offers community-based long-term care services and financial support to cover necessary services such as respite care, home-delivered meals, and personal care assistance. Service providers are paid directly, so caregivers cannot receive any compensation under this program. You can find out more information by contacting your local Executive Office on Aging (EOA).
Additionally, the Chore Services Program is a non-Medicaid-funded program managed by the Department of Human Services’ Adult Protective and Community Services Branch, providing assistance to older adults or Hawaii residents with disabilities with household tasks and assistance with activities of daily living (ADLs). Participants are able to choose their own care providers, including certain family members, friends, and neighbors, who may be compensated. Information is sparse on the Department’s website, so it is advisable to contact them directly for more information.
The Hawaii Community Living Program (CLP) is a self-directed program, allowing recipients to determine the mix of services and supports that best meet their needs and hire and manage their own service providers. The CLP program is only available in certain areas at the time of writing (Kauai, Maui, and Hawaii counties). Reach out to the ADRC for more information.
Hawaii offers a VDC through the VA Pacific Islands Health Care System.
Summary: How to obtain financial assistance for caregivers in Hawaii
Under Idaho's Medicaid for Older adult or Disabled Adults program, older adults as well as those with disabilities can access a variety of Home and Community Based Services (HCBS). These services may include adult day health services, personal care, case management, respite care, and more.
Idaho uniquely offers a self-directed program as an option under the Developmental Disabilities Waiver called My Voice, My Choice. This program gives participants greater choice and control over the Medicaid funds for the services and supports they receive to ensure they fit their needs. Participants can hire and manage their own workers, and even hire people they know.
Idaho offers a VDC program through the Boise, ID VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Idaho
Illinois has two managed care health plans relevant to those caring for an older adult or an individual with a disability.
Illinois HealthChoice is a managed care program that provides numerous long-term care services. It is mandatory for Medicare/Medicaid enrolled older adults or individuals with a disability who get waiver services to join. Medicare-Medicaid Alignment Initiative represents a “joint effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid Services.”
There is currently no non-Medicaid-funded or Medicare-funded participant-directed caregiving program in the state of Illinois. However, older adults may be eligible for the Community Care Program, a Medicaid-funded waiver program managed by the Illinois Department on Aging. These services were formerly offered under the My Choices Program, which was terminated in 2016.
Under the Community Care Program, a variety of supports, services, and technologies are provided to eligible participants who are at risk of being placed in a Medicaid-funded nursing home in order to enable them to remain in their own homes. This program is offered through the Home and Community Based Services Waiver.
Services offered under the Community Care Program include adult day services, homemaker services, medication management, transportation, and more. The former My Choices Program offered more flexibility in choosing a care provider, and the Community Care Program is a bit more restrictive. Care providers must offer services in the client’s geographic area of residence and must be part of the Department on Aging’s aging network.
Summary: How to obtain financial assistance for caregivers in Illinois
The Indiana Aged and Disabled Medicaid Waiver includes a consumer-directed option known as the Consumer-Directed Attendant Care Service. The Waiver is part of the Home and Community Based Services (HBCS) Waiver and is administered by the Family and Social Services Administration.
Under the Consumer-Directed Attendant Care Service, participants may hire and manage their own care providers, including friends and certain family members (but not spouses), at an hourly rate determined by the state of Indiana. As this is a Medicaid-funded program, participants must be eligible for Medicaid in order to take advantage of these services.
Indiana also has a Program of All-Inclusive Care for the Elderly (PACE®) program that provides services such as home health care and personal care, social services, adult day care, medical care, and other services for participants who are deemed eligible for nursing home care.
The Structured Family Caregiving / Indiana Caregiver Homes Program provides financial and support services for caregivers, including a tax-free daily stipend and coaching from a professional care team. The program is a benefit under Indiana's Aged and Disability Medicaid Waiver or Indiana Programs of All-Inclusive Care for the Older adult (PACE). Family members, including spouses in some cases, can become paid caregivers under this program. Benefits include up to 15 days of non-skilled respite care services per year and regular supportive visits from a case manager and registered nurse. The paid caregiver is responsible for providing the recipient’s care, including assistance with activities of daily living, housekeeping, transportation, and other personal care needs. Care recipients may receive other services simultaneously through the Aged and Disabled Waiver, such as adult day care and transportation services.
Indiana offers a VDC program through the VA Northern Indiana Health Care System (Fort Wayne Campus), VA Northern Indiana Health Care System (Marion Campus), and the Richard L. Roudebush VAMC, Indianapolis.
Summary: How to obtain financial assistance for caregivers in Indiana
Iowa’s Area Agencies on Aging (AAAs) provide a Case Management service that is “designed to promote and support the independent living of older Iowans by helping them coordinate the home and community-based services and supports they need.” (Iowa previously provided a non-Medicaid-funded program called Case Management Program for Frail Older adults (CMPFE), which has since disbanded).
The Iowa Medicaid HCBS Older adult Waiver is a Medicaid-funded program that offers a Consumer Choices Option (CCO), which gives participants the opportunity to be responsible for recruiting, hiring, training, managing, supervising, and firing workers and service providers. The program also offers a Consumer Directed Attendant Care (CDAC) option that allows participants to “have help in their own homes” via CDAC service providers. CDAC service providers may be a family member, friend, or neighbor, but not the participant's spouse. The participant and the CDAC service provider must come to an agreement about the wage the provider will be paid. More information about this option can be found in the CDAC Member Handbook.
If your loved one is a veteran, the Iowa Veteran-Directed Home and Community Based Services program may be a good option.
Summary: How to obtain financial assistance for caregivers in Iowa
Kansas offers non-Medicaid-funded services for older adults through the Kansas Senior Care Act (SCA), which is funded by the Kansas Department for Aging and Disability Services (KDADS) Commission on Aging and administered through the state's 11 local Area Agencies on Aging. Personal care and other forms of non-medical in-home supportive services are provided, although individual services offered are determined at the county level. Some services that are non-medical in nature may be consumer-directed, including personal care and homemaker services. Spouses are typically ineligible to be hired as caregivers, although some exceptions apply, and other family members may be hired and paid for caregiving services in some cases.
Older adults in Kansas who qualify for Medicaid may receive similar services through the Kansas Medicaid (KanCare) HCBS Frail Elderly Waiver. KanCare, the state’s Medicaid program, is a managed care program administered by the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE). Some services provided through this program may be consumer-directed, although in most cases, spouses and legal representatives cannot be hired to provide caregiving services. There are some exceptions in rare circumstances, however.
Kansas does not currently offer a Veteran Directed Care program.
Summary: How to obtain financial assistance for caregivers in Kansas
Non-Medicaid-funded options include the Kentucky Hart-Supported Living Program and the Kentucky Personal Care Attendant Program (PCAP). The Hart-Supported Living Program offers grants to eligible older adults to help them remain in their own homes or the home of a loved one. This program is entirely self-directed, meaning that recipients are responsible for determining the services and supports they need as well as the provider of those services. Spouses and other family members may be paid for caregiving services through the Hart-Supported Living Program, which is a state-funded program designed for Kentucky residents with disabilities, regardless of age.
PCAP is also a state-funded program for Kentucky residents who are 18 years of age or older and have a functional loss of two or more limbs. It’s a consumer-directed program, allowing beneficiaries to choose and manage their own personal care attendant to assist with day-to-day activities including housekeeping, personal care, and meal preparation.
