Can a family member get paid to take care of me?

What this means

• Self-directed care, also called consumer-directed or participant-directed care, means you choose and supervise your own caregiver instead of a home care agency assigning one.
• The money comes from Medicaid, usually through a home and community-based services waiver, which is Medicaid's way of paying for care at home instead of in a nursing home.
• In most states an adult child, a grandchild, a niece or nephew, or a friend can be hired and paid an hourly wage as your worker.
• A spouse or a legal guardian is allowed to be paid in some states and not in others. This is the single most common place people are surprised.
• The caregiver becomes an employee: there is a background check, a training requirement, timesheets, and a payroll company called a fiscal intermediary that issues the paychecks and handles taxes.
• The number of paid hours is set by an assessment of what help you actually need with things like bathing, dressing, eating, toileting and moving around. It is rarely full time.
• Veterans have a separate route through Veterans Affairs programs, and some long-term care insurance policies also pay a family caregiver.
• This is a real program used by hundreds of thousands of families, and it is also a program with waiting lists in many states. Both things are true.

What to do first

1. Call your state Medicaid agency and ask, in these words: does my state have a self-directed personal care option, and can a family member be the paid caregiver?
2. Call your Area Agency on Aging through the Eldercare Locator at 1-800-677-1116 and ask for an options counseling appointment, which is free.
3. Ask for a functional assessment, because the assessment is what sets the number of approved hours.
4. Ask whether there is a waiting list for the waiver and request to be added to it the same day you call.
5. If you are a veteran or the surviving spouse of one, ask Veterans Affairs about the Veteran-Directed Care program and about Aid and Attendance.

What you'll need

• Proof of address
• Proof of income and assets
• Medical records
• VA Form 21-2680 completed by a doctor
• Usually nothing beyond a phone assessment
• DD-214 or other discharge papers
• A doctor's assessment of your care needs
• Medicare and Medicaid cards
• Bank statements going back five years for the look-back review
• Deed or lease
• Records of unreimbursed medical expenses
• Marriage and death certificates where relevant
• Medicare and insurance cards
• Proof of all income and assets
• Financial information if applying for Medicaid at the same time

Where to go

• Medicaid Home and Community-Based Services, Including Paying a Family Caregiver: https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip
• PACE: Program of All-Inclusive Care for the Elderly: https://www.medicare.gov/plan-compare/#/pace
• National Family Caregiver Support Program: https://eldercare.acl.gov/Public/Index.aspx
• VA Aid and Attendance, Housebound, and Veterans Pension: https://www.va.gov/get-help-from-accredited-representative/find-rep/