Government assistance for taking care of elderly parents

This common and demanding responsibility can affect everything from finances to health, as caregivers often report higher stress, difficulties balancing personal relationships, and greater economic insecurity than their peers. The monetary toll can prove especially draining: AARP’s report found that unpaid family members provide the equivalent of $470 billion in caretaking services each year, with the average family spending over $7,000 out of pocket.

For Amy, a 41-year-old grocery store worker in Florence, Alabama, these challenges inspired her to start the process of getting paid to be a family caregiver.

“I had a part-time job that let me spend time with my kids and help support the family,” says Amy. “When my mom came to live with us, it was an either/or: Quit working at the store, or not get to do things with my kids anymore on top of my hours and taking care of her.”

Then, Amy discovered a state program that allowed individuals to become paid caregivers for family members.

“At first, it felt like, ‘Why would someone pay me for doing that? It’s just what families do,’” she recalls. “But that way of thinking makes it hard to continue your own life.”

The process of getting paid to be a family caregiver can vary based on many factors, including your loved one’s income, where you live, and your family’s eligibility for certain programs. However, caregiving doesn’t have to mean financial sacrifice. There are many options to explore at the government and private level that can help, from Medicaid to long-term care insurance.

Getting paid to be a family caregiver through Medicaid

Medicaid is a state and federal insurance program that extends coverage to those with limited resources, including low-income adults, older adults, and individuals with significant disabilities. As part of this program, Medicaid has several benefits that allow seniors to both select and compensate their in-home caregivers, allowing them to designate an adult child or — in some states — their spouse.

Is your family member eligible for Medicaid?

To receive caregiver compensation through Medicaid, your family member must be eligible for coverage or already receiving benefits. To qualify for Medicaid, your loved one must meet one of the following requirements:

• Be considered low-incomebased on state-specified guidelines. Income ceilings vary based on where you live, so research your state’s Medicaid policies. Generally, people who qualify for Medicaid make around 138% of the federal poverty limit or lower.
• Be determined “medically needy.” This distinction means that a person has intensive health needs that may result in overwhelming expenses.

Medicaid policies that support paid family caregivers

Several state plans permit family members to become paid caregivers. With these options, the money that Medicaid would typically provide for care in a senior living community can be reallocated toward in-home services, including those administered by relatives.

Home and Community-Based Services Waivers, often referred to as HCBS waivers, aid seniors who would prefer to receive in-home care. More than 1 million older adults in the U.S. coordinate their care through an HBCS waiver program. While guidelines vary depending on a senior’s state of residence, older adults must meet some general qualifications:

• Demonstrate the need for a level of care typically found in a skilled nursing, assisted living, or memory care community. Often, this means older adults need help with at least two activities of daily living (ADLs), such as showering, feeding, and mobility assistance.
• Create an individualized, person-centered care plan with their caregiver. A person-centered approach to care acknowledges that no two seniors are alike and takes into account an individual’s hobbies, abilities, and lifestyle preferences.
• Ensure that in-home care payments won’t exceed the costs they would pay for similar care at a senior living community.

In addition to qualifying based on income, seniors typically need to meet an age or diagnosis requirement to receive an HCBS waiver.

Whether you can become a paid caregiver for a family member depends on your state’s rules. While it’s more common to get paid to become a caregiver for parents, several states offer payment to caretaking spouses.

Self-directed personal assistant services

Self-directed personal assistant services (PAS) empower seniors to hire their own caregivers, which typically include family members and close friends. In many states, getting paid to be a caregiver for your parent or spouse is due to self-directed PAS. The program allows enrolled participants to facilitate their own care and exercise autonomy through key actions:

• Hiring relatives
• Managing cash payments
• Purchasing or directing purchases of products that enhance senior safety or health, such as mobility ramps, pill dispensers, and grab bars

Under PAS, a caregiver must work with their loved one to develop a care plan that takes into account the senior’s preferences and abilities. They must also construct an “individualized back-up plan” to outline what steps will be taken if the selected caregiver can no longer perform their duties.

Community First Choice

Much like HBCS waivers and self-directed PAS, the Community First Choice (CFC) program grants seniors the ability to manage their own care. This often involves appointing family and friends to take on these responsibilities within a paid role. Established under the Affordable Care Act, the CFC option is currently available in nine states:

• Alaska
• California
• Connecticut
• Maryland
• Montana
• New York
• Oregon
• Texas
• Washington

Due to differences in Medicaid’s state guidelines, older adults may benefit from consulting an elder care attorney to help them navigate the application process. If an older adult is eligible for multiple Medicaid caregiving plans — such as an HBCS waiver and self-directed services — an attorney can help determine which plan yields the most financial benefit. Learn more about state-by-state benefits below.

