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How to Become a Paid Caregiver for a Family Member: 6 Steps to Uncovering Financial Assistance Options for Family Caregivers

Serving as a caregiver for a family member is one of the most rewarding jobs you can do. Not only do you get to spend time with your loved one, but you have the opportunity to ensure she receives the best quality care possible. You don’t have to worry about strangers who may not be sympathetic or attentive caring for your loved one when you become the primary caregiver.

Unfortunately, being a caregiver for a family member carries a price. Caregivers often have to significantly reduce their number of hours working outside the home or leave their jobs completely in order to provide quality care for their loved one. This means that caregivers are spending hours assisting loved ones with daily tasks, cooking meals, taking them to appointments, ensuring their safety and well-being, and providing companionship but are not being compensated for their time.

One study shows that 31.3% of caregivers who help significantly impaired people have financial difficulties related to caregiving, and another study shows that caregiving increases the likelihood that women will experience poverty or rely on public assistance. Thus, caregivers lose a great deal of income when they care for their loved ones yet also often have to pay for caregiving expenses out of their own pockets.

That’s why caregivers need to know how to get paid for taking care of their loved ones. We share a few steps you can take to receive compensation for caring for your family member:

  1. Determine your eligibility for Medicaid’s Cash & Counseling Program
  2. Opt into a home and community-based services program
  3. Determine whether your loved one is eligible for Veterans Aid
  4. Determine whether your loved one has a long-term care insurance policy that provides for caregiver compensation
  5. Determine whether your company offers paid leave for caregivers
  6. Determine whether your family is willing to pay you for your caregiving time

If you need to become a paid caregiver, look into the following possibilities for caregiving compensation.

Step 1: Determine Your Eligibility for Medicaid’s Cash & Counseling Program

If your loved one is eligible for Medicaid, you may receive financial aid from the Cash & Counseling Program. This program is available in 15 states and provides people with disabilities, including senior citizens, the option to manage a budget and determine how to use their money to pay for goods and services directly relating to their personal care needs. Program participants may use their budget from the Cash & Counseling Program to hire and pay for caregivers, so you may be able to receive payment if this financial aid program is available in your state. To determine your family member’s eligibility for this program, contact your local Medicaid office.

Step 2: Opt into a Home and Community-Based Services Program

Many seniors are eligible to opt into a home and community-based services program (HCBS). HCBS programs, such as services provided by Caregiver Homes, deliver ongoing support and care oversight to assist caregivers while providing them with a tax-free daily stipend to make the financial burden of caregiving easier to bear.

These programs typically are available to Medicaid beneficiaries who receive in-home care. And, these programs are not limited to seniors; they often are available to people with intellectual or developmental disabilities, physical disabilities, or mental illnesses. Overall, the guidance and financial assistance HCBS programs provide to caregivers enable them to focus on providing quality care instead of worrying about financial problems.

Step 3: Determine Whether Your Loved One Is Eligible for Veterans Aid

Around the United States, some veterans who are in danger of being placed in nursing homes can enroll in Veteran-Directed Home and Community Based Services programs that empower them to manage their own care, which includes hiring and paying for in-home caregivers. Another option for veterans who require in-home care is a benefit known as Aid and Attendance. This benefit may be used to cover assisted living, nursing home, and in-home care costs including paying family caregivers.

In many cases, your loved one must need assistance with activities of daily living and fall in line with income and asset guidelines. If you need more assistance in determining your loved one’s eligibility for these veterans benefits, contact your local Veterans Affairs office or your local veterans service organization.

Step 4: Determine Whether Your Loved One Has a Long-Term Care Insurance Policy That Provides for Caregiver Compensation

According to the American Association for Long-Term Care Insurance (AALTCI), some long-term care insurance policies do include provisions for paying a family member who provides care. First, you need to determine whether your loved one has such a policy. Then, you need to determine if caregiver payment is one of the benefits included in the policy. If you need clarification about your loved one’s long-term health insurance policy, contact the agent or the insurance company and specifically ask about the caregiver payment benefit.

Step 5: Determine Whether Your Company Offers Paid Leave for Caregivers

As more families require at least one member to serve as a caregiver for aging parents, companies are realizing that they need to assist employees with paid leave. If you find yourself serving as a caregiver to a family member while you are employed, your company may offer an elder care program or benefit. Companies like Deloitte and Nike are allowing up to 8-16 weeks of paid leave for caregiving employees, and nearly 20% of companies today offer some form of paid family leave with a provision for caring for an elderly parent.

