If a person with a disability is already receiving Medicaid, their state may allow a family member or friend to become a paid caregiver. Self-directed services and payments to family caregivers are one of the tools that states use to address the shortage of direct care workers, including those who work at home and in the community. The shortage and high turnover rates among the direct care workforce reflect demanding work and low salaries. The COVID-19 pandemic compounded the workforce's existing problem for Medicaid home care, and states used new federal funding and flexibility to maintain service levels by increasing self-directed services and payments to family caregivers.
While the flexibilities of the pandemic era are over and additional funding is running out, states continue to provide extensive support to family caregivers through Medicaid home care programs. Yes, some family members may receive compensation for providing care. Each state has specific criteria for paying caregivers for their work, which may include siblings, parents, adult children, friends, or neighbors. Some states may exclude spouses or legal guardians from eligibility. Contact Careforth to better understand your state's specific program offerings.
They also highlighted that the broader state goals of offering services based on home and community rather than institutional services are a fundamental factor in supporting the self-direction of individuals who require institutional levels of care and the compensation of family caregivers. If a caregiver is an employee of an agency, the agency is responsible for background checks, training, and supervision of the caregiver. In many states, ABD Medicaid long-term care coverage includes a consumer-oriented care option that allows the beneficiary to hire a caregiver of their choice to provide personal care assistance during activities of daily living (mobility, bathing, dressing, eating, going to the bathroom), as well as cleaning, cooking, shopping, bill payment, medication management, etc. Medicaid for the Elderly, Blind and Disabled (ABD) provides basic health coverage and long-term care goods and services to people who are older (65 years and older), blind or disabled and who live in the community. Most states offer programs aimed at consumers through the Medicaid 1915 (c) home and community-based exemption authority (HCBS).
The first step in getting paid for providing care through one of these programs is to ensure that the older person who needs help meets Medicaid requirements. And if your loved one has savings or investments saved, they will likely have to spend almost everything they need on health care before they are entitled to long-term care coverage through Medicaid. While not specifically a Medicaid program, the exception for child caregivers is a Medicaid exemption that allows an adult child to “pay” for providing assistance for the care of an older parent. Medicaid wealth recovery programs (MERP) are required by law to seek reimbursement for Medicaid beneficiaries' health care costs after their death.
While small-scale studies have shown savings, states can also incorporate cost-containment mechanisms into these models by exempting enrollment or spending limits, or through reimbursement methodologies that limit the payment of consumer care to a percentage of agency fees. However, if payments are made to a family member who lives in the same house as the participant, the member must submit documentation justifying the hiring of the family member who lives in the same house as a “last resort option”. Whether it helps compensate for a caregiver's loss of pay due to other jobs or helps with home modifications or durable medical supplies, financial compensation can significantly reduce caregiver stress and anxiety. States can turn to a variety of Medicaid authorities to support consumer-facing options that allow family members to receive reimbursement for care provided.
Each state Medicaid program, and the corresponding exemptions, have unique requirements and limitations; however, if you are a family member who lives with your family and provides daily care for a loved one who is eligible for Medicaid, you may be eligible. While some families divide care responsibilities among several family members, it's common for one family member to handle most of the work.