Kentucky’s Home and Community Based Services (HCBS) Waiver is the Medicaid-funded option, which includes a Participant Directed Services (PDS) option allowing participants to select and hire their preferred care providers for non-medical, non-residential waiver services. Friends, neighbors, and certain family members may be hired under this program as employees. Those hired under this program are paid via a financial management agency. Kentucky’s Area Agencies on Aging (AAAs) and Community Mental Health Centers (CMHCs) act as support brokers for the program. It is possible to hire spouses or adult children to serve as caregivers under this program.
Summary: How to obtain financial assistance for caregivers in Kentucky
Louisiana does not offer a non-Medicaid-funded support program for caregivers. The Medicaid-funded option, the Louisiana Community Choices Waiver, is a program for older adult or disabled Louisiana residents. The Community Choices Waiver includes an option called the Monitored In-Home Caregiving (MIHC) program. MIHC, provided by Caregiver Homes of Louisiana, enables a family member or friend who lives in the same house as the care recipient to receive payment for providing caregiving services. Along with a tax-free daily stipend, the program includes support services and coaching from a professional care team. Care providers must be approved as a MIHC service provider and comply with rules set by the Department of Health.
Louisiana also offers a Veteran-Directed HCBS Waiver program, which is administered from the Shreveport, LA VA Medical Center (Overton Brooks).
Summary: How to obtain financial assistance for caregivers in Louisiana
The Consumer-Directed Home Based Care (CDHBC) Program, administered by Maine's Office of Aging and Disability Services (OADS), is a non-Medicaid-funded program offering consumer-directed personal assistance services. Services include nursing services and personal care assistance in addition to funding for assistive technology (i.e. personal emergency response services). These services are typically limited to essential services required to avoid placement in a residential care facility. For more information, contact the Office of Aging & Disability Services at 207-287-9200 or 1-800-262-2232.
Those eligible for MaineCare (Maine Medicaid) have two options: the MaineCare Consumer Directed Attendant Services (CDAS) Program and the MaineCare Older adult and Adults with Disabilities Waiver. The CDAS Program allows consumers to choose and hire their own care providers who may be paid for their caregiving services. This may include adult children who are not also the legal representative of the care recipient. Spouses and parents are currently not able to be hired to provide services; however, adult children of aging parents are eligible as long as they are not also their parent’s legal representative.
The MaineCare Older adult and Adults with Disabilities Waiver is administered by Maine’s Department of Health and Human Services’ Office of Aging and Disability Services. The program includes a Participant-Directed Option under which consumers can hire their preferred care provider, including adult children, other family members, and friends in some circumstances. Spouses are not eligible to receive compensation for providing caregiving services through the program. Participants are required to use a third-party financial management company to facilitate payroll and taxes.
The Augusta, Maine VA Medical Center offers a VDC waiver program for eligible veterans.
Summary: How to obtain financial assistance for caregivers in Maine
The Maryland Attendant Care Program (ACP) is a non-Medicaid-funded program offering assistance in the form of financial reimbursement for attendant care services provided to adult residents with severe physical disabilities age 64 and younger. Administered by the Maryland Department of Disabilities, this is a consumer-directed program in which qualified family members over age 18 are eligible to receive compensation for providing care. Spouses, however, are not eligible.
For Medicaid-eligible care recipients, there are several Medicaid-funded programs available, including the Maryland Community Pathways Waiver, the Maryland Community First Choice Program, and Maryland’s Community Personal Assistance Services. The Maryland Community Pathways Waiver is intended for Maryland residents with a physical and/or mental impairment. Funding is provided by Maryland’s Developmental Disabilities Administration (DDA) under the Department of Health. A self-directed option is available, although spouses may not be hired to provide caregiving services under this program.
Maryland Medicaid's Community First Choice (CFC) program is for older adult and disabled Maryland residents who would otherwise require institutional care. Services may be provided in the home setting, in a loved one’s home, or in a foster care home. The specific level of assistance provided is based on individual needs but typically includes assistance with activities of daily living and instrumental activities of daily living such as meal preparation. The program emphasizes self-directed care and with a few exceptions, family members may be hired to provide caregiving services.
Maryland’s Community Personal Assistance Services, formerly known as Medical Assistance Personal Care, is another Medicaid-funded program under which participants may opt to select their own care providers. Administered on a county-by-county basis, the Community Personal Assistance Services program requires caregivers to be approved, certified in first aid and CPR, and supervised by a nurse monitor.
Maryland also offers a VDC program, with services available through the Perry Point, MD VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Maryland
Massachusetts offers a Home Care Program (HCP) and an Enhanced Community Options Program (ECOP) for older adult residents through its In-Home Services, both of which provide services aimed at helping older adults remain in their own homes in the community. ECOP is designed for older adults with greater care needs. Benefits may include home delivered meals, adult day care services, medication assistance, chore services, and more. Services may be free of charge to recipients or they may require a co-pay, depending on the recipient’s income. Both programs allow for consumer self-direction of personal care, home care, and homemaker services, and family members can be paid to provide these services as long as the paid family member is not also the recipient’s legal guardian or surrogate. Both programs are managed by the Executive Office of Elder Affairs.
Massachusetts Medicaid, known as MassHealth, administers the Medicaid-funded option, the Personal Care Attendant (PCA) program, which provides services for older adult and disabled Massachusetts residents. Consumers are provided with funds for self-directed care, and friends, neighbors, and certain family members (including adult children and former spouses) may be hired and paid as care providers. Current spouses and legal guardians, however, are not eligible to receive compensation for providing services.
Adult Foster Care is another Medicaid-funded option available in Massachusetts, through which the state pays caregivers (including family members) for providing 24-hour care. The Enhanced Adult Foster Care program available through Caregiver Homes of Massachusetts provides caregivers with support services from a professional care team along with a daily tax-free stipend.
Summary: How to obtain financial assistance for caregivers in Massachusetts
The Michigan Choice Older adult and Disabled Waiver is one of two Medicaid-funded options in the state. The MI Choice Waiver Program (formerly known as the Home and Community Based Services for the Older adult and Disabled (HCBS/ED) program) gives participants the option of having the state manage their care or self-directing their care, including hiring and managing the caregivers of their choice. This option is known as Self Determination in Long-Term Care (LTC). Family members including adult children may be hired, although spouses and legal guardians are ineligible to receive payment for providing caregiving services in most cases.
The Home Help program is another Medicaid-funded option, managed by the Michigan Department of Health and Human Services (MDHHS). Like the MI Choice program, Home Help allows for a self-directed caregiving option. Parents caring for a minor child and spouses are not eligible to be paid for their services, although other family members, friends, and neighbors may be hired as caregivers. The Michigan MI Health Link Program is another program available to dual Medicare/Medicaid eligible individuals. Participants may choose their own caregivers, who are referred to as Home Help Providers. Home Help Providers can receive compensation for their care services, but the program is only available in 25 counties throughout the state. MI Health Link includes an Expanded Community Living Supports (ECLS) Waiver program that offers services to enable older adults to delay nursing home placement, but the person in question must meet a “nursing home level of care” to qualify.