Become a paid caregiver for a family member with VA benefits

If you’re a family member overseeing long-term care for a veteran, VA benefits stand out as an important resource. Two different programs — Aid and Attendance and Housebound benefits — can help compensate family caregivers.

VA Aid and Attendance

For adult children wondering how to get paid to be a caregiver for their parents, VA Aid and Attendance may be the solution. However, the program doesn’t allow spouses to become paid caregivers.

VA Aid and Attendance provides a substantial monthly payment in addition to existing VA pensions for eligible veterans and surviving spouses. Older veterans or spouses who can no longer manage their care independently can use the sum to pay for outside help, such as aid from a family member.

A senior may be eligible for Aid and Attendance if they meet certain income, age, and disability requirements, along with having served in active duty and receiving an honorable discharge.

VA Housebound benefits

If your loved one is a veteran who spends most of their time at home due to a disability or illness, they’re likely eligible for VA housebound benefits. Much like Aid and Attendance, housebound benefits grant an additional stipend to bolster veteran pensions.

Adult children and other relatives can become paid caregivers for family members through this method, while spouses can’t collect pay.

To be considered for Aid and Attendance or housebound benefits, print and complete the application. For assistance with the process, you and your senior loved one can call the VA at 1-800-698-2411 or visit your regional VA office.

Family caregiver payments from long-term care and life insurance policies

Long-term care insurance and life insurance are proactive investments designed to benefit seniors in retirement and old age.

While all long-term care insurance varies depending on the company and a senior’s individual policy, most policies pay for in-home caregivers. Consult with your parent’s insurance company to determine if a family member can fulfill this role.

Using life insurance to pay for care is another strategy, one seniors and their families often overlook. Some life insurance policies may have a long-term care component already built in to their coverage. In other cases, older adults can sell their policy or surrender it for a cash value, freeing up funds to support a paid caregiving arrangement. Consider exploring these options with your family member’s insurance agent.

Can caregivers get paid through tax credits and reimbursements?

Many family members are surprised to discover the wide array of tax credits and deductions for caregivers.

“At first, we didn’t even know about tax credits, but they help a lot without having to apply for anything extra,” says Amy.

If your parent’s gross annual income doesn’t exceed $4,300 — excluding social security — and you pay for more than half the cost of their support, you’re able to claim them as a dependent.

Even if you don’t meet these guidelines, you’ll likely be able to deduct the majority of care expenses:

• Premiums for Medicare Part B and Part D, as well as supplemental insurance
• Prescription drugs or insulin
• Dental treatment, including X-rays, oral surgery, and fillings
• Nursing services
• Long-term care, including housing, food, and personal costs
• In-home medical equipment or mobility improvements required for medical care
• Transportation to medical appointments
• Surgeries or other in-patient procedures

Though tax credits aren’t a direct way of getting paid to be a family caregiver, they can significantly lower your tax bill or result in a substantial tax refund. It’s worth noting that some state-funded caregiver payment programs prohibit family members who claim elderly loved ones as dependents from receiving compensation. Consult an accountant or the list of state-by-state benefits below to discover if claiming a senior relative on your taxes will be the most financially beneficial option for your family.

Negotiate family caregiver payments with your loved ones

While some government programs can reimburse caregiving costs, many older adults and their families don’t qualify. In these cases, it may be time to bring up payment with your parents or other family members. Your elderly relative may be able to compensate you for your care, or contribute to bills and rent. If you have siblings who aren’t hands-on caregivers, set up a plan for them to pitch in.

Having this conversation can often feel uncomfortable, but caregivers shouldn’t be afraid to stand up for themselves and advocate for their own needs. Browse the following resources to learn more about the personal impact of caregiving, signs it may be time to pursue senior living, and how to talk with your loved one about next steps.

Create a caregiver contract. A written agreement between family members can clarify how much care you’re able to provide, compensation you’ll receive, and your daily responsibilities.

Evaluate the hidden costs of caregiving. Lost income, weakened job security, and increased personal health care costs affect six out of 10 family caregivers, according to the Family Caregiver Alliance. Know what you’re up against to plan accordingly.

Advocate for your needs. It can be hard to talk with family about how caregiving affects you. Understand how to discuss payment, whether respite care is an option, and when you’ve reached your limit.

Understand the mental and physical risks of caregiving. More than half of caregivers say a decline in their health affects their ability to provide care. Make sure you have the resources you need to protect your own mental and physical well-being.