Step 6: Determine Whether Your Family is Willing to Pay You for Your Caregiving Time

Considering the amount of money you are saving your loved one and the rest of the family by serving as the primary caregiver, you are well within your rights to ask your loved one or other family members if they will compensate you for your time. Chances are, the family would be paying out of pocket for a home health aide, which the Genworth Cost of Care Survey reports would cost an average of $3,861 per month. To protect yourself and your family, meet with an attorney to draft a contract to explicitly state your work and payment schedule. This contract may be used later in the event your loved one needs to apply for Medicaid or enter an assisted living facility or nursing home.

Overall, you need to know your loved one’s eligibility for various government programs, insurance policy benefits, employee benefits, and family payment options if you hope to become a paid caregiver for a family member. Spending a few hours determining your eligibility will be worth it when you get compensated for all of the time and energy you give to provide loving, attentive care for your loved one.

STEPS TO OBTAINING FINANCIAL ASSISTANCE FOR CAREGIVERS BY STATE

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Caregivers in need of financial assistance often find it difficult to determine what services are available to them in their state and local area, let alone navigate the options once they figure out where to go. The programs available differ by state, and in some cases, from county to county. To help you navigate the options available to you, we’ve put together a step-by-step, state-by-state guide to help you obtain financial assistance for caregiving services.

Note that not all states make this option available, and some states have restrictions on the family members that may be hired as caregivers. We’ve also included helpful resources to find your local Aging and Disability Resource Center or local Area Agency on Aging to get in touch with local experts who can provide further guidance. Finally, we’ve provided information on the states that offer Veteran-Directed Home and Community Based Support Waiver programs (VD-HCBS) as well as links to the state Veterans Administration to make it easy for you to get in touch with the right representatives for the help you need. Click on a state below to go directly to the information for your state: 

 

Alabama

Alabama offers the Alabama Cares Program, which is administered under the Alabama Department of Senior Services (ADSS) through the 13 Area Agencies on Aging (AAA). This program offers assistance to caregivers including information, respite care, caregiver access assistance, and supplemental services including meals, assistive technologies, incontinence supplies, and more to caregivers of qualified individuals.

 

The Alabama Medicaid Elderly & Disabled Waiver Program is available to eligible Alabama residents, providing services for elderly and disabled persons who qualify for Medicaid financially and would otherwise quality for placement in a long-term care facility. Services include case management, personal care, homemaker services, respite care, companion services, adult day care, and nutrition and meals. The Personal Choices program enables Alabama seniors to select and manage their own care providers and is available to Medicaid participants who are currently receiving services under the State of Alabama Independent Program (SAIL). More information on Medicaid for the Elderly & Disabled, including information on applying for Supplemental Social Security Income (SSI) can be found here.

Alabama does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Alabama:

  1. Review Medicaid eligibility requirements. If eligible, you may apply for Medicaid in Alabama online or by contacting one of Alabama’s Medicaid District Offices for assistance.
  2. Contact the Alabama Department of Senior Services.
  3. Complete the Application for a §1915(c) Home and Community-Based Services Waiver.
  4. Evaluate other waiver program options in Alabama, including:
    1. State of Alabama Independent Living (“SAIL”) Waiver
    2. Intellectual Disabilities (“ID”) Waiver
    3. Living At Home (“LAH”) Waiver
    4. Technology Assisted (“TA”) Waiver for Adults
    5. Alabama Community Transition (“ACT”) Waiver
  5. Contact the Alabama Department of Rehabilitative Services at 1-844-602-7275 for information on the SAIL Waiver, including information on how to apply.
  6. Contact your local Area Agency on Aging (AAA) and Aging and Disability Resource Center (ADRC) by calling 1-800-AGELINE (1-800-243-5463) for more information on local programs and assistance with determining program eligibility and accessing programs.

 

Alaska

The Alaska Commission on Aging (ACoA), under the Alaska Department of Health and Social Services, engages in planning, advocacy, and interagency collaboration on issues impacting older Alaskans. The ACoA collaborates with the Division of Senior and Disabilities Services and the Alaska Mental Health Trust Authority on program development, grand fund allocation, and more.

The state of Alaska offers a Personal Care Services (PCS) program, which provides assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, and eating, as well as instrumental activities of daily living (IADLs) such as meal preparation and assistance with medications, for eligible seniors. The program operates in two primary ways: under the Agency-Based PCA Program (ABPCA), the state hires and manages care personnel who provide services, while under the Consumer-Directed PCA Program (CDPCA), participants manage their own care services and may hire friends or certain family members to provide care; however, spouses and legal guardians may not be hired as care providers under this program.

Home and Community Based Waiver Programs are also available in Alaska, as well as grant programs for those who are waiting or don’t qualify for Home and Community Based services under the Medicaid Waiver program, or for those who only require minimal support offered by grant services. Grant funds provide support for “families and individuals experiencing Developmental Disabilities (DD), Alzheimer's Disease and related Disorders (ADRD), family caregivers of seniors aged 60 and over, grandparents raising grandchildren aged 55 or over, seniors aged 60 and over, and/or frail or disable seniors who need assistance in the home.”