Summary: How to obtain financial assistance for caregivers in Michigan
The Minnesota Alternative Care (AC) Program is the non-Medicaid-funded program available to eligible Minnesota residents. The program serves Minnesota residents age 65 and older who “require the level of care provided in a nursing home, choose to live in the community and are not yet financially eligible for Medical Assistance.”
Some of the services received through the AC program may be self-directed under a service option known as Consumer Directed Community Supports (CDCS). Family members, including adult children, may be hired to provide caregiving services. While spouses may also be hired under this program, the services provided by a spouse are limited to personal assistance services. Any family member participating in the program must be registered with the state as a care provider, and participants are required to use a third-party financial management company as an intermediary to facilitate payments. The AC program can also assist with home modifications such as wheelchair ramps.
The program also offers a few services not covered by the Older adult Waiver (discussed further below), including conversion case management for transition from a nursing home, discretionary services, nutrition services, and a relative hardship waiver.
The Minnesota Consumer Support Grant (CSG) Program is another state-funded program which provides a monthly cash grant to eligible recipients in place of in-home services. In 2018, participants received an average monthly grant of $938. This program is designed to be an alternative to services covered by Medicaid such as a home health aide, personal care assistance, and/or private duty nursing. The funds may be used for care support as well as services such as home modifications, transportation assistance, and meal delivery services. Based on the self-directed services model for Medicaid service delivery, this flexible grant program allows recipients to choose a mix of services and supports that best meet their needs. Under the CSG program, recipients can hire family members as paid caregivers, including spouses, adult children, and other relatives, in addition to employees of traditional home health care agencies. The CSG program is not available statewide at the time of this writing. More information about this grant can be found in this fact sheet.
The Minnesota Essential Community Supports (ECS) Program is another state-funded option. It’s designed for older adults who do not require a nursing home level of care but do require assistance to continue living independently in their homes. There are financial eligibility requirements, although eligible participants are financially outside the Minnesota Medicaid limits. Administered by the Minnesota Department of Human Services, the ECS program offers up to $424 per month towards essential services such as homemaker services, adult day care services, and home meal delivery, as of 2021. Eligibility for the ECS program must be reevaluated each year.
Those who are Medicaid eligible have several program options administered by the Minnesota Department of Human Services. In Minnesota, the state’s Medicaid program is referred to as Medical Assistance (MA). Examples of relevant programs include:
The Medicaid Elderly Waiver (EW) Program is a waiver program that funds both home and community-based services for people age 65 and older who wish to live in the community but require the level of care provided in a nursing home. It includes a self-directed option, under the Consumer Directed Community Supports (CDCS) service option, that allows participants the flexibility to choose their own care providers. The Minnesota Personal Care Assistance Program (PCA) is also a self-directed program, allowing family members and adult children to receive compensation for caregiving services.
Spouses and parents of minor children may also be able to receive compensation for caregiving services, provided that they meet eligibility criteria. The Community Access for Disability Inclusion (CADI) Waiver is a similar program that offers assistance for people with disabilities and includes Consumer Directed Community Supports (CDCS) as a service option. More information can be found in this fact sheet.
Minnesota does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in Minnesota
The Mississippi Division of Medicaid offers three Medicaid waiver programs that focus on supporting the needs of older adult and/or disabled individuals. The Office of Long Term Care is responsible for ensuring that providers of these home and community based waiver services meet enrollment requirements.
The Mississippi Independent Living Waiver (IL) is available to anyone who 16 years of age or older who has neurological and/or orthopedic impairments. There are several diagnoses that would qualify an older adult Mississippi resident for this program, including Alzheimer’s disease, Parkinson’s disease, Lewy Body Dementia, osteoarthritis or arthritis, and joint fractures.
The Mississippi Independent Living Waiver allows participant direction through the Personal Care Attendant (PCA) service option. Participants may select their own PCA, as long as the PCA meets basic competencies, including educational and functional requirements. More information about this waiver can be found in the Independent Living Waiver brochure.
Another waiver that provides participation direction via the Personal Care Attendant (PCA) service option is the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. More information about this waiver can be found in the TBI/SCI Waiver brochure.
Mississippi’s other two Medicaid waiver options relevant to older adult and/or disabled individuals include the Mississippi Older adult and Disabled (E&D) Medicaid Waiver and the Mississippi Assisted Living Waiver. Unfortunately, neither of these waivers allow for consumer directed care.
Summary: How to obtain financial assistance for caregivers in Mississippi
Missouri does not offer a state-funded program to support older adults and people with disabilities outside of the Medicaid-funded programs. These programs from Missouri Medicaid (known as MO HealthNet) include: the Personal Care Assistance services program (See “Personal Care-State Plan” under “available Home and Community-Based Services”), the MO HealthNet Independent Living Waiver, and the Missouri Medicaid Care Options (MCO) program.
Through the Personal Care Assistance services program, services may be consumer-directed. Family members other than spouses and legal guardians may be hired and compensated for providing care services. Care providers must register as CDS providers with the Missouri Medicaid Audit and Compliance Unit (part of the Department of Social Services).
Personal care assistance is also self-directed through the Independent Living Waiver program. Spouses and legal guardians are ineligible to receive compensation for providing care, although other family members may be hired. Payments and other financial matters are handled through Financial Management Services. Other Medicaid waiver programs include the Missouri Medicaid Aged and Disabled Waiver and the Nursing Home Coverage program. Neither of these waiver programs offer consumer directed care options.
The Missouri Medicaid Care Options program offers assistance with activities of daily living such as bathing and dressing, companion care services to relieve family caregivers, assistance with tasks such as housekeeping, laundry, and meal preparation, nursing care, and adult day care services. This program does not allow participant direction of services.
Summary: How to obtain financial assistance for caregivers in Missouri
Montana doesn’t offer a non-Medicaid-funded option for older adult care services, although it does offer the Montana Big Sky Rx Program, a no-cost program funded by the state that can help with the cost of Medicare-approved prescription drug insurance premiums.
For those who are Medicaid-eligible, there are two programs: the Montana Medicaid Home and Community Based Services Waiver (Big Sky Waiver) and Montana Community First Choice / Personal Assistance Programs (CFC / PAS). The Big Sky Waiver is administered by Montana’s Older adult and Long Term Care Division (part of the Department of Public Health & Human Services). It’s also known as the Older adult/Physically Disabled Waiver. Consumer-directed care is an option under this program, and certain family members (provided they are qualified to provide care) may be hired as care providers – subject to approval by the state of Montana. Spouses are typically excluded, but may be hired under certain circumstances. Adult children may be hired as caregivers, with services limited to personal care or homemaker services.
The CFC/PAS program also includes a self-directed option. Spouses, parents, and legal guardians are ineligible to be hired, while adult children of aging parents and ex-spouses are eligible to receive compensation for providing services. The recipient is responsible for approving timesheets, and timesheets are reviewed and payments issued to caregivers by the state.
Montana’s VDC program is offered through the Fort Harrison, MT VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Montana
Nebraska offers four state-funded non-Medicaid programs for older adult and disabled residents, including the Disabled Persons and Family Support (DPFS) Program, the Social Services for Aged and Disabled Adults (SSAD) Program, the Aid to the Aged, Blind, or Disabled (AABD) Program, and the Nebraska Lifespan Respite Subsidy Program.