Explore senior living options. In some cases, it may be necessary to admit you can no longer care for an aging parent, especially if getting paid to be a caregiver isn’t possible. Alternatives like assisted living, memory care, and nursing home communities introduce a way to transition caregiving responsibilities from a family member to a supportive, well-trained staff.

Getting paid to be a caregiver: A state-by-state guide

Can a family member get paid to be a caregiver in your state? Regulations and compensation vary across the U.S. Some states offer multiple options for self-directed care — meaning seniors can select their own caregivers — while other states don’t offer funds to family caregivers at all. Find out more below about where you live.

ALABAMA

Non-Medicaid: The Alabama Cares Program is administered by the ADSS and is based on your residing county.

Medicaid: Though Alabama offers multiple Medicaid waiver programs, only the Personal Choices Program permits seniors to self-select caregivers including neighbors, friends, and family members. Relatives of eligible adults may receive compensation or caregiving resources.

Veteran: If your loved one is a veteran, visit the Administration of Community Living webpage for more information about which centers offer the Veteran Directed Care Program.

ALASKA

Non-Medicaid: The state of Alaska offers a Personal Care Services (PCS) program, which provides assistance with activities of daily living as well as homemaking for eligible older adults. Some programs are consumer-directed, meaning seniors can hire friends and family members, with the exception of spouses and legal guardians.

Medicaid: The Community First Choice Program (CFC) allows recipients to receive care in their home as an alternative to state-funded nursing homes.

Veteran: Alaska’s Veteran Directed Care Program is offered through the Alaska VA Health System.

Other: Grant programs may be available for those who are waiting or don’t qualify for a Medicaid Waiver program, or for those who only require minimal support. Grants are geared toward those with disabilities or cognitive concerns that would otherwise require a nursing home.

ARIZONA

Non-Medicaid: Arizona does not offer a state funded program to support older adults at this time.

Medicaid: Arizona offers the Arizona Long Term Care System (ALTCS) and Arizona’s Health Care Cost Containment System (AHCCCS) for eligible seniors who would otherwise require a nursing facility. Member-selected options allow older adults to personally hire care aides, including some eligible family members.

Veteran: Contact the Southern Arizona VA Health Care System if your loved one is a veteran for more information about the Veteran-Directed Care program.

ARKANSAS

Non-Medicaid: Arkansas does not offer a state funded program to support older adults at this time.

Medicaid: Arkansas offers multiple Medicaid waiver programs, including the Arkansas Independent Choices (IC) program. This member-directed option allows the senior to hire, train, and supervise their own in-home caregiver, including some relatives and family members.

Veteran: All individuals that are veterans should contact the Arkansas Department of Veteran Affairs for information about the Veteran Directed Care program.

CALIFORNIA

Non-Medicaid: California’s Family Caregiver Services Program receives funding from the state’s 33 Area Agencies on Aging. Local programs assist family caregivers with services, training, counseling, and respite care. Some financial compensation may be available to eligible caregivers.

Medicaid: California’s Medicaid program offers In-Home Supportive Services that offer assistance to qualifying older to help them remain in their own homes as they age. Seniors hire, train, and supervise their personal care aides, including family members. Spouses may be eligible to receive caregiving compensation on a case-by-case basis.

Veterans: The California Department of Veteran Affairs funds a Veteran Directed Care Program.

COLORADO

Non-Medicaid: The Colorado State Unit of Aging, a division of the Department of Human Services, is responsible for elderly caregiver programs, and may offer counseling, respite services, and training to family caregivers at no charge.

Medicaid: The Consumer Directed Attendant Support Services (CDASS) program isn’t technically a Medicaid waiver, but it allows Medicaid-eligible recipients to hire, train, and manage their own personal care providers, including adult children and spouses.

Veteran: If your loved one is a Veteran, contact the Colorado Division of Military and Veteran Affairs for more information on Veteran Directed Care program.

CONNECTICUT

Non-Medicaid: Local Area Agencies on Aging sponsor a National Family Caregiver Support network. While family caregivers aren’t directly compensated, they are eligible for services like short-term respite care and items necessary to help elderly adults age in place safely.

Medicaid: Medicaid programs and waivers are available through HUSKY Health. Family caregivers generally can’t receive payment — however, Caregiver Homes of Connecticut allow a family member or friend who lives with an aging adult to be compensated for their caregiving services.

Veteran: The Veteran-Directed Care program in Connecticut is offered through VA Connecticut Health Care System West Haven Campus.