Alaska’s VD-HCBS program is offered through the Anchorage, AK VA Medical Center.

How to obtain financial assistance for caregivers in Alaska:

  1. Evaluate Alaska’s Senior Benefits services to determine eligibility.
  2. Determine eligibility for Medicaid, and if eligible, submit an application (you may also apply online at alaska.gov).
  3. Apply for the Personal Care Services (PCS) program if eligible.
  4. Apply for Alaska’s Home and Community Based Waiver program.
  5. Evaluate Alaska’s grant programs to determine eligibility and apply for grants you’re eligible for.
  6. Contact your local Area Agency on Aging and Aging and Disability Resource Center (ADRC) for more information on local programs and assistance with determining program eligibility and accessing programs.
  7. Contact the Alaska VA Healthcare System for information on the VD-HCBS program if your loved one is a Veteran.

 

Arizona

Arizona’s Department of Economic Security (DES) Division of Aging and Adult Services (DAAS) provides non-medical home and community-based services for qualified individuals. These services are offered through local Area Agencies on Aging (AAA), and the AAA may also provide caregiver support services. However, the DES Division of Aging and Adult Services doesn’t offer programs that enable family caregivers to be paid for providing care for a loved one.

The Arizona Long Term Care System (ALTCS), Arizona’s Health Care Cost Containment System (AHCCCS) (the state’s Medicaid program) is the only agency that offers such a program. The individual receiving care must either be eligible to receive or already receiving benefits and/or services under the ALTCS programs. Caregivers for these individuals would apply to become an employee through a AHCCCS/ALTCS contracted home health care agency, and after passing rigorous screening and eligibility processes, would be able to receive payment for providing care services to their loved one. This is known as the Self Directed Attendant Care (SDAC) Program.

Arizona does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Arizona:

  1. Determine Medicaid eligibility and follow the application process if your loved one meets the criteria.
  2. Contact your local ALTCS office. You may also get in touch with the AHCCCS/ALTCS program by calling 602-417-6600.
  3. Visit Arizona’s Family Caregiver Support Program (FCSP) for more information on caregiver support services in your area.
  4. Get in touch with your local Area Agency on Aging (AAA) for information on the Home and Community Based Waiver program, including eligibility criteria and application information, as well as information on accessing FCSP programs.
  5. Visit Arizona’s Aging and Disability Services (ADS) website for more information on programs for older adults in Arizona.

 

Arkansas

The Arkansas Department of Human Services, Division of Aging and Adult Services, administers the Family Caregiver Support Program for the state. Under the FCSP, services for family caregivers are provided by local Area Agencies on Aging (AAA), including information, respite care, assistance, counseling, and limited supplemental services such as home modifications and transportation.

Arkansas also offers a grant program for family caregivers, the Arkansas Independent Choices program. This is a member-directed option for seniors and disabled persons following the “Cash and Counseling” model, in which a monthly stipend is provided to qualifying individuals to pay for care services. Under this model, recipients may elect to use funds to pay for personal care, including hiring a friend or family member to provide personal care services; however, spouses and legal guardians may not be hired as caregivers through this program.

The state’s Medicaid Home and Community Based Waiver program is called Elderchoices and provides services such as homemaker services, adult day care, meals, and more. The Program of All Inclusive Care for the Elderly (PACE) is a joint Medicare-Medicaid program that also emphasizes consumer-directed care.

Arkansas offers a VD-HCBS program through the Little Rock and Fayetteville, AR VA Medical Centers.

How to obtain financial assistance for caregivers in Arkansas:

  1. Determine Medicaid eligibility and find out how to apply by visiting the Arkansas Department of Human Services.
  2. Get in touch with your local Area Agency on Aging (AAA) for information on local programs, eligibility, and application information.
  3. Evaluate grant program options and eligibility. Contact the Arkansas Independent Choices Program by calling 1-844-581-6018.
  4. Determine eligibility for the Elderchoices program. Get in touch with your local DHS County Office for application information, or call the Division of Aging and Adult Services at 501-682-2441 or the Choices in Living Resource Centerat 1-866-801-3435 for information on Elderchoices or the PACE program.
  5. Visit the Division of Aging and Adult Services for more information on programs for the elderly and disabled in Arkansas.
  6. Veterans should contact the Arkansas Department of Veterans Affairs for information on the VD-HCBS program.