The Nebraska Disabled Persons and Family Support (DPFS) Program serves the needs of older adults and disabled Nebraska residents who are not Medicaid-eligible. The program is a self-directed model, allowing participants to select their own care providers, including relatives. A legal contract between the care provider and recipient is required, and providers must meet state regulations. The maximum monthly spend amount is $300. Under this program, the state may also provide funding for certain home modifications that support the individual’s independence, such as wheelchair ramps and handicapped-accessible bathroom modifications. The program is managed by the Nebraska Department of Health and Human Services, Office of Medicaid and Long-Term Care.
The SSAD program provides services ranging from housekeeping and meal delivery to food preparation, adult day care services, and limited personal care services. There is no consumer-directed option under the SSAD program.
The AABD program offers a cash stipend and medical coverage to eligible Nebraska residents who are blind or disabled based on Social Security rules but are not eligible to receive Supplemental Security Income (SSI) due to a disability that is expected to last less than 12 months.
The Lifespan Respite Program offers a monthly stipend of $125 to eligible recipients to be applied towards respite care services. While respite care services may be provided in the home or in a location such as an adult day care center or older adult center, respite care providers must be chosen from an approved provider list.
There are two additional programs available to Medicaid-eligible Nebraska residents: the Nebraska Aged & Disabled Medicaid Waiver and the Nebraska Medicaid Personal Assistance Services (PAS) program. The PAS program includes a self-directed option, allowing recipients to choose their care provider as well as the types of services provided. Family members, other than spouses and those who are legally responsible for the care recipient, may be hired to provide services. The PAS program is administered by the Special Services for Children and Adults Division, Office of Aging and Disability Services within the Nebraska Department of Health and Human Services.
Nebraska does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in Nebraska
Older adults in Nevada who are not eligible for Medicaid may qualify for Nevada's Community Options Program for the Elderly (COPE). Administered by Nevada's Aging and Disability Services Division and funded by the state, COPE provides non-medical services such as adult day care, personal care, and homemaker services, and some services are self-directed. Care providers, which may include certain family members, must be approved by the state, and the hourly rate is regulated.
Those eligible for Medicaid have three programs available, including the Nevada Home and Community Based Waiver for the Frail Elderly (HCBW-FE), the Nevada Waiver For Persons with Physical Disabilities (HCBW-PD), and Nevada Medicaid Personal Care Services. Self-direction is possible through all three programs, but only to a very limited extent in the HCBW-FE program. Under HCBW-FE, participants may choose from a pre-approved list of care providers. Under the HCBW-PD program, participant direction is permitted for some services such as attendant care, respite care, and homemaker services, and friends and family members other than spouses or legal guardians may be hired to provide care.
Under Personal Care Services, however, it is possible to hire any qualified caregiver of the participant’s choosing. Financial aspects such as payments are handled by an Intermediary Service Organization (ISO). Siblings and adult children may be hired as caregivers, provided they are not the legal representative of the care recipient. Spouses and anyone legally responsible for the recipient are not eligible to receive compensation for providing services.
Summary: How to obtain financial assistance for caregivers in Nevada
While New Hampshire doesn’t have a non-Medicaid-funded program, those who are Medicaid-eligible may qualify for New Hampshire’s Choices for Independence Waiver. Formerly known as the Older adult and Chronically Ill Waiver, the Choices for Independence Waiver provides services for those who are clinically eligible for nursing home placement but prefer to remain in their own homes in the community.
The Choices for Independence Waiver provides support and services as long as the costs of those services don’t exceed a certain percentage as similar services provided in a nursing home setting would cost. There is some level of consumer direction offered under this program, which applies mostly to non-skilled and custodial care services. Family members, however, are not able to be hired to provide services under this program.
New Hampshire also offers a Social Services Block Grant (SSBG), funded under Title XX of the Social Security Act, which provides home and community-based services for older adults age 60 and older as well as residents between the ages of 18 and 60 who have a chronic illness or disability. It does not appear as though the SSBG includes a self-directed option, but services include adult in-home care, adult medical day services, home delivered meals, homemaker services, and more.
Another Medicaid-funded option is the Personal Care Attendant Services (PCAS) program. It’s primarily designed for those who are wheelchair-bound most of the time and intended to enable disabled residents to remain independent and postpone nursing home placement. Recipients may self-direct their care by interviewing, selecting, training, managing, supervising, and dismissing their Personal Care Attendant (PCA). PCAs must be a “qualified nonfamily member,” so relatives may not be hired to provide caregiving services under the PCAS program.
The Manchester, NH VA Medical Center offers the state’s VDC program.
Summary: How to obtain financial assistance for caregivers in New Hampshire
There are a variety of options for getting assistance with personal care services in New Jersey. Non-Medicaid-funded programs include New Jersey Assistance for Community Caregiving (JACC), New Jersey Family Leave Insurance, and New Jersey Statewide Respite Care. Under JACC, family members and friends who meet the program’s requirements may be hired to provide services such as attendant care, household chores, or transportation assistance. Spouses and adult children are also eligible to receive compensation for providing these services in New Jersey, and minor home modifications that support independence, such as wheelchair ramps, may also be offered under this program.
New Jersey’s Family Leave Insurance (FLI) program provides up to six weeks of paid time off for caring for a family member with a serious illness. It can be used in conjunction with the federal Family Medical Leave Act (FMLA), which requires employers to hold an employee’s job and continue to provide healthcare benefits during this time off. Administered by the New Jersey Department of Labor and Workforce Development, the FLI program is funded by employee wage deductions.
The New Jersey Statewide Respite Care Program (SRCP) offers respite services for unpaid caregivers with the aim of avoiding unnecessary nursing home placement. The SRCP program is managed locally by Aging and Disability Resource Centers and is administered by the New Jersey Department of Health and Older adult Services. Caregivers utilizing this program are able to select the agency or individual of their choosing to provide respite care services.
The New Jersey Medicaid Personal Preference Program (PPP) is the state’s Medicaid program, which distributes a budget to recipients that would otherwise be spent on the provision of services. Participants may choose their own care providers, including friends and family members who are 18 years of age or older.
New Jersey’s VDC program is offered through the Lyons, NJ VA Medical Center.
Summary: How to obtain financial assistance for caregivers in New Jersey
There is no state-funded, non-Medicaid program offering support for family caregivers in New Mexico, although older adults and their caregivers may receive some services offered through local Area Agencies on Aging via the Older Americans Act, such as adult day care services, in-home respite care services, transportation assistance, and homemaker services.
Those who are Medicaid-eligible can receive services through NM Centennial Care, the state’s Medicaid program under the Community Benefit program. This program focuses on enabling older adults to remain living in their own homes in the community. Services include adult day care, respite care, and personal care services such as assistance with ADLs. It includes a Self-Directed Community Benefit (SDCB) option, allowing participants to select their preferred care providers. Family members and friends may be hired for non-skilled services (including personal care services), although the managed care organization (MCO) makes determinations on whether the selected provider is qualified. New Mexico’s MCOs include Molina Health Care of New Mexico, Blue Cross Blue Shield of New Mexico, Presbyterian Healthcare Services, and United Healthcare.
New Mexico offers a VDC program through the New Mexico VA Health Care System.