DELAWARE

Non-Medicaid: The Division of Services for Aging and Adults with Physical Disabilities offers Non-Medicaid alternative assistance programs for older Delaware residents. The Delaware Personal Care Program offers payment for various family caregiving services that help seniors live independently.

Medicaid: The Division of Services for Aging and Adults offers a variety of Medicaid programs. Some family members can receive payments for providing caregiving services, including spouses and adult children.

Veteran: Delaware does not currently offer a Veteran-Directed Care program.

FLORIDA

Non-Medicaid: Florida’s Department of Elder Affairs administers the National Family Caregiver Support Program for non-Medicaid assistance programs.

Medicaid: Statewide Medicaid Managed Care Long-Term Care Program offers a participant-directed option, allowing older Florida residents or their chosen representatives to manage their care providers, which can include family members.

Veteran: Florida offers a Veteran-Directed Care program in select counties. Contact the Florida Department of Veteran Affairs for more information.

GEORGIA

Non-Medicaid: Home and Community Based Services Program (HCBS) offers services through Non-Medicaid funded programs. HCBS may offer funding for personal care services and minor home modifications, as well as family caregiver training and support.

Medicaid: The Georgia Department of Human Services offers two waiver services through the Older Adult & Disabled waiver program. Often, family members only qualify as paid caregivers in rural locations and unique circumstances. Spouses cannot be compensated for senior care.

Veteran: Georgia does not currently offer a Veteran-Directed Care program.

HAWAII

Non-Medicaid: The Kupuna Caregivers Program offers assistance up to $210 a day to Honolulu city and Honolulu county residents. The Chore Services Program is an alternative non-Medicaid funded service managed by the Department of Human Services’ Adult Protective and Community Services Branch which may offer family caregiver compensation.

Medicaid: Under the Hawaii Department of Human Services, the State of Hawaii Med-QUEST Division administers the state’s Medicaid alternative. Family caregivers may be compensated for personal care and respite care, but not medical assistance.

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Veterans: If your loved one is a veteran, contact the VA Pacific Island Health Care System for more information regarding the Veteran-Directed Care program.

IDAHO

Non-Medicaid: Idaho does not offer a state funded program to support older adults at this time.

Medicaid: Idaho’s My Voice, My Choice gives participants greater control over the Medicaid funds they receive, allowing them to select care that best fits their needs. Participants can choose to hire people they know, though spouses are not eligible for compensation.

Veteran: The Idaho Division of Veteran Services sponsors a Veteran-Directed Care program.

ILLINOIS

Non-Medicaid: Illinois does not offer a state funded program to support older adults at this time.

Medicaid: Illinois has both the Illinois HealthChoice and Medicare-Medicaid Align Initiative to provide family caregiver assistance. They’re designed to fund in-home care for seniors who would otherwise be at risk of placement in a Medicaid-funded nursing home.

Veteran: Illinois offers a Veteran-Directed Care program through several VA Medical Centers. Contact the Illinois Department of Veteran Affairs for more information.

INDIANA

Non-Medicaid: Indiana participates in 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, but may not be Medicaid-eligible.

Medicaid: The Structured Family Caregiving program provides financial and support services for caregivers. Family members may be eligible for tax-free daily stipends, training, up to 15 days of respite services, and visits from registered nurses.

Veteran: If your loved one is a veteran contact the Indiana Department of Veteran Affairs for more information about the Veteran-Directed Care program.

IOWA

Non-Medicaid: Iowa’s Area Agencies on Aging (AAAs) provides Case Management Services to help support and promote independent living for older Iowa residents.

Medicaid: The Iowa Department of Human Services provides Medicaid assistance to all eligible elderly adults. Consumer-directed attendant care is one option that allows seniors to hire and supervise family members, friends, and neighbors, excluding spouses and domestic partners.

Veteran: If your loved one is a veteran apply for the Iowa Veteran-Directed Home and Community Based Services program. 

KANSAS

Non-Medicaid: Kansas offers non-Medicaid-funded services through the Kansas Senior Care Act. Family members may be compensated for homemaking services and other non-medical care. However, spouses aren’t eligible for payment.

Medicaid: KanCare, Kansas’s Medicaid program, may offer consumer-directed care from non-spouse family members.

Veteran: Kansas does not offer a Veteran-Directed Care program at this time.

KENTUCKY

Non-Medicaid: Kentucky offers the Kentucky Hart-Supported Living Program and the Kentucky Personal Care Attendant Program for those seeking non-Medicaid options. These programs are self-directed, meaning Kentucky seniors are able to compensate spouses and other family members of their choosing for medical and non-medical caregiving services.