 

California

California’s Department of Aging offers a Family Caregiver Support Program with funding from the U.S. Administration on Aging through the state’s 33 Area Agencies on Aging (AAAs). The AAAs coordinate local programs to assist family caregivers who are caring for a senior loved one. Services include information for caregivers, help with gaining access to services, training, counseling, respite care, and limited supplemental services aiming to complement the care provided by a family caregiver. These services are provided either directly by AAA staff or through partnerships with public or private agencies.

Additionally, California’s Medicaid program offers an In-Home Support Services (IHSS) program which pays for services provided to qualifying seniors to enable them to remain in their own homes, such as housekeeping, meal preparation, laundry, grocery shopping, and personal care services. The recipient is responsible for hiring, training, and supervising their individual provider.

California’s VD-HCBS program is offered through the San Diego VA Medical Center.

How to obtain financial assistance for caregivers in California:

  1. Apply for Medi-Cal (California’s Medicaid program) by calling 1-866-550-4355, through your local county assistance office, or online through COMPASS.
  2. Contact the AAA’s Information & Assistance program for information about local programs and services, eligibility criteria, and application information by calling 1-800-510-2020.
  3. Visit the California Department of Social Services for contact information for your local Social Services office.
  4. Complete an IHSS application and submit it to your local IHSS office. A complete list of local IHSS offices can be found here.
  5. Get in touch with your local Area Agency on Aging (AAA) for information on programs and services offered in your area.
  6. Veterans should contact the California Department of Veterans Affairs for information on the VD-HCBS program.

 

Colorado

The Colorado State Unit on Aging is part of the Department of Human Services, overseeing a variety of programs and services for older adults including caregiver support, nutrition services, legal services, and aging and disability resources. The National Family Caregiver Support Program (NFCSP) provides information, respite care, counseling, assistance for caregivers who need help gaining access to available services, and limited supplemental services such as home modifications, assistive technologies, emergency response systems, and other equipment and supplies.

Colorado’s AAAs also provide supportive services including transportation, outreach, care coordination, in-home services, home health care, and other services aimed at helping older adults remain in their homes independently. Alongside the AAAs, Aging and Disability Resources for Colorado (ADRC) aids individuals in planning for their long-term care needs, provides personalized assistance to empower older adults and their caregivers to make informed decisions, and more.

In-Home Support Services (IHSS) includes an Elderly, Blind, and Disabled (EBD) waiver program that enables recipients to direct their own care with the added support of an agency. The program is an added benefit offered by Health First Colorado, Colorado’s Medicaid program, for qualified individuals.

The Colorado VD-HCBS program is available through the Grand Junction and Denver VA Medical Centers.

How to obtain financial assistance for caregivers in Colorado:

  1. Determine eligibility for Medicaid by visiting Health First Colorado and applying for benefits.
  2. Contact a Single Entry Point (SEP) Agency to apply for the Elderly, Blind, and Disabled (EBD) waiver through Colorado’s In-Home Support Services program.
  3. Determine eligibility for the Program of All-Inclusive Care for the Elderly (PACE) (a joint Medicare-Medicaid program) and inquire about services available. You may also inquire about PACE through a Single Point of Entry Agency. You must apply for PACE through a local PACE organization, which can be found here.
  4. Contact your local ARDC office by calling 1-844-COL.ADRC (1-844-265-2372) for information on programs and services.
  5. Get in touch with your local Area Agency on Aging (AAA) for information on the NFCSP and other programs and services available in your local area, eligibility criteria, and application information.
  6. Veterans should contact the Colorado Division of Veterans Affairs for information on the VD-HCBS program.

Connecticut

The state of Connecticut has five Area Agencies on Aging (AAAs) under the Department of Rehabilitation Services, State Unit on Aging. AAAs receive funding from the Federal Older Americans Act (Title III) which are then allocated to elderly service providers through a request for proposal (RFP) process. These services are offered through the National Family Caregiver Support Program (NFCSP).

The Connecticut Home Care Program for Elders (CHCPE) and the Personal Care Assistance (PCA) Waiver Program are programs offered by the Connecticut Department of Social Services (DSS). These programs help seniors over the age of 65 and adults between the ages of 18 and 64, respectively, employ personal care attendants to help with activities of daily living (ADLs) and other needs such as housekeeping and meal preparation. Note that family members are not eligible to be paid as caregivers, except under rare circumstances, under this program.

Under the Adult Family Living (AFL) program, however, “Personal care and supportive services, (homemaker, chore, attendant services, meal preparation) that are furnished CHCPE & PCA participants who reside in a private home by a principal caregiver who lives in the home,” with the exception of spouses or legal guardians. 

The VD-HCBS program in Connecticut is offered through the West Haven, CT VA Medical Center.