Summary: How to obtain financial assistance for caregivers in New Mexico
Older adults who are not eligible for Medicaid in New York may qualify for the New York Expanded In-home Services for the Elderly (EISEP) program. The program allows for Consumer-Directed In-Home Services (CDS), allowing participants to hire their own caregivers, including family members, as long as the care provider meets the state’s requirements. This program varies from county to county, so it’s important to reach out to your local Office for the Aging (also referred to as a local Area Agency on Aging) to get more information on service availability and requirements. EISEP is designed for adults age 60 and older who live at home and require assistance with activities of daily living.
Those who are eligible for Medicaid may be able to utilize New York's Consumer-Directed Personal Assistance Program (CDPAP), offered through NY Managed Medicaid Long Term Care and the Community First Choice programs. Participants work with a county caseworker and a medical professional to determine their required level of care and create a personalized care plan, which includes the number of hours of assistance they require each week. Participants are then able to hire their own caregivers to provide services up to the specified number of hours each week. Spouses and legal guardians are ineligible to be paid caregivers; however, ex-spouses, adult children, and siblings may receive compensation for providing services. A third-party financial management agency oversees payment processing and timesheet approvals.
New York also has a Paid Family Leave Policy which went into effect on January 1, 2018. The Paid Family Leave for Family Care provision allows workers to take up to 12 weeks of paid family leave each year to care for an older adult relative who has a serious illness. The 12 weeks can be taken all at one time or in smaller portions throughout the year.
A number of other options for assistance are available in the state of New York. For example, the Elderly Pharmaceutical Insurance Coverage (EPIC) program provides financial assistance for prescription medications and Medicare Part D drug plan premiums, and the Residential Emergency Services to Offer (Home) Repairs to the Elderly (RESTORE) offers financial assistance for low-income older adults in need of emergency home repairs. Local New York Area Agencies on Aging can direct older adults and their caregivers to the available programs and services in their area for which they might qualify and, in some cases, assist with the application process.
Summary: How to obtain financial assistance for caregivers in New York
North Carolina In-Home Aide Services is a program available in North Carolina for residents who are not eligible for Medicaid. This program was previously known as Chore, Homemaker, Homemaker-Home Health Aide, Respite, and Personal Care Services. Services are provided to older adults and caregivers to enable participants to avoid nursing home placement. Personal care and chore services are among the broad range of services offered, and these services may be provided by relatives, including adult children and spouses, if the participant chooses. Care providers must be at least 18 years of age, and they must have given up other employment in order to provide care for their loved one. A health care professional and a case manager will screen applicants to determine eligibility and define the services to be provided.
The North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA) is a Medicaid-funded program that offers similar services. The program also covers minor home modifications to support independence in addition to personal care and other services. This program offers consumer directed services, which allows the participant to freely choose who will provide care to meet medical and functional needs. They can hire an employee (personal assistant) of their choice and independently set their pay rate. Coordinated Caregiving from Seniorlink is another option for live-in family caregivers under this waiver. In addition to a tax-free stipend, the service includes ongoing support from a professional care coach.
The State/County Special Assistance In-Home Program for Adults (SA/IH) program provides a monthly cash stipend to help older adults remain independent who would otherwise require adult care home placement. The funds provided can be used for rent, food, daily necessities, and clothing. The amount of the stipend will vary from participant to participant. This is not a consumer-directed program. A case manager from the county’s Department of Social Services conducts a comprehensive assessment to identify the factors that would impact the recipient’s ability to live independently, determine if the recipient could remain safely independently in their home, and what services would be needed. Case managers work with recipients to determine the amount of the payment and how the funds will be used. Other programs are offered by the state of North Carolina, such as Project C.A.R.E. (Caregiver Alternatives to Running on Empty), which provides respite care services for unpaid caregivers for those with Alzheimer’s or dementia. Dementia information and training for caregivers is also provided.
Summary: How to obtain financial assistance for caregivers in North Carolina
North Dakota Service Payments for the Elderly and Disabled (SPED and Ex-SPED) Programs are available to state residents who do not qualify for Medicaid benefits. This program includes two levels of services with different eligibility requirements, with SPED serving those who are more functionally impaired. Both programs offer services to enable older adults and people with disabilities to remain in their own homes, including adult foster care. Both programs allow for self-direction via the Family Home Care service option. Family Home Care “reimburses a family caregiver who meets the relationship requirements defined by state law and resides in a client's home 24-hours per day.”
Medicaid-eligible North Dakota residents are served through the North Dakota Medicaid State Plan Personal Care Services (MSP-PC) program. Services may be provided in several settings, including their own home, the home of a loved one, or in adult foster care or assisted living communities. Services are not provided to residents in nursing homes, hospitals, or intermediate care communities.
This program includes three service levels (Level A, Level B, and Level C) with different eligibility criteria. The number of hours of care available varies based on the participant’s service level. It is consumer-directed, and care providers, who are called Qualified Service Providers, may include a family member, neighbor, or friend who has met the standards set by the North Dakota Department of Human Services (DHS). Payment is at a Medicaid-approved hourly rate.
North Dakota does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in North Dakota
Ohioans who are not eligible for Medicaid may qualify for services through the Ohio Elder Services Program (ESP). The program allows for consumer direction of some services, and family members may be hired in some cases to provide caregiving services if they work for the provider organization and are qualified to provide the necessary services. ESP is only available in Butler, Clinton, Hamilton, and Warren counties presently. The program is funded by a county tax levy and administered by the Ohio Council on Aging (COA).
Ohio’s Medicaid PASSPORT (Pre-Admission Screening System Providing Options & Resources Today) Waiver is a Medicaid-funded program offering similar services, although the cost of in-home services provided must not exceed 60% of the cost of the same care if it were provided in a nursing home setting. PASSPORT Consumer-Directed Service Options allow participants to hire their own direct service workers. They can be hired from a Choices-Home Care Attendant Service (C-HCAS), in which the participant trains the worker and also negotiates their hourly pay rate with care manager input. Or, they can be hired from a Personal Care Service if the worker is certified as an STNA, HHA, or has completed an annual a 60-hour ODA-approved training program and 12 hours of continuing education. If the worker is hired via a Personal Care Service, they will be paid a state-contracted hourly pay rate.
Note that dual Medicare/Medicaid-eligible residents are unable to receive services through PASSPORT; however, those who live in a county with the Integrated Care Delivery System (ICDS) can receive the same services through MyCare Ohio, which is Ohio’s mandatory managed care program. This program is called the MyCare Ohio Plan (MCOP), or Managed Medicaid Program for Elder Care.
Medicaid-eligible Ohioans with developmental disabilities may also qualify for a HCBS waiver. The Individual Options Waiver is the most comprehensive of the three waivers Ohio offers.
For caregivers who are legal guardians of adults with intellectual or developmental disabilities, Shared Living (formerly Adult Foster Care or Adult Family Living) from Caregiver Homes of Ohio may be an option. The program provides a tax-free stipend for caregiving expenses along with support and coaching from a professional care team.
Other services and support programs are available through the Ohio Department of Aging. An example of one service that may prove useful is the Golden Buckeye program. Under this program, businesses provide participants with special savings, such as discounts, waived fees, free products or services, and more.
