Nearly 80% of adults living at home and receiving long-term care assistance depend solely on relatives and friends, according to the Family Caregiver Alliance (FCA). The role of informal caregiver is not an easy one to take on. Most of us in this position still need to work to make ends meet. There is good news, however. If you are caring for a loved one, you might be able to get paid to provide this service. Let’s look at the states that pay family caregivers.
Medicaid is the primary payer of family caregivers but there are other options as well. In fact, if you are caring for a veteran, you are more likely to find programs that will pay you for providing care.
For Medicaid Recipients
All 50 states plus the District of Columbia offer what is called self-directed medicaid services for long-term care. These programs allow states to grant waivers that allow qualified individuals to manage their own in-home care services. This is an alternative option to having your care managed by an agency. Some states even allow family members to provide that care.
Since these self-directed services are managed by the states, the name of the program and eligibility requirements can vary by state. It may be called Consumer Directed Care, Participant-Directed Services, In-Home Support Services, or Cash and Counseling depending on the state you are in. Check out your state’s alternative Medicaid name and contact information for more details.
Some state programs will pay family caregivers but may exclude spouse or legal guardian. Others will pay caregivers only if they do not live in the same house as the care recipient. So, make sure to check your state Medicaid program for more information.
For Veterans
Veteran Directed Care
This is similar to Medicaid’s Self-Directed Care program. It allows qualified military veterans to manage their own long-term care and support services. This program is currently available in 37 states, the District of Columbia and Puerto Rico. The veteran receiving care must be registered with the Veterans Health Administration health care system. And, they must require the level of care that a nursing facility provides but wish to live at home or with a loved one.
The average budget under this program is around $2,200 per month and allows the veteran to choose the goods and services they find most useful. This includes a caregiver to help with activities of daily living (ADL’s) such as cooking, bathing, dressing, feeding, using the restroom, and changing prosthetic devices. The veteran is allowed to choose their own caregiver which includes any physically and mentally qualified family member.
The VA medical centers are responsible for determining eligibility and making referrals. Contact your nearest VA medical center for more information on this program.
Aid and Attendance
This is a program I’m very familiar with as many of my home care clients took advantage of this. The Aid & Attendance benefit supplements the military pension to help pay for the cost of a caregiver, which could be a family member. In order to be eligible for this benefit you must qualify for a VA pension and meet one of the following criteria:
- Require help from another person for certain activities of daily living such as bathing, dressing and eating.
- Are confined to bed due to a disability.
- Are in a nursing home because of a physical or mental incapacity.
- Has very limited eyesight, even with corrective lenses, or a significantly contracted visual field.
Surviving spouses of qualified veterans may also be eligible for this benefit.
To apply, complete the Aid & Attendance Application form. Be very specific about your condition and disability and what a typical day looks like with respect to the type of care you need. You can mail the form or deliver in person to your regional VA benefits office.
Housebound Benefits
This benefit is a monthly pension supplement for veterans who receive a military pension and are substantially confined to home due to a permanent disability.
The application process is the same as for the Aid & Attendance benefits. However, you cannot receive both Housebound Benefits and Aid & Attendance Benefits at the same time.
Program of Comprehensive Assistance for Family Caregivers
This program pays a monthly stipend to family caregivers who care for a military veteran who suffered a traumatic injury in the line of duty on or after September 11, 2001 and require assistance with activities of daily living.
The person receiving care must be enrolled in the VA Health Services. The caregiver must be at least 18 years old and can be a family member, extended family member or full-time housemate of the veteran.
There are other benefits available under this program including:
- Access to health insurance
- Comprehensive training
- Lodging and travel expenses when accompanying vets who are receiving care
- Up to 30 days of respite care per year
For more information on assistance for family caregivers visit the VA Caregiver Support Page.
Getting Paid By A Family Member
If your loved one has the financial resources to do so, they can choose to pay you or another family member directly for 
providing care. This has the potential to be an awkward arrangement so it’s helpful to follow some guidelines when considering this option.
- Talk About It – Be open and honest about what you both want / need out of this arrangement. Discuss scheduling, pay rate, and how sick days / respite care will be handled if the caregiver is unable to be there. Put the awkward feelings aside and be proactive about this conversation.
- Draw up a Personal Care Agreement – Consider drawing up a personal care agreement that will serve as a contract between the caregiver and care recipient. It should cover things like pay rate, services provided, length of the contract, and other conditions you want to specify. It’s also helpful to include other family members in the conversation when drawing up a care agreement.
- Consult a Lawyer – It may be helpful to have an eldercare attorney review the care agreement. This could help eliminate unforeseen problems down the road and ensure you follow the required tax laws.
- Keep Emotions in Check – Some family members may feel uncomfortable about this type of arrangement or disagree with aspects of the agreement. You may want to consider meeting with a family counselor or a mediator who specializes in eldercare issues to make sure everyone is on the same page.
- Keep Records – I recommend keeping professional records of the services performed, hours worked and pay rate. If your loved one goes to apply for Medicaid at some future time, this paperwork is essential.
- Report Income – As with any paid job, caregivers are required to report wages as taxable income. If your loved one applies for Medicaid at some point and your taxes have not been paid, this money could be considered a gift and may disqualify them from receiving Medicaid.
Long Term Care Insurance
If your loved one has long term care insurance, the policy may cover costs associated with a caregiver to assist with certain activities of daily living. Keep in mind that all long term care insurance policies are different. And, some do not pay for a family member to provide the care. Check with your insurance agent or insurance carrier for the specifics of your policy.
Please feel free to reach out to me in the comments section below if you have questions or comments. I’ll get back with you right away.