How to obtain financial assistance for caregivers in Connecticut:

  1. Determine eligibility for HUSKY Health, Connecticut’s state Medicaid program and apply for benefits by visiting ConneCT.
  2. Visit the Connecticut Home Care Program for Elders (CHCPE) website for information on eligibility and how to apply.
  3. Contact your local Department of Social Services office for information on applying for a Personal Care Assistance (PCA) wavier.
  4. Get in touch with Caregiver Homes of Connecticut to learn more about the Adult Family Living program, eligibility criteria, and how to apply.
  5. Contact your local Area Agency on Aging (AAA) to learn more about programs in your area, eligibility criteria, and how to apply.
  6. Veterans should contact the Connecticut Department of Veterans Affairs for information on the VD-HCBS program.

 

Delaware

The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) offers a number of services to provide help for caregivers, including adult day services, Alzheimer’s day treatment, respite care, and more. The Lifespan Respite program provides vouchers to eligible caregivers to pay for care for their care recipient to allow them to take a break from their caregiving responsibilities. Eight Caregiver Resource Centers are located throughout the state of Delaware to provide information, assistance, and support to family caregivers.

Delaware also offers both Personal Care and Personal Attendant Services Programs. Under the Personal Care program, various services are provided to enable a care recipient to live independently in the community, such as assistance with personal hygiene, light housekeeping, meal preparation, and similar activities. Under the Personal Attendant Services Program, participants serve as employers of their own attendants, who provide services similar to those offered under the Personal Care program. Assistance may also be available for assistive devices, home modifications, and emergency response systems; more information on these services can be found here.

Delaware’s Diamond State Health Plan - Plus (DSHP-Plus) is Delaware Medicaid’s managed long-term care program, which includes a Long Term Care Community Services (LTCCS) Program that allows for consumer-directed services such as personal care assistance. Under this program, some family members can receive payments for providing caregiving services, including spouses and adult children.

Delaware does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Delaware:

  1. Visit Delaware ASSIST to review eligibility requirements and apply for Delaware Medicaid benefits.
  2. Contact the Delaware Aging and Disability Resource Center at 1-800-223-9074 or visit the DADRC website here for information on caregiver support programs and how to apply for these services.
  3. Inquire about the Personal Attendant Services Program through the DADRC.
  4. Contact the Division of Medicaid and Medical Assistance for information on the Diamond State Health Plan – Plus and the Long Term Care Community Services program.

 

Florida

Florida’s Department of Elder Affairs administers the National Family Caregiver Support Program, which provides information and assistance to caregivers of frail elderly relatives or other loved ones. Florida’s Home Care for the Elderly (HCE) program provides support for Florida residents age 60 and older who are living in family-type living arrangements as an alternative to nursing homes or other long-term care settings. In some cases, subsidies may be provided for services or supplies, although a basic subsidy (which averages $106 per month) is provided for all participants.

The Community Care for the Elderly (CCE) program “provides community-based services organized in a continuum of care to help functionally impaired elders live in the least restrictive yet most cost-effective environment suitable to their needs.” Under this program, clients receive a range of services including adult day services, personal care, shopping assistance, respite care, and more. The Department of Elder Affairs also provides a number of other services for elderly Floridians.

Florida’s Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) includes a Participant Directed Option (PDO) that allows elderly Floridians or their designated representatives to hire, train, and manage care providers, and spouses and adult children may be hired and receive compensation for caregiving services under this program.

Florida offers a VD-HCBS program through VA Medical Centers in several locations including Bay Pines, Tampa, Gainesville, Orlando, Miami, and West Palm Beach, FL.

How to obtain financial assistance for caregivers in Florida:

  1. Determine eligibility for Florida Medicaid. If eligible, apply through Access Florida. More information on Medicare and Medicaid, as well as other benefits options, can be found here.
  2. Contact your local Aging and Disability Resource Center for information on applying for the HCE program.
  3. Call the Elder Helpline at 1-800-96-ELDER (1-800-963-5337) to find out where your nearest ADRC is located or to inquire about other services that may be available to you. Individual office numbers can be found here.
  4. Veterans should contact the Florida Department of Veterans Affairs for information on the VD-HCBS program.

 

Georgia

The Georgia Department of Human Services, Division of Aging Services is the entity that oversees and administers services provided for the aging population in Georgia. Georgia offers both Medicaid-funded services through the Community Care Services Program (CCSP) and non-Medicaid-funded services through the Home and Community Based Services Program (HCBS). The Division of Aging Services contracts with Georgia’s 12 Area Agencies on Aging to administer the HCBS program, which consists of services such as home-delivered meals, senior recreation, emergency response services, home modifications, personal care assistance, and more. HCBS also includes services for caregivers including education and support groups, adult day services, mobile day care, and kinship care programs.