Medicaid: The Kentucky Home and Community Based Services Waiver is available for those who are eligible for Medicaid. Older adults can select and hire care providers, including friends, neighbors, and select family members for non-medical, non-residential care services.

Veteran: Contact the Department of Veteran Affairs for more information on veteran benefits.

LOUISIANA 

Non-Medicaid: Louisiana does not offer a state funded program to support older adults at this time.

Medicaid: The Louisiana Community Choices Waiver is the Medicaid program offered to eligible older adults. Their Monitored In-Home Caregiving Program allows a family member or friend to receive payment for caregiving services IF they live in the same home. Caregivers must comply with state guidelines.

Veteran: Louisiana offers a Veteran-Directed HCBS Waiver program to Medicaid-eligible residents from the Shreveport, LA VA Medical Center.

MAINE

Non-Medicaid: The Consumer-Directed Home Based Care (CDHBC) Program provided by Maine’s Office of Aging and Disability Services (OADS) is a non-Medicaid program for consumer-directed personal assistance services. These services are limited to essential care, and generally don’t include homemaking.

Medicaid: MaineCare offers an option for seniors to hire their preferred care provider, including adult children, friends, and other family members, excluding spouses. Caregivers must use a third-party financial manager to facilitate payroll and taxes.

Veteran: The Augusta, Maine VA Medical Center offers a Veteran-Directed Care waiver program for eligible veterans.

MARYLAND

Non-Medicaid: The Maryland Attendant Care Program is a non-Medicaid funded program that offers financial reimbursement for senior care.

Medicaid: For those eligible for Medicaid, Maryland offers the Maryland Community Pathways Waiver and Maryland Community First Choice Program. Some self-directed care options are available, though spouses and other select family members can’t receive compensation.

Veteran: If your loved one is a veteran, be sure to contact your local Maryland Department of Veteran Affairs office for more information about the Veteran-Directed Care program.

MASSACHUSETTS

Non-Medicaid: Massachusetts offers the Home Care Program and Enhanced Community Options Program through it’s In-Home Services for adult residents. Family members may be compensated for personal care, home care, and homemaker services.

Medicaid: MassHealth administers Medicaid funding through the Personal Care Attendant Program. Funds are available for self-directed care, and can be paid to certain family members, friends, and ex-spouses. Spouses and legal guardians aren’t eligible.

Veteran: Veteran-Directed Care is available for veterans in Massachusetts through the VA Medical Centers located in Boston and Bedford.

MICHIGAN

Non-Medicaid: Michigan does not offer a state funded program to support older adults at this time.

Medicaid: The MI Choice Waiver Program and Home Help program are two Medicaid-funded care options, both of which allow seniors to hire the caregiver of their choosing. However, some family members are ineligible to receive compensation.

Veteran: Contact the Michigan Veteran Affairs Agency for more information on the available Veteran-Directed Care program.

MINNESOTA

Non-Medicaid: The Minnesota Alternative Care Program,  Minnesota Consumer Support Grant program, and Minnesota Essential Community Supports program are state-funded services that provide monthly assistance to seniors who require nursing home-level care but aren’t eligible for Medicaid. Monthly grants can exceed $900, and caregiver choices are self-directed.

Medicaid: Minnesota Department of Human Services offers several paid caregiver programs for Medicaid-eligible seniors.

Veteran: Minnesota does not currently have a Veteran-Directed Care program.

MISSISSIPPI

Non-Medicaid: Mississippi Department of Rehabilitation and services offers an IL Waiver Program based on eligibility. Through this program, seniors can select their own personal care assistant, provided the assistant meets state-set education and functionality requirements.

Medicaid: While Mississippi offers several Medicaid waiver programs, none compensate for family caregiving.

Veteran: If your loved one is a veteran, contact the Gulf Coast Veterans Health Care System or G.V. Montgomery VA Medical Center for more information about the Veteran-Directed Care program.

MISSOURI

Non-Medicaid: Missouri does not offer a state funded non-Medicaid program to support older adults at this time.

Medicaid: The state of Missouri offers the Personal Care Assistance Services program and Missouri Medicaid Care Options program as options for Medicaid assistance. Some family members may be eligible to receive up to $11 an hour for personal care — however, spouses and legal guardians are ineligible.

Veterans: If your loved one is a veteran, contact the Missouri Veteran Commission for more information about the Veteran-Directed Care program.

MONTANA

Non-Medicaid: Montana doesn’t sponsor a state-funded caregiver program.