Summary: How to obtain financial assistance for caregivers in Ohio
Oklahoma does not offer an in-home support program for family caregivers and older adults who are not Medicaid-eligible. Those eligible for Medicaid, however, can take advantage of the Oklahoma State Plan Personal Care Program. Care is self-directed, and participants may opt to hire friends, neighbors, and some non-immediate family members to provide caregiving services. Spouses and legal guardians are not eligible to be compensated for providing services.
Another option is the Oklahoma’s ADvantage Program Waiver, in which participants may opt to self-direct their care, choosing their own care providers which may include family members. In some cases, spouses and legal guardians may be hired to provide services. This is known as the CD-PASS option. ADvantage is managed by the Aging Services Division of the Oklahoma Department of Human Services and replaces the former My Life, My Choice and Sooner Seniors programs.
Oklahoma offers a VDC program through the Jack C. Montgomery VA Medical Center in Muskogee, OK.
Summary: How to obtain financial assistance for caregivers in Oklahoma
Oregon Project Independence (OPI) is the only state-funded non-Medicaid program that offers older adults long-term care. This program provides in-home supervision and assistance with activities of daily living such as bathing and dressing. The OPI program is consumer-directed, allowing recipients to choose their own care providers, including certain family members but excluding spouses. However, family members must be qualified to provide caregiving services and have a provider number. The program is administered through Oregon’s local Area Agencies on Aging.
There are several options serving Medicaid-eligible residents: the Oregon Client-Employed Provider Program, Oregon Independent Choices Program, Oregon Spousal Pay Program, and Oregon K Plan.
The Client-Employed Provider Program (CEP) is a self-directed program allowing participants to hire friends, neighbors, and family members of their choosing to provide services. This includes adult children and spouses. However, an individual who is also serving as the recipient’s Durable Power of Attorney or official representative may not be hired to provide caregiving services. Recipients do not receive cash to compensate their caregivers; they authorize the state to make payments on their behalf under this program.
The Spousal Pay Program, administered by the Oregon Department of Human Services, is similar, but focuses on the spouse as primary caregiver. Through this program, the spouse becomes an official Homecare Worker and joins the Homecare Workers Union. The spouse receives a salary, is taxed on earnings, pays union fees, and is eligible for unemployment insurance.
The Oregon Independent Choices Program (ICP) is also similar in nature to the CEP program. Also a self-directed program, individuals receiving services may hire friends, neighbors, and family members – including adult children and spouses – to provide caregiving services. Under this program, participants receive cash benefits from the state and handle paying their caregivers without the state or another agency serving as an intermediary. Legal guardians are not able to be hired as care providers, however. Participants are also able to negotiate hourly rates with care providers.
The Oregon K Plan – Community First Choice Medicaid Program also offers in-home support services to Medicaid-eligible recipients as an alternative to long-term home and community based Medicaid waivers, which have limited enrollment. The CFC program, by contrast, is an entitlement program and available to any eligible resident who requires services.
Summary: How to obtain financial assistance for caregivers in Oregon
Pennsylvania's OPTIONS Program is a non-Medicaid-funded program that provides assistance to older adults and family members who are caring for aging loved ones at home. The OPTIONS program funds some assistance services through block grants (Aging Block Grants or ABG) provided through local Area Agencies on Aging. Recipients cannot also be receiving services through the Pennsylvania Department of Aging Medicaid Waiver, but those who are not eligible for Medicaid may be able to receive some free or low-priced services through other funding avenues. Some services provided through the OPTIONS program may be self-directed, allowing participants to choose their own service providers, although family members are typically not eligible to be paid for providing services through this program.
Medicaid-funded programs in Pennsylvania include the Community HealthChoices Program (CHC) and Pennsylvania Services My Way. The CHC program began in January 2018 and rolled out in phases. Those who were previously enrolled in the Pennsylvania Aging Waiver (PDA) were automatically enrolled in CHC as it became available in their area. The Community HealthChoices Program is a Medicaid managed care program serving adults 21 years of age and older who are dual-eligible (eligible for both Medicare and Medicaid), or individuals who require skilled nursing care (and would otherwise qualify for nursing home placement).
CHC provides older adults and physically disabled individuals with medical benefits, as well as long-term support services to promote independent living and prevent unnecessary nursing home placements. Benefits include personal care services, such as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADL), like bathing, meal preparation, and medication management. Enrollment in this program is mandatory for those who meet the eligibility requirements. Seniorlink offers a support program, known as CarePlus, for family caregivers enrolled in the CHC program.
The Pennsylvania Services My Way (SMW) Program allows recipients to choose their own care providers, and while it’s not technically a distinct Medicaid waiver, it is a program that provides another way for waiver recipients to receive services. Through the SMW program, certain family members may receive compensation for providing services. Participants work with a state case manager to determine care needs and a budget, resulting in an Individual Services Plan – from there, participants can choose providers for obtaining the required goods and services. Adult children, neighbors, and other family members may be hired, although spouses and legal guardians are ineligible for compensation for providing services. An Employer Agent, a fiscal intermediary, handles payments to care providers.
The Pennsylvania Domiciliary Care program, also known as Dom Care, is a state-funded program that offers an alternative to assisted living by allowing care recipients to receive care in the home of a caregiver. Providers are screened by the PA Area Agencies on Aging and may care for up to three recipients in their homes, although most providers care for a single resident or married couple. Care recipients cannot move into the home of a relative, but they may move into the home of a friend provided they’re qualified to provide the required services and pass the background and safety screenings.
Summary: How to obtain financial assistance for caregivers in Pennsylvania
Rhode Island Paid Family Leave, or the Temporary Caregiver Insurance (TCI) Program, is one option for family caregivers of loved ones who are not eligible for Medicaid. This program provides up to four weeks of paid benefits in a 12-month period to care for a loved one (such as an aging parent) who has a serious illness. Caregivers are paid up to a maximum of $852 per week as of 2019 under this program, and it requires employers to offer a comparable position to the employee following their leave. It is administered by the Rhode Island Department of Labor and Training. More information can be found here.
The Rhode Island Global Consumer Choice Compact Waiver is a Medicaid-funded option administered by the RI Department of Human Services (DHS), with many of the programs for the older adult administered by the RI Executive Office of Health and Human Services. The program is self-directed, enabling recipients to select their own care providers, which includes adult children and other relatives.
This global waiver now encompasses several former programs, including the Personal Choice Program, Home and Community Care Medicaid Waiver, and the Shared Living Program, and now aims to provide a comprehensive range of services under a single program. Additionally, the program offers some services to older adults who are not fully Medicaid-eligible.
Live-in family caregivers of Medicaid-eligible individuals should be aware of the RIte @ Home from Caregiver Homes of Rhode Island, which falls under the Shared Living program. RIte @ Home provides a tax-free stipend and coaching support from a professional local care team of nurses and social workers.
Rhode Island does not currently offer a VDC program. However, various support services and programs are offered through the Rhode Island Office of Veterans Services, including home-based primary care, homemaker services, home health aide services, and respite care. Caregiver-specific services include a local Caregiver Support Coordinator, Caregiver Support Line (1-855-260-3274), and support groups. Eligible caregivers of post-9/11 veterans may be able to receive a stipend, health Insurance, counseling, and training.
