How to Get Paid for Being a Family Caregiver

Where to find the funds and how to settle on the terms for providing in-home care.
Mother and daughter

If you're one of more than 70 million people who provide unpaid caregiving 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 caregiving 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 person receiving care 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 the 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.

SEE ALSO: Find In-Home Care Help Near You

Medicaid 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 California) healthcare coverage. This includes in-home care, which can mean some low-level healthcare monitoring and services but which usually consists mostly of personal care -- the same kind of care you probably provide: help with bathing, dressing, cooking, cleaning, eating, moving around, and similar activities of daily living.

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.

SEE ALSO: Find In-Home Care Help Near You

In-Home Care on Medicaid: How Cash and Counseling Programs Can Help

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.

Seniors can then use the money to pay anyone of their choosing -- including you or other family members -- to provide care. They can also use some of the money to buy things for the home that would make life more comfortable, such as kitchen items, a new vacuum cleaner, safety equipment, or the like. Or they 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: Alabama, Arkansas, Florida, Illinois, Iowa, Kentucky, Michigan, Minnesota, New Jersey, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia. Other states have programs similar to Cash and Counseling, offering cash for in-home care to seniors who have little money but whose income or assets are slightly too high for them to qualify for Medicaid in that state.

How the cash assistance programs work

Cash assistance programs have several components and application processes and eligibility vary among states:

SEE ALSO: Find In-Home Care Help Near You

  • Eligibility. If the seniors you're caring for don't already have Medicaid coverage, you can help them apply for Medicaid or another cash assistance program. This means gathering bank, tax, and other records that show how much they have in income and assets. Medicaid (or the other relevant cash assistance program) can then determine if they're financially eligible.
  • Assessment. If the seniors you're caring for are financially eligible, the program will come to their residence to assess their in-home care needs. They'll speak with you and other caregivers about the care currently provided, and they may speak to their doctor.
  • Determination. Based on the assessment of 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 seniors every month to help with in-home care.
  • Plan. The seniors decide who they want to provide the care and how much they'll pay you or other caregivers out of the program's monthly payment. (It has to be at least minimum wage, but it can be any reasonable amount you and they agree on.) They can also decide how else they might want to spend some of the money. The program helps seniors work out this plan, including paperwork and taxes.

Finding out about state programs where you live

To find out whether your state has a consumer-directed cash assistance program for seniors, 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 your nearest Area Agency on Aging and ask them who to call in your state to learn about direct payment programs for in-home care.

Long-Term Care Insurance and Family Care Agreements

Veteran's benefits

Veterans needing home-based care may be eligible for Veteran-Directed Home and Community-Based Services (VD-HCBS). This program serves veterans of any age who are at risk for institutional placement by providing home and community-based services that allow vets to continue to live independently in their own homes. Beneficiaries can choose the mix of goods and services that best meet their needs and manage their own flexible spending budgets for personal care services, which can mean hiring their own workers, including family and friends. For more information on VD-HCBS and to find program contacts in each state, visit the partner organization web site National Resource Center for Participant-Directed Services.

Long-term care insurance benefits to family caregivers

SEE ALSO: Find In-Home Care Help Near 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 this type of certification yourself. Often, low-cost certification classes are offered at local adult schools or community colleges.

Drawing up a personal care agreement

If the person or people you're caring for are going to pay you (from any source, including independent funds) for caregiving, 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 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 where the money is going. If the person or people you're caring for ever need to enter a nursing home and aren't already on Medicaid, the agreement will show that these payments to you were legitimate, and not just an attempt to "hide" funds in order to qualify for Medicaid. Find out more about why a personal care agreement can be a good idea, and how to draft one.

Dependent tax exemptions

If none of the direct pay options apply to you, investigate whether you're eligible to claim your parent or other qualifying relative as a dependent on your income tax return. Your relative does not have to live in your residence, but in order to qualify, you must cover more than 50 percent of their basic living expenses, including housing, food, medical services, and clothing. Several requirements must be met. For example, your relative’s earned income must be less than $3,900 (2013 tax year). Non-taxable income such as Social Security does not count toward this limit. For more information and to see if you qualify, check with your tax professional or view IRS information on the subject.

5 days ago, said...

Hello I have been taken care of my uncle with everyday things like cooking,cleaning,grocery shopping, doctors appointments and picking up his meds. He is o2 depend it and he does have Medicaid and we live in nh just wondering how can I get paid to take care of him?

2 months ago, said...

My dad has United Healthcare as his supplemental and they cover home health care but I have to go through a certified home care agency problem I run across is all that Ive contacted says he needs to be on medicaid also well supposedly he doesnt qualify for medicaid but If United Healthcare will pay why wont the homecare agencies atleast call and verify his insureance . Im loosing everything but All my dad has is me!!!

2 months ago, said...

I need immediate help. I currently take care of my mom full time. Her SSI is pending and im trying to get help through Elder Options. The friend that was helping us get by wont be able to help anymore and financially I dont know what to do. I appreciate any feed back. A lot of these things ive tried and they lead to dead ends, I appreciate any feed back.

2 months ago, said...