Medicaid: The Big Sky Waiver and Montana Community First Choice / Personal Assistance Programs (CFC / PAS) offer Medicaid assistance to eligible seniors. Both programs have self-directed care options, and certain family members can be compensated for caregiving, provided they meet Montana’s approval requirements.

Veterans: Montana’s Veteran-Directed Care program is offered through the Fort Harrison, MT VA Medical Center.

NEBRASKA

Non-Medicaid: Nebraska offers four state-funded, non-Medicaid programs. However, only the Disabled Persons and Family Support program provides compensation for caregiving expenses, with a maximum monthly spend of $300.

Medicaid: The Nebraska Aged & Disabled Medicaid Waiver and the Nebraska Medicaid Personal Assistance Services program both allow seniors to choose their care providers as well as the type of care that best fits their needs. Non-spouse family members of Medicaid-eligible older adults can receive payment for services.

Veterans: Nebraska does not offer a Veteran-Directed Care program at this time.

NEVADA

Non-Medicaid: Those in Nevada who aren’t eligible for Medicaid may qualify for Nevada’s Community Option for the Elderly. Certain family members may receive compensation for care services, with a state-regulated hourly wage.

Medicaid: Nevada offers three Medicaid-funded programs. Nevada Medicaid Personal Care Services allows seniors to select any eligible caregiver, including select family members. Payments and taxation are handled by an intermediary service organization.

Veterans: If your loved one is a veteran, contact the Nevada Department of Veteran Services for more information about the Veteran-Directed Care program.

NEW HAMPSHIRE

Non-Medicaid: New Hampshire doesn’t have a non-Medicaid-funded program available for family caregiver assistance.
Medicaid: No New Hampshire Medicaid programs compensate family members as primary caregivers — however, friends and neighbors of qualifying elderly adults may be eligible.

Veterans: The Manchester, NH VA Medical Center sponsors the state’s Veteran-Directed Care program.

NEW JERSEY

Non-Medicaid: New Jersey offers the New Jersey Assistance for Community Caregiving program as an option for non-Medicaid assistance. Family members, spouses, and adult children are all eligible to receive payment for attendant care, household chores, and transportation. Funds for mobility devices and minor home modifications may be available.

Medicaid: The New Jersey Medicaid Personal Preference Program offers seniors a budget that would otherwise be spent on skilled nursing services or nursing home placement. Friends and family members over 18 can be compensated through this budget.

Veterans: New Jersey’s Veteran-Directed Care program is offered through the VA New Jersey Health Care System Lyons Campus.

Other: New Jersey offers a Statewide Respite Care Program managed locally by Aging and Disability Resource Centers through which unpaid caregivers can secure free, temporary respite services. The goal of the program is to reduce unnecessary nursing home placement.

NEW MEXICO

Non-Medicaid: New Mexico doesn’t offer any state-funded, non-Medicaid caregiver support.

Medicaid: NM Centennial Care offers resources to help older adults remain in their homes. Family and friends may be compensated for unskilled care tasks, including housekeeping, transportation, and personal care services. However, family caregivers must be deemed qualified by a managed care organization.

Veterans: New Mexico offers a Veteran-Directed Care program through the New Mexico VA Health Care System.

Other: Caregivers may receive adult daycare services, in-home respite care, and transportation services for their aging loved ones free of charge from Older American Act funding.

NEW YORK

Non-Medicaid: 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, which allows seniors to hire family members as caregivers. However, all caregivers must meet New York’s legal requirements, so relatives will need to complete required training.

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Medicaid: Those who are eligible for Medicaid may be able to utilize New York’s Consumer-Directed Personal Assistance Program (CDPAP).

Veterans: Veterans should contact the New York State Division of Veterans’ Services for information on the VD-HCBS program and how to apply.

Other: For shorter-term caregiving needs, New York’s 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.

NORTH CAROLINA

Non-Medicaid: North Carolina In-Home Aide Services is a program available in North Carolina for residents who are not eligible for Medicaid. Family caregivers must be over 18 and pass state screenings to receive compensation.

Medicaid: The North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA) pays for personal care services as well as minor home modifications. The State/County Special Assistance In-Home Program for Adults (SA/IH) offers a monthly cash stipend to cover rent, clothing, and daily living expenses.

Veterans: The Fayetteville VA Medical Center and Durham VA Medical Center offer North Carolina’s Veteran-Directed Care waiver program.

NORTH DAKOTA

Non-Medicaid: 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. Both require seniors to be disabled or functionally impaired.

Medicaid: 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 a senior’s home or the home of a loved one.