The Veterans Affairs Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers "enhanced clinical support for caregivers of eligible veterans who are seriously injured." Benefits for eligible caregivers include a financial stipend, travel and per diem compensation (when traveling for a veteran's VA healthcare appointment) as well as respite care, mental health counseling, and more. There are seven eligibility requirements that must be met in order to qualify. More information can be found on this fact sheet.
Summary: How to obtain financial assistance for caregivers in Rhode Island
South Carolina’s Medicaid program is also known as Healthy Connections, although it is sometimes called South Carolina Community Long Term Care or CLTC. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS).
Healthy Connections offers two Medicaid-funded programs to support older adults in the community and family caregivers: the South Carolina Community Supports Waiver and South Carolina Community Choices. The South Carolina Community Choices Medicaid Waiver is also called the Older adult and Disabled Waiver. Under this program, the cost of care provided in the community setting cannot exceed a certain percentage of the cost of comparable services provided in the nursing home setting.
Participant direction is possible for some services, including personal assistance, respite care, and companion services, allowing recipients to select their own care providers. Certain family members are eligible to receive compensation for services, including adult children of aging parents. Care providers are required to pass the state’s background checks and receive approval from the state. Home modifications and some medical equipment and supplies, as well as adult day care, may also be covered through this program.
The South Carolina Community Supports Waiver is intended for individuals with intellectual disabilities or a related disability (ID/RD) of any age who are eligible for Medicaid. It’s a self-directed program, and family members may be hired to provide care services – other than spouses or legal guardians.
Under the Older Americans Act, older adults can receive non-Medicaid services such as respite care, home-delivered meals, and home living support. The services offered are region-dependent, so check with your local Area Agency on Aging for more information.
Summary: How to obtain financial assistance for caregivers in South Carolina
South Dakota offers four Medicaid waivers for residents: the CHOICES Waiver, Family Support 360, Assistive Daily Living Services (ADLS), and the Home and Community Based Services Waiver for South Dakotans. The CHOICES Waiver is for those with intellectual and developmental disabilities, as is Family Support 360. The Assistive Daily Living Services Program offers services for residents with quadriplegia.
The Home & Community-Based Options and Person Centered Excellence (HOPE) Waiver serves older adults (age 65 and older), or those age 18 and older with disabilities. It does not appear that the HOPE Waiver includes self-directed service options, however.
For those who are not eligible for the state Medicaid program and the Home and Community Based Services waiver programs, South Dakota offers a state-funded option called the South Dakota Division of Adult Services and Aging (ASA) In-Home Services program. Funded by the Division of Long Term Services and Supports, the program offers services to allow eligible recipients to remain in their homes rather than require nursing home care, such as assistance with daily activities such as bathing and grooming, grocery shopping, meal preparation, and other homemaker services, and more. This program does not appear to allow for consumer self-direction of services.
Structured Family Caregiving(SFC) is also available for Medicaid-eligible families. The SFC model is a caregiver support program designed for family and friends who are caring for a loved one at home. Under the SFC program, family caregivers receive financial and professional support to make in-home caregiving possible.
Caregivers in South Dakota can benefit from respite care and other supportive services offered through the Caregiver Support Program.
South Dakota offers a VDC program through the Sioux Falls VA Medical Center.
Summary: How to obtain financial assistance for caregivers in South Dakota
Tennessee residents who are eligible for Medicaid may qualify for the TennCare CHOICES in Long-Term Care Program. This is the only Medicaid waiver for older adults. Services are provided for older adults and/or residents with disabilities who would otherwise require nursing home placement. Services are offered in a multitude of settings such as the recipient’s home, a loved one’s or caregiver’s home, an adult foster care home, or an assisted living community. In addition to personal care services, the program offers assistive technology, personal emergency response services, and minor home modifications to support independent living.
Some services in the CHOICES program are self-directed. Adult children of aging parents may be hired as caregivers through the CHOICES program, as well as other friends, neighbors, and certain family members, excluding spouses and legal guardians or anyone who has a Power of Attorney for the care recipient.
The state-funded (non-Medicaid) program providing in-home services and supports to older adults is the Tennessee OPTIONS for Community Living program. Services include personal assistance, meals, and homemaker services. The program allows for self-direction of care, allowing recipients to choose their own care providers, including family members. However, spouses may not be paid to provide caregiving services under the OPTIONS program.
How to obtain financial assistance for caregivers in Tennessee:
Several programs exist to serve the needs of Texas residents who are not eligible for Medicaid. These include the Texas: Community Attendant Services (CAS) Program, Texas CCAD Program / Client Managed Personal Attendant Services, and Texas DADS Services to Assist Independent Living.
The Community Attendant Services (CAS) program allows certain family members to be hired as caregivers, with the exception of close relatives and legal guardians. The CAS program requires the use of a financial management agency to serve as an intermediary to facilitate the transfer of funds.
The Texas Community Care for Aged/Disabled (CCAD): Non-Medicaid Services for the Elderly program offers a similar suite of services, but it does not appear as though self-directed care is an option via this program.
The Texas Community First Choice Program and Texas STAR+PLUS Waiver are Medicaid-funded programs. Both programs are similar, although the Community First Choice (CFC) program is newer. CFC is also an entitlement program, meaning there are no waiting lists – services are available to anyone who is eligible and in need of services, while STAR+PLUS is capped and therefore waiting lists may exist.
STAR+PLUS is a managed Medicare program, with services provided by a managed care organization (MCO). The CFC program is a consumer-directed program, allowing participants to choose their own care providers, including family members with the exception of spouses.
Summary: How to obtain financial assistance for caregivers in Texas
Utah's Home and Community Based Services Waiver Programs are state-funded programs that help Utah residents avoid having to spend-down their assets in order to qualify for Medicaid. In addition to personal care services, adult day care, and other caregiving services, the program also offers some assistance for minor home modifications to accommodate aging-related impairments. The program allows family members to provide paid caregiving services to loved ones, although spouses are not eligible to be paid to provide services. Adult children and siblings are eligible, although they must obtain a Utah business license. Additionally, the recipient must have attempted to receive care from a provider who was previously licensed without success.
The Utah State Plan Medicaid Personal Care Services program is an entitlement program, meaning there are never wait lists to receive services. It’s not clear whether consumer direction is an option through this program.
This Utah Medicaid Waiver for Individuals Age 65 or Older or the Aging Waiver is a Medicaid Home and Community Based Services (HCBS) waiver that allows for consumer direction of services. Participants are able to hire friends or relatives, with the exception of spouses and legal guardians, to provide caregiving services. Support is also provided for in-home medical equipment, personal emergency response services, and home modifications necessary to support independence, as well as medication reminder systems, respite care, and adult day services. Payments for caregivers are handled by a financial management agency. The Aging Waiver is managed by the Utah Department of Health.
Utah's New Choices Waiver (NCW) is a Medicaid program provides services designed to enable individuals to move from an assisted living community, nursing home, or health care facility back to their own home or into the home of a loved one or caregiver. The NCW provides funds for support services including homemaker services, home modifications required for accessibility, home delivered meals, non-medical transportation, and other services such as attendant care and adult day services. It allows for consumer direction of services, including the option to hire friends or relatives, with the exception of spouses or legal guardians. An open enrollment period applies to this program, and it’s only available for those who are currently residing in a care facility and want to transition back into the community.
