Quick summary
If you're one of more than 70 million people who provide unpaid care giving for a family member or friend, either in that person's home or in your own, you know that the time and energy burden can be enormous. In fact, you may have cut back or given up your paying job. Your smaller (or now nonexistent) paycheck may be pinching you hard. If so, it might be possible for you to get a small but regular payment for your care-giving work.
Here's how: If the parent, spouse, or other person you're caring for is eligible for Medicaid, its Cash and Counseling program, available in some states, can provide direct payments that could go to you. A few other states have similar programs for low-income seniors, even if the senior doesn't quite qualify for Medicaid. Also, if the person you're caring for has long-term care insurance that includes in-home care coverage, in some cases those benefits can be used to pay you.
If your parent or other person you're caring for will be paying you from any source, it may be a good idea -- for both of you -- to draft a short written contract setting out the terms of your work and payment.
Back to TopMedicaid in-home care assistance for people with little money
People with low income and few assets other than their home may be eligible for Medicaid (called Medi-Cal in
When Medicaid provides in-home care, it usually does so through a licensed home health care agency. Medicaid pays the agency, which sends its care aides to the senior's home on scheduled visits. This arrangement works well for many people. But for others, in-home care through an agency isn't the best arrangement. Many in-home care agencies are overstretched, with high worker turnover. This can mean that in-home care visits are sometimes irregular, with changing caregivers who don't know the senior's needs and preferences. And if you (or another family member) are already providing most of the care, the occasional presence of an outsider may not be that helpful.
Back to TopCash and Counseling programs pay directly for in-home care
Experts in in-home care understand that family members often make the best caregivers. Knowing this, and recognizing that professional home care agencies aren't always able to provide consistent care, Medicaid in some states runs a program called Cash and Counseling, which pays seniors directly to cover their in-home care. The amount the senior receives depends on a Medicaid assessment of need and the prevailing pay rate for in-home care aides in that state.
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The senior can then use the money to pay anyone of her choosing -- including you or other family members -- to provide care. She can also use some of the money to buy things for the home that would make life more comfortable for her, such as kitchen items, a new vacuum cleaner, safety equipment, or the like. Or she can use some of the money to pay for services such as cleaning, meal delivery, or transportation.
Cash and Counseling programs are currently in effect in the following states:
How the cash assistance programs work
Cash assistance programs have several components:
- Eligibility. If the senior you're caring for doesn't already have Medicaid coverage, you can help her apply for Medicaid or another cash assistance program. This means gathering bank, tax, and other records that show how much she has in income and assets. Medicaid (or the other relevant cash assistance program) can then determine if she's financially eligible.
- Assessment. If the senior you're caring for is financially eligible, the program will come to her residence to assess her in-home care needs. They'll speak with you and other caregivers about the care currently provided, and they may speak to her doctor.
- Determination. Based on the assessment of her needs, the Cash and Counseling or other program determines how many monthly hours of in-home care assistance it would approve if the care were coming from an in-home care agency. Using the rate that in-home care workers are paid in the state, it then figures out how much in total it will directly pay to the senior every month to help with in-home care.
- Plan. The senior decides who she wants to provide the care, and how much she'll pay you or other caregivers out of the program's monthly payment to her. (It has to be at least minimum wage, but it can be any reasonable amount you and she agree on.) She can also decide how else she might want to spend some of the money. The program helps the senior work out this plan, including paperwork and taxes.
Finding out about state programs where you live
To find out whether your state has a Cash and Counseling or similar program, contact your local Medicaid, human services, or social services office. To find the nearest Medicaid or other state office that handles in-home care programs, contact the Eldercare Locator online or by phone at 800-677-1116. Ask them about direct payment programs for in-home care.
Back to TopLong-term care insurance benefits to family caregivers
Only a relatively small number of seniors have long-term care insurance. But if the person you take care of has such a policy and it covers in-home care, there may be a way for you to be paid out of its benefits. If the policy covers in-home care but the senior isn't yet collecting benefits, you can help her file a claim for benefits based on her care needs. If the senior qualifies for monthly in-home care benefits and the policy pays them directly to the senior, she can use that money to pay you.
If, on the other hand, the policy requires that payment be made only to a state-certified in-home care aide, check with the National Family Caregivers Association or the Family Caregiver Alliance to find out the requirements in your state for getting such certification yourself. Often, low-cost certification classes are offered at local adult schools or community colleges.
Back to TopDrawing up a personal care agreement
If the person you're caring for is going to pay you -- from any source, including independent funds -- for care giving, it's a good idea to draw up a simple contract that sets out the terms of the care and payment. This can help avoid uncertainty and disagreement between you and your parent about what you're supposed to be doing and when. Also, it can help avoid misunderstandings with other family members about who's supposed to be providing care and about where your parent's money is going. If your parent ever needs to enter a nursing home and isn't already on Medicaid, the agreement will show that these payments to you were legitimate, and not just an attempt to "hide" her funds in order to qualify for Medicaid. To find out more about why a personal care agreement can be a good idea, and how to go about drafting one, see Prepare a Personal Care Agreement With Your Parent.
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