CCSP is a Medicaid waiver program administered by the Department of Community Health (DCH) and includes services similar to those offered under the HCBS program, such as personal support services, adult day health, alternative living services, and others, as well as a Consumer-Directed PSS Option (CD-PSS). Under CD-PSS, the consumer hires and supervises personal care assistants of their choosing. Participants must also enroll in Financial Management Services. Under CCSP in Georgia, however, spouses cannot be hired and compensated as caregivers. Typically, family members are only hired as caregivers in rural areas or in unique conditions that make it difficult to find home care providers.

Georgia does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Georgia:  

  1. Visit Applying for Medicaid for information on eligibility and how to apply for Medicaid in Georgia. You can also apply online by visiting the GA COMPASS online portal. Additional information on Georgia Medicaid can be found here.
  2. Call (866) 552-4464 to connect with your local Area Agency on Aging in Georgia, or visit this page to find contact information for the location nearest to you.
  3. Inquire with your local AAA about eligibility for CCSP or HCBS and how to apply.

 

Hawaii

Under the Hawaii Department of Human Services, the State of Hawaii Med-QUEST Division (MQD) administers the state’s Medicaid program. Under Med-QUEST, HBCS waivers are replaced by a Managed Care Organization (MCO), which centralizes administration of beneficiaries’ health and personal care services. Med-QUEST offers funding for home health care, adult day care, personal care, and respite care, although only personal care and respite care are eligible for consumer-directed care. Under the consumer-directed care model, some family members and friends can be compensated for providing caregiving services.

The State of Hawaii Department of Health, Executive Office of Aging administers the Family Caregiver Support Program, which provides caregiver support services to caregivers of eligible care recipients, with the goal of enabling recipients to remain in their home environment. The Kupuna Caregivers Program, administered by the Hawaii Aging and Disability Resource Center, provides eligible working caregivers with up to $70 per day to cover the cost of adult day care, home-delivered meals, personal care or homemaker services, respite care, or transportation.

Additionally, the Chore Services Program is a non-Medicaid-funded program managed by the Department of Human Services’ Adult Protective and Community Services Branch, providing assistance to elderly or disabled Hawaii residents with household tasks and assistance with activities of daily living (ADLs). Participants are able to choose their own care providers, including certain family members, friends, and neighbors. 

Hawaii offers a VD-HCBS program through the Honolulu, HI VA Medical Center.

How to obtain financial assistance for caregivers in Hawaii:

  1. Determine eligibility for Medicaid and, if you meet the eligibility requirements, apply for coverage.
  2. Contact your county Office of Aging for information on caregiver support services, other programs, and eligibility and application information. Contact information for local offices can be found on this page.
  3. Visit this page to answer a few questions to assess your needs. After completing the questionnaire, you’ll be directed to resources on programs and services that can best meet your needs.
  4. For information on the Kupuna Caregivers Program, long-term support, and other services, contact the Hawaii Aging and Disability Resource Center (ARDC). You can also reach the statewide ARDC by calling (808) 643-2372 or the ADRC TTY line, (808) 643-0899.
  5. Contact the Department of Human Services’ Adult Protective and Community Services Branch at 808-832-5115 for eligibility information and how to apply for the Hawaii Chore Services Program.
  6. Veterans should contact the VA Pacific Islands Health Care System for information on the VD-HCBS program.

 

Idaho

The state of Idaho does not offer a non-Medicaid-funded, consumer-directed program for in-home care services, although those eligible for Medicaid may be able to participate in the Idaho HCBS Aged & Disabled Medicaid Waiver. The HCBS Aged & Disabled Medicaid Waiver is administered by the Idaho Department of Health and Welfare.

Under the HCBS Waiver, some services may be participant-directed, including attendant care, homemaker and chore services, companion services, and skilled nursing. Other services are offered under the waiver which are not eligible for participant direction, including non-medical transportation, home modifications, respite care services, adult day care, and more. While participants are able to hire and manage care providers of their choosing for participant-directed services, including some family members and friends (provided that they meet qualification criteria and pass a background check), participants are required to utilize a third-party financial management agency to process payroll.

Idaho offers a VD-HCBS program through the Boise, ID VA Medical Center.

How to obtain financial assistance for caregivers in Idaho:

  1. Contact your regional Idaho Department of Health and Welfare office for information on Medicaid eligibility and application information.
  2. Complete an application for the HBCS Aged & Disabled Medicaid Waiver.
  3. Contact your local Aging and Disability Resource Center (ADRC) for information on other programs and services that you may be eligible for.
  4. Veterans should contact the Idaho Division of Veterans Services for information on the VD-HCBS program.