Utah’s VDC program is offered through the Salt Lake City VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Utah
There are a few programs available to Vermont residents who are eligible for Medicaid, including the Vermont Attendant Services Program and the Vermont Global Commitment to Health Waiver.
The Attendant Services Program (ASP) provides services to those with disabilities who require assistance with ADLs. It’s a self-directed program, and participants are able to hire, train, and manage their own care providers, which includes certain family members such as adult children of aging parents. Spouses, civil union partners, and legal guardians are ineligible to be paid for providing services, however. The hourly rate is a Medicaid-approved rate typically between $14.75 and $18.75 per hour.
Vermont's Global Commitment to Health (GC) 1115 Waiver is a Medicaid (Green Mountain Care) program offering a wide range of services to individuals with varying needs, including older adult residents requiring ongoing assistance. In addition to personal care services, adult day services and respite care are available, as well as emergency response services, assistance for assistive technology or medical equipment, and home modifications to support independent living. Vermont Choices For Care, the self-directed care option within this waiver, allows participants to hire family members to provide caregiving services. Spouses and legal guardians cannot be hired.
Other programs available in Vermont (without consumer-directed options) include the Vermont Home Sharing Program, which matches older adults requiring assistance with housemates who are able to offer the needed assistance, and the Vermont Home Access Program, which offers assistance with home modifications.
Vermont’s VDC program is offered through the White River Junction VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Vermont
The Virginia Elderly or Disabled with Consumer Direction (EDCD) Waiver was available to Virginia residents who are Medicaid-eligible, until July 2017, when the program merged with the Technology Assisted Medicaid Waiver into a single, comprehensive program called the Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver.
The CCC Plus Medicaid Waiver rolled out statewide on January 1, 2018. Under the CCC Plus program, some family members may be compensated for providing care services, including adult children, although spouses and legal guardians cannot be hired to provide care. The CCC Plus Medicaid waiver is mandatory for all eligible Virginia residents.
Adult Services (AS) and Auxiliary Grant (AG) are Virginia's two state assistance programs for older adult residents. Adult Services Program supports adults with an impairment to remain as independent as possible, ideally in their own home. Services include homemaker services, adult foster care, and long-term care services and support (LTSS) screenings. The Auxiliary Grant is for low-income adults with a disability age 60 and older who are entering or already living in certain licensed or approved facilities that accept auxiliary grant payments, so it is not appropriate for those with loved ones still living at home. In any case, both of these programs do not offer an option for participant direction.
Summary: How to obtain financial assistance for caregivers in Virginia
Medicaid-eligible Washington residents have several programs available to obtain support and services including Washington COPES, the Washington Medicaid Personal Care (MPC) Program, Washington Medically Needy In-Home Waiver, Washington New Freedom Program, and the Washington Community First Choice Option. In Washington, Medicaid is referred to as Apple Health.
COPES is a Washington State Medicaid (Apple Health) waiver program offers supports and services including personal care, home modifications, emergency response services, and transportation assistance. The program is administered by the Health Care Authority and the Washington State Department of Social and Health Services.
The Washington Medicaid Personal Care Program is administered by the Home and Community Services (HCS) and Developmental Disabilities (DDA) administrations. A CARE assessment is completed by a case manager, nurse, or social service specialist from DDA, HCS, or Area Agency on Aging (AAA) to determine eligibility and required services.
The Washington New Freedom Program is self-directed. After an individual budget and spending plan is created, based on assessed needs and preferences, the participant is able to use their budget to hire their own personal care attendants and purchase items and services that enable them to live independently. Blood relatives may be hired as a personal care attendant – but not spouses or legal guardians. The Washington Community First Choice Option offers similar services, although it’s not clear if consumer direction is an option through this program.
Summary: How to obtain financial assistance for caregivers in Washington
The West Virginia Ron Yost Personal Assistance Services program and the West Virginia Lighthouse Program are two options for West Virginia residents who are not eligible for Medicaid.
The Ron Yost Personal Assistance Services program (RYPAS) is modeled after the Medicaid Cash and Counseling model (although it is not a Medicaid-funded program). It is a consumer-directed program, allowing participants to hire friends, neighbors, and even spouses to provide caregiving services.
The Lighthouse Program offers four levels of support for older adults – age 60 and over – in their homes, including personal care services, nutrition, mobility assistance, and homemaker services. Like the RYPAS program, certain family members may be hired to provide services (though not in all counties) for a maximum of 60 hours per month. However, the specific hours of care permitted will be determined by the Plan of Care, developed by a county caseworker and a medical professional. Adult children may be hired as caregivers; spouses may not. Caregivers are hired and provided training by the county.
West Virginia’s Aged and Disabled Waiver is a Medicaid-funded program offering services ranging from non-medical personal care assistance to non-medical transportation and homemaker services. Family members may receive payment for providing care services through this program, with the exception of legal guardians and spouses. The hourly rate is capped by Medicaid and as of 2020, the maximum is $17.00 per hour.
West Virginia does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in West Virginia
Wisconsin’s Family Care Program and Family Care Partnership Program are available for eligible Wisconsin residents who do not qualify for Medicaid. Both programs are managed care programs, while the Family Care and Partnership program is a self-directed program called SDS or Self-Directed Supports. The Family Care program is designed for non-medical care while the Partnership program provides more comprehensive services, including complete medical care and prescription drugs. The Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II) have transitioned into the Family Care and Family Care Partnership Programs.
Participants in the SDS program are provided with funds that would otherwise be spent on their care services in a residential setting such as a nursing home, which they may then utilize to pay for goods and services that support independent living. Participants may hire friends, neighbors, and certain family members as caregivers, which may include adult children but generally excludes spouses and legal guardians.
Wisconsin Medicaid offers the Include, Respect, I Self-Direct (IRIS) Program, a waiver program that includes self-directed care (Self Directed Personal Care or SDPC). After a Service and Support Plan is developed, the participant is provided with a budget that they may spend on any goods or services outlined in the plan. They may also select their own care providers, including family members (adult children, spouses, and other family members are eligible). However, family members cannot be hired to provide live-in caregiving services under this program. Caregivers must pass background checks and be qualified to provide the services. They are also taxed on their wages.
Summary: How to obtain financial assistance for caregivers in Wisconsin
The Wyoming Community Choices Home & Community Based Services Medicaid Waiver (CCW) is a Medicaid-funded program offering services including personal care assistance, home meal delivery, adult day services, respite care, and other services to help individuals remain in their own homes and avoid nursing home placement.
Administered by the Wyoming Department of Health’s Division of Healthcare Financing (DHCF), CCW offers an In-Home Participant Directed Option enabling participants to select their own care provider, called a direct service worker. Family members including adult children may be hired to provide caregiving services, although spouses, legal guardians, and anyone with a Power of Attorney for the care recipient are ineligible to receive compensation for services.
Caregivers are limited to a maximum of 40 hours per week and are paid at a rate typically ranging between $10.25 and $12.25 per hour. It is not an entitlement program, so there may be wait lists.
Wyoming state offers a single non-Medicaid based program called the Wyoming Home Services Program (WyHS). A number of services are provided by WyHS, including care coordination, personal and respite care, and homemaker services, to support qualified individuals who are at risk of premature institutionalization.
Wyoming does not currently offer a VDC program.
Summary: How to obtain financial assistance for caregivers in Wyoming