Veterans: North Dakota does not currently offer a Veteran-Directed Care waiver program.

OHIO

Non-Medicaid: Seniors in Ohio who don’t qualify for Medicaid may receive funds for services through the Ohio Elder Services Program (ESP). ESP is currently only available in five counties, and family caregivers must meet state qualifications.

Medicaid: Ohio’s Medicaid PASSPORT does pay family caregivers, but in-home caregiving reimbursement must not exceed 60% of the cost of similar services provided in a nursing home or elder care facility.

Veterans: Ohio offers a Veteran-Directed Care waiver program through major-city VA medical centers.

OKLAHOMA

Non-Medicaid: No in-home care payment programs are available for Oklahoma seniors who don’t qualify for Medicaid.

Medicaid: The Oklahoma State Plan Personal Care Program is one resource for residents who qualify for Medicaid. Seniors can hire and reimburse family members, friends, or professional caregivers.

Veterans: Oklahoma offers a Veteran-Directed Care program through the Jack C. Montgomery VA Medical Center in Muskogee, OK.

OREGON

Non-Medicaid: Oregon Project Independence (OPI) is a state-funded, non-Medicaid program that allows seniors to select paid family caregivers to assist with ADLs. However, spouses don’t qualify for OPI payments, and all caregivers must be registered with a provider number through local Agencies on Aging. Oregon also offers several short-term, self-directed caregiver assistance programs.

Medicaid: 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.

Veterans: Oregon’s Veteran-Directed Care waiver program is offered through the Portland, Southern Oregon, and Roseburg VA Medical Centers.

PENNSYLVANIA

Non-Medicaid: Pennsylvania’s OPTIONS Program uses funding from block grants to offer assistance to family members caring for older adults at home.

Medicaid: The Community HealthChoices Program (CHC) and Pennsylvania Services My Way are Medicaid-funded programs serving individuals who require skilled nursing care or would otherwise qualify for nursing home placement.

Veterans: Pennsylvania’s Veteran-Directed Care program is offered through various cities’ VA medical centers.

Other: The Pennsylvania Services My Way (SMW) Program allows recipients to choose their own care providers, including select family members. While this isn’t a Medicaid-funded program, it does require seniors to qualify for Medicaid waivers.

RHODE ISLAND

Non-Medicaid: Rhode Island’s Temporary Caregiver Insurance (TCI) Program pays family members for up to four weeks of employment leave annually. Caregivers are paid up to $852 a week, and employers are required to offer a similar position to the employee following their leave.

Medicaid: Seniors may qualify for the Rhode Island Global Consumer Choice Compact Waiver if they’re Medicaid-eligible.

Veterans: Rhode Island doesn’t offer a Veteran-Directed Care program.

Other: The Rlte @ Home program offers a tax-free stipend for family caregivers to receive professional training and coaching support.

SOUTH CAROLINA

Non-Medicaid: While South Carolina doesn’t offer a state-funded program to support family caregivers, some may qualify for respite care and home living support stipends under the Older Americans Act. These funds are region-specific.

Medicaid:  The Healthy Connections Medicaid program allows recipients to pay family caregivers for personal assistance and companion services, but not medical help.

Veterans: South Carolina offers a Veteran-Directed Care waiver program through its Charleston and Columbia, SC VA Medical Centers.

SOUTH DAKOTA

Non-Medicaid: While South Dakota offers state-funded support to seniors who don’t qualify for Medicaid, these programs aren’t self-directed, meaning older adults can’t choose family members as paid caregivers. The Caregiver Support Program does offer respite care and other supportive services to in-home family caregivers.

Medicaid: South Dakota offers four separate Medicaid waivers for senior care assistance. However, each has unique health and disability requirements. Contact a Long-Term Services and Support Specialist to learn more.

Veterans: South Dakota offers a Veteran-Directed Care program through the Sioux Falls VA Medical Center.

TENNESSEE

Non-Medicaid: Tennessee OPTIONS for Community Living is a state-funded program that allows seniors to choose a relative to receive compensation for personal assistance, meals, and homemaker services. However, spouses don’t qualify for OPTIONS.

Medicaid: The TennCare CHOICES in Long-Term Care Program is Tennessee’s only Medicaid waiver designed for senior care support, and is available to older adults who would otherwise require nursing home placement. TennCare funds personal care services, as well as assistive technologies, emergency response services, and minor home modifications.

Veterans: Tennessee offers a Veteran-Directed Care waiver program through the Tennessee Valley Healthcare System Nashville.