 

Illinois

There is currently no non-Medicaid-funded, participant-directed caregiving program in the state of Illinois. However, older adults may be eligible for the Community Care Program, a Medicaid-funded, consumer-directed program managed by the Illinois Department on Aging. These services were formerly offered under the My Choices Program, which was terminated in 2016. Under the Community Care Program, a variety of supports, services, and technologies are provided to eligible participants who are at risk of being placed in a Medicaid-funded nursing home in order to enable them to remain in their own homes. This program is offered through the Home and Community Based Services Waiver.

Services offered under the Community Care Program include adult day services, homemaker services, medication management, transportation, and more. While the former My Choices Program offered more flexibility in choosing a care provider, the Community Care Program is a bit more restrictive. Care providers must offer services in the client’s geographic area of residence and must be approved by the department.

Illinois offers a VD-HCBS program through several VA Medical Centers including the Danville, North Chicago, Chicago, Hines, and Marion, IL locations.

How to obtain financial assistance for caregivers in Illinois:

  1. Visit the Illinois Department of Healthcare and Family Services for information about Medicaid eligibility in Illinois.
  2. If eligible, apply for Illinois Medicaid coverage.
  3. Contact your local Community Care Program Care Coordination Unit (CCU) to apply for the HCBS Waiver and the Community Care Program.
  4. Contact the Senior Helpline at 800-252-8966 or get in touch with your local Illinois Area Agency on Aging for information on other services and programs for caregivers in Illinois.
  5. Veterans should contact the Illinois Department of Veterans Affairs for information on the VD-HCBS program.

 

Indiana

The Indiana Aged and Disabled Medicaid Waiver includes a consumer-directed option known as the Consumer-Directed Attendant Care Program (CDAC) Program. This program is part of the Home and Community Based Services (HBCS) Waiver and is administered by the Family and Social Services Administration.

Under the CDAC Program, participants may hire and manage their own care providers, including friends and certain family members, at an hourly rate determined by the state of Indiana. As this is a Medicaid-funded program, participants must be eligible for Medicaid in order to take advantage of these services.

Indiana also has a Program of All-Inclusive Care for the Elderly (PACE®) program that provides services such as home health care and personal care, social services, adult day care, medical care, and other services for participants who are deemed eligible for nursing home care.

Indiana offers a VD-HCBS program, although the program is not offered specifically through any VA Medical Centers located in the state. Veterans may be able to receive services through a neighboring state VA Medical Center.

How to obtain financial assistance for caregivers in Indiana:

  1. Determine eligibility for Indiana Medicaid and, if eligible, apply for benefits.
  2. Contact your local Division of Family Resources office to learn more about the Aging and Disabled HCBS Waiver and how to apply.
  3. Get in touch with Caregiver Homes of Indiana to learn more about the Structured Family Caregiving program, eligibility criteria, and how to apply.
  4. Contact your local Area Agency on Aging and Aging and Disability Resource Center for more information on caregiver support services and other programs you may be eligible for.
  5. Veterans should contact the Indiana Department of Veterans Affairs for information on the VD-HCBS program.

 

Iowa

Iowa’s non-Medicaid-funded program is known as the Iowa Senior Living Program, which includes the Case Management Program for Frail Elders (CMPFE) that provides assistance to families in the form of services that aid older adults in continuing to live independently in their homes and delay nursing home placement, as well as services that help family members serve as caregivers. Some services may be consumer-directed, and family members may be hired in certain circumstances as caregivers. The program is administered by the Iowa Department of Aging.

The Iowa Medicaid HCBS Elderly Waiver / IA Health Link Managed Care Program is a Medicaid-funded program that offers similar services and includes a Consumer Choices Option (CCO) and Consumer Directed Attendant Care (CDAC). If your loved one is a Veteran, the Iowa Veteran-Directed Home and Community Based Services program may be an option.

How to obtain financial assistance for caregivers in Iowa:

  1. Apply for Iowa Medicaid at the online DHS benefits portalor download a paper DHS Application.
  2. Get information on the HCBS Waiver programs in Iowa. Download the Elderly Waiver Information Packet for information on eligibility and how to apply.
  3. Caregivers must apply as an individual CDAC provider.
  4. Get in touch with your local Iowa Area Agency on Aging to get started with the application process for CMPFE.
  5. If your loved one is a Veteran, apply for the Iowa Veteran-Directed Home and Community Based Services program if eligible.

 

Kansas

Kansas offers non-Medicaid-funded services for elders through the Kansas Senior Care Act (SCA), which is funded by the Kansas Department for Aging and Disability Services (KDADS) Commission on Aging and administered through the state's 11 local Area Agencies on Aging. Personal care and other forms of non-medical in-home supportive services are provided, although individual services offered are determined at the county level. Some services that are non-medical in nature may be consumer-directed, including personal care and homemaker services. Spouses are typically ineligible to be hired as caregivers, although some exceptions apply, and other family members may be hired and paid for caregiving services in some cases.

