written by
Lucinda Koza

What States Pay Family Caregivers?

caregiver 5 min read , July 2, 2024
Financial problem. Thoughtful hispanic woman sit by home laptop lean on clasped hands consider on tax loan credit debt. Upset young lady freelancer understand her small business is close to bankruptcy
Financial problem. Thoughtful hispanic woman sit by home laptop lean on clasped hands consider on tax loan credit debt. Upset young lady freelancer understand her small business is close to bankruptcy | Photographer: fizkes

When you’re a caregiver for a family member, balancing the books is going to be a top priority. It’s hard to make ends meet as it is, and caregiving adds pressure to both your time and your wallet.

Of course, you’re happy to put in the hours for your spouse or parent, but the fact of the matter is those hours are in addition to the career that’s paying the bills, and it makes for some extremely long and tiring days. If only there was a way to get paid for your hard work…

Good news! Depending on where you live, you may have access to state funding that will compensate you for your blood, sweat, and tears, and allow you to free up some of your on-the-job hours to make caregiving more manageable and sustainable.

We know how busy you are, so we’re going to make this easy: we’re telling you what states pay family caregivers, and how you can take advantage of the opportunity.

The Need For Support

There are 53 million non-professional caregivers in the nation today, and they’re collectively providing $470 billion worth of healthcare services. That’s over $100 billion more than the total out-of-pocket expenses paid for all other healthcare expenses combined, and the average caregiver is spending a whopping 26% of their annual income on caregiving activities.

Moreover, nearly 60% of family caregivers provide at least 21 hours of care a month, and that’s in addition to the job they have to pay the bills. 72% of all caregivers are working at least 30 hrs a week, and over half are full-time. Ever wonder why the caregivers you know look tired all the time? That’s why.

Why not Medicare?

Medicare—the largest funder of healthcare in the nation—will pick up a lot of the overhead for supplies, medications, and professional services if the person you’re caring for is eligible for benefits. It will even pay for limited professional in-home care, including various therapies, skilled nursing care, and home health services, although it’s capped at 8 hours a day for a maximum of 21 days.

However, Medicare does not compensate family caregivers for all the hands-on time they contribute to the cause. That’s considered pro bono work when it’s someone you love.

Medicaid to the Rescue

Fortunately, Medicaid is designed to fill in the gap. Medicaid is a joint state-federal program that helps families who have very low income access healthcare, and each state determines what their requirements are for participation.

However, what states pay family caregivers—and the scope of the caregiving they are allowed to provide—can vary significantly. The majority of states allow the person who requires care to pick their caregiver, and that can often include an adult child or relative. Through Medicaid, that person is eligible to be compensated for their services, but the rules are much tighter when it comes to spouses.

Currently, only Alabama, Arizona, California, Colorado, Delaware, Florida, Hawaii, Kentucky, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Utah, Vermont, and Wisconsin allow a spouse to be a paid caregiver.

If you’re lucky enough to live in one of them, congratulations! Click here to find out if you or a family member is eligible for Medicaid caregiver benefits.

How to Access Medicaid Caregiving Resources

There are several ways each state can set up its Medicaid program to allow for family members and spouses to become paid caregivers. All of these are offered as part of consumer-directed care initiatives, which means the person receiving care has the option to choose, hire, and train (or even fire!) the caregiver of their choice.

Each has its unique benefits and limitations, and it’s important to check with your state to find out which path will best suit your situation.

Home and Community-Based Services (HCBS) State Plan Option

The HCBS option allows patients within participating states to select the caregiver of their choice—including relatives—to provide an individualized care regime. That person can be compensated for doing chores, doing laundry, cooking meals, and basic daily tasks in addition to providing direct caregiving services.

This is one of the best, most flexible options states can provide for family caregiving situations, because caregivers are not required to meet the standards of professional care facilities.

HCBS Waivers

Depending on a state’s demographics and regional challenges, there may be waivers in place that allow some residents to provide traditionally institutionalized care in-home. It might have to do with a lack of available care facilities, economic considerations, or other state-specific factors. Waiver programs may also allow a relative or spouse to be the primary caregiver, but all of these factors vary from waiver to waiver and from state to state.

Community First Choice (CFC) Option

CFC programs are designed to allow institution-level standards of care to be delivered in the home. CFC option won’t pay for a spouse or relative to provide caregiving services, they can be appointed as a personal attendant to help with daily tasks in support of professional caregiving. Currently, only Alaska, California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington provide this option.

Adult Foster Care

When an elderly person in need of daily assistance moves into their caregiver’s home, they may be eligible for adult foster care support through Medicaid. While it doesn’t pay for room and board, adult foster care funding will cover most personal care services that are usually unpaid when a relative or spouse is caring for a loved one.

Unfortunately, a spouse can’t “foster” their partner, so that’s a no-go for this option. However, other relatives and adult children commonly find themselves in this role, and if you live in Connecticut, Indiana, Louisiana, Massachusetts, Ohio, Rhode Island, or Texas, you can take advantage of Medicaid assistance.

Making In-Home Caregiving Rewarding With I-Ally

Caregiving can put an incredible strain on family members and spouses, and nobody should have to go it alone. I-Ally is a dedicated community of experts and in-home caregivers just like you who can get you the information you’re looking for—and give you the support you deserve—to access the resources you desperately need.

The wonderful people contributing to I-Ally have seen and done it all. If you need to know what states pay family caregivers and how to cut through the red tape, they will give you all the tips and tricks to make it as smooth and painless as possible.

I-Ally: empowering you to make caregiving a meaningful and rewarding experience.

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