TEXAS

Non-Medicaid: Texas’s Community Attendant Services (CAS) Program allows family members — with the exception of legal guardians and some other close relatives — to receive compensation from financial management agencies in exchange for caregiving services.

Medicaid: The Texas Community First Choice Program is a Medicaid-funded entitlement program, meaning there are no waiting lists for eligible seniors. Participants can choose family members as caregivers, with the exception of spouses.

Veterans: Texas offers a Veteran-Directed Care program through the state’s VA Medical Centers located in San Antonio, Houston, and Central Texas.

UTAH

Non-Medicaid: Utah’s Home and Community Based Services Waiver Programs allow family members — with the exception of spouses — to provide paid caregiving services to loved ones. Recipients must acquire a Utah business license to qualify.

Medicaid: The Aging Waiver allows qualifying adults to hire relatives to provide caregiving services, with the exception of spouses and legal guardians. Aging Waivers also cover in-home medical equipment, emergency response services, and basic home modifications.

Veterans: Utah’s Veteran-Directed Care program is offered through the Salt Lake City VA Medical Center.

VERMONT

Non-Medicaid: While Vermont does offer state-sponsored in-home care programs, none are self-directed, meaning seniors can’t select family members as paid care aids.

Medicaid: The Attendant Services Program (ASP) provides funds to seniors and those with disabilities who need daily assistance. Older adults can hire, train, and manage their own caregivers, including family members but not spouses or domestic partners. Rates are between $14.75 and $18.75 an hour, and are determined by Medicaid.

Veterans: Vermont’s Veteran-Directed Care program is offered through the White River Junction VA Medical Center.

VIRGINIA

Non-Medicaid: Family members aren’t compensated for caregiving services through Virginia’s state-funded programs.

Medicaid: The Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver allows some relatives — but not spouses or legal guardians — to receive pay for senior care.

Veterans: Virginia’s Veteran-Directed Care program is offered through the Richmond and Hampton VA Medical Centers.

WASHINGTON

Non-Medicaid: State-funded paid caregiving programs aren’t currently available in Washington — however, some Medicaid programs are open to select seniors who don’t otherwise meet income requirements.

Medicaid: Washington’s Medicaid program, referred to as Apple Health, offers five programs that may offer paid care services to eligible seniors and their family members. All programs require assessment by a case manager, and some are self-directed.

Veterans: Washington’s Veteran-Directed Care program is offered through the VA Medical Centers located in Puget Sound, Walla Walla, and Spokane, WA.

WEST VIRGINIA

Non-Medicaid: The Ron Yost Personal Assistance Services program (RYPAS) allows West Virginia residents who aren’t eligible for Medicaid to hire friends, neighbors, relatives, and even spouses for personal care services. In some counties, The Lighthouse Program also offers select family members compensation for up to 60 hours of senior care a month.

Medicaid: West Virginia’s Aged and Disabled Waiver is a Medicaid-funded program that offers payment to select relatives — not spouses or legal guardians — for services including transportation, personal care, and homemaking. The maximum hourly wage is $17.

Veterans: West Virginia does not currently offer a Veteran-Directed Care program.

WISCONSIN 

Non-Medicaid: Wisconsin’s Family Care Program provides residents who aren’t eligible for Medicaid with funds that would otherwise be spent on nursing home or residential care services. Participants can hire friends, neighbors, and some family members to provide services that support aging in place.

Medicaid: The Include, Respect, I Self-Direct (IRIS) Program, a waiver program offers qualifying seniors a set budget to spend on services outlined in their prescribed care plan. Eligible relatives can be compensated for care services, but not for rent or live-in caregiving. All family caregivers must pass background checks and will be taxed on their wages.

Veterans: Wisconsin offers a Veteran-Directed Care program through the state’s VA Medical Centers located in Milwaukee and Tomah.

WYOMING

Non-Medicaid: Wyoming offers state-funded services to help family caregivers, but doesn’t compensate them directly. The Wyoming Home Services Program (WyHS) offers care coordination and respite care.

Medicaid: The Wyoming Community Choices Home & Community Based Services Medicaid Waiver allows seniors to hire caregivers to assist with activities of daily living and homemaking services. Select family members are eligible, and are limited to 40 hours a week at a maximum rate of $12.25 an hour.

Veterans: Wyoming does not currently offer a Veteran-Directed Care program.

Sources:

American Association of Retired Persons (AARP) and the National Alliance for Caregiving. Caregiving in the United States 2020.

Centers for Medicare & Medicaid Services. Home & Community Based Service Authorities.

Family Caregiver Alliance. Caregiver Statistics: Work and Caregiving.

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