I have recently had to let my job go. Due to my husband health issues, she needs help around the house and he falls a lot. So I can't leave him alone. Can I become a paid caregiver to help balance out my monthly expences.

3 months ago, said...

Hello,i am a 38 years old mom who unfortunately get a disable boy age of 3 .Since he is born I stopped working and did everything to take care him.I did learn from doctors and nurse how to manage my son.Now he finish early intervention and start preschool with a nurse but I see that the way I can manage my son nobody can.Is that anyway in this world a mom who doesn't have a social sn and a working permit,just have an tax identification number ,I am an immigrant and tried with USCIS but get denied because I pass the I 94 date,and not authorized to stay in the USA.This is a double case but I just want to work for my son and get paid because the money is truely needed and the real problem ,the nurse is getting paid when you are doing the work and they add stress on you because for anything your son will be send home and living with this you can be concentrate in any job.I am desperate really with the system.

4 months ago, said...

how can I get paid to help take care of a family member. I've been taking care of my uncle since my grandparents have passed, he is disabled and needs help with everyday things. He is on a very limited income and cant afford to pay me to do his everyday things like, grocery shop, clean the house, laundry, fix meals, I don't live by him so I have to travel everyday to tend to him....can u please help with my questions..thank you angel higgins

4 months ago, said...

I want to be a caregiver to my grandmother in law and was wondering how to apply for it and get paid for caring for her and taking her places to. She has Medicare but we don't know if she is being cover all the way without wasting money to pay the doctor a fee or something like that. We stay in Georgia and trying to find out everything right now.

4 months ago, said...

Hello. I was wondering if I can get help with a few questions . I care for my mother who is retired and her health has declined . She is unable to care for herself so he moved in with me and my youngest son . We live in Michigan. She has had many operations which didn't help (she has scoliosis, spinal stenosis and other issues with her back) I have had to leave my job three years ago due to not being able to work my scheduled days due to her doctor appointments , surgeries and ER trips. We applied for medicaid for her but was denied . She only has a small pension as well as soc sec from retirement. She is paying for her own insurance through Humana working with medicare. She is not able to walk without assistance because she falls even with her walker . She can't cook or take care of herself because she is so weak and frail . She is in bed most f the time. I had to return to work after exhausting all of my financial resources such as saving etc. I am unable to work many hours as she is not able to go a long without needing help. We do not want anyone else caring for her . She refuses anyone but me and I honestly do not want someone else caring for my Mom or in my home with her and my youngest son who is also a medical needs child but he goes to school ...and that is when I go to work. I get home when he does . Her Humana says they will pay for a part time care giver but they won't pay me . Again we do not want a stranger caring for her or in my home. I am finding it so very hard to make ends meet especially with a mortgage . I really hope that someone can direct me on how I may be able to get some compensation for caring for my mother ....even though I do care for her without hesitation as she has always taken care of us when we were young . It doesn't feel right hoping to get some sort of pay for caring for her but in order to survive and pay our bills as well as put food n the would help so much . I read some things on here but it branches off in so many directions that I thought it might be easier to ask. Thank you so much .

4 months ago, said...

My fiancé & I have been together 9 yrs. almost and I just turned 36 and for the whole time we've been together, I'm totally disabled and live in GA..I need to know what he can do to get paid to take care of me bc I had home health before and I had 4 different people who came to take care of me and he's the one who knows what I need and has to physically carry me some days and some of the people the company sent couldn't hv physically done that, I go to pain management but meds hv stopped helping and I hv a back brace, both knees, a rare syndrome and go to specialists and everybody is too scared to touch me bc of my deformities. My fiancé can't work, we hv a 5 yr. old, and he also has to try to take care of him also, they said my condition would never get better can someone please help us!?!

4 months ago, said...

live in Missouri, my brother s already on (Medicare/medicaid) lives with me and I care for him. I'm paid by an agency an hr. rate for 26hours and 25 min a week. They also provide a nurse who visits once a week who claims vitals, sets up pills. I want to move to Florida, and will bring my brother along, how do I sign up for your Fl. Program so my brother can get the help he needs?

4 months ago, said...

How do I get paid to take care of my boyfriend he is disabled and it's hard to find out how.

5 months ago, said...

My situation I have a 22 try old disabled son. He lives at home with me. My soon to be ex-husband wants to place him in a home . I believe he's better in home with me. I'm a stay at home mom. Please help me to be able to keep him home

5 months ago, said...

Hey i was woundering how I can get my husband to work for home so he can keep a eye on me cus I can't be a lone due to i faint at any moment please can anyone help

5 months ago, said...

I'm taking care of my boyfriend at home,(he is laid up for about 3 months or longer)I was wondering if I can get paid by the state to care for him while he gets better(this just temporary)or until the doctor says differently.

5 months ago, said...

I am getting ready to go home from a nursing facility. Does medicaid pay to help me to get back on my feet, I.e.. rent, food, transportation, electricity

6 months ago, said...

I am a member. I get emails from people on this site with questions. when I follow the link to here, sign in, and try to find the article it is not here. Since I go to many of the conversations on your site how can I find the person that is contacting me? i have put his name in the above search engine but nothing comes up. Darlene