Older adults in Kansas who qualify for Medicaid may receive similar services through the Kansas Medicaid (KanCare) HCBS Frail Elderly Waiver. KanCare, the state’s Medicaid program, is a managed care program administered by the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE). Some services provided through this program may be consumer-directed, although in most cases, spouses and legal representatives cannot be hired to provide caregiving services. There are some exceptions in rare circumstances, however. Kansas does not currently offer a Veteran-Directed HCBS program.

How to obtain financial assistance for caregivers in Kansas:

  1. Determine eligibility for KanCare, and if eligible, submit an application for benefits.
  2. Contact the Frail/Elderly Program Manager at (785) 296-8288 for information on applying for the Frail/Elderly HCBS Waiver program. Or, you can contact your local Aging and Disability Resource Center or call (855) 200-2372.
  3. If not Medicaid eligible, find your local Kansas Area Agency on Aging or call (855) 200-2372 for information on the Senior Care Act program.

 

Kentucky

Non-Medicaid-funded options include the Kentucky Hart-Supported Living Program and the Kentucky Personal Care Attendant Program (PCAP). The Hart-Supported Living Program offers grants to eligible seniors to help them remain in their own home or in the home of a loved one. This program is entirely self-directed, meaning that recipients are responsible for determining the services and supports they need as well as the provider of those services. Spouses and other family members may be paid for caregiving services through the Hart-Supported Living Program, which is a state-funded program designed for Kentucky residents with disabilities, regardless of age.

PCAP is also a state-funded program for Kentucky residents who are 18 years of age or older and have a functional loss of two or more limbs. It is a consumer-directed program, allowing beneficiaries to choose and manage their own care providers to provide assistance with ADLs, housekeeping and laundry, grocery shopping and other errands, and other services.

Kentucky’s Home and Community Based Services (HCBS) Waiver for Aged and Disabled is the Medicaid-funded option, which includes a Consumer-Directed Option allowing participants to select and hire their preferred care providers. Kentucky’s Area Agencies on Aging (AAAs) and Community Mental Health Centers (CMHCs) act as support brokers for the program. It is possible to hire spouses or adult children to serve as caregivers under this program. While the state of Kentucky does offer a Veteran-Directed HCBS program, there are currently no locations in Kentucky administering the program. That said, it may be possible for veterans to receive services from a VA Medical Center in a neighboring state in order to participate.

How to obtain financial assistance for caregivers in Kentucky:

  1. Apply for Medicaid and/or Medicaid Waivers online using the Benefind Self Service Portal.
  2. Contact your local office of the Cabinet for Health and Family Services(CHFS) for more information or assistance applying for the HCBS Waiver program, or call 1-855-459-6328 or TTY 1 -855-326-4654.
  3. Get in touch with your regional Hart-Supported Living Coordinator for information on eligibility requirements and how to apply for the program.
  4. If eligible for the PCAP program, contact your local Area Agencies on Aging and Independent Living for guidance with the application process.
  5. If your loved one is a Veteran, contact the Kentucky Department of Veterans Affairs for information on Veteran’s benefits and how to apply for services.

 

Louisiana

Louisiana does not offer a non-Medicaid-funded support program for caregivers. The Medicaid-funded option, the Louisiana Community Choices Waiver, is a program for elderly or disabled Louisiana residents. The Community Choices Waiver includes an option called the Monitored In-Home Caregiving (MIHC) program, which enables a family member or friend to reside with the care recipient and receive payment for providing caregiving services. Care providers must be approved as a MIHC service provider and comply with rules set by the Department of Health and Hospitals (DHH).

Louisiana also offers a Veteran-Directed HCBS Waiver program, which is administered from the Shreveport, LA VA Medical Center (Overton Brooks).  

How to obtain financial assistance for caregivers in Louisiana:

  1. Determine eligibility for Louisiana Medicaid. If eligible, apply for benefits.
  2. Call the Louisiana Options in Long Term Care Help Line at 1-877-456-1146 for information on the Community Choices Waiver program, how to apply for benefits, and how to register as a care provider.
  3. Get in touch with Caregiver Homes of Louisiana to learn more about the Monitored In-Home Caregiving (MIHC), eligibility criteria, and how to apply.
  4. If your loved one is a Veteran, contact the Louisiana Department of Veterans Affairs or the Overton Brooks VA Medical Center in Shreveport for information on the VD-HCBS program and how to apply for services.

 

Maine

The Consumer-Directed Home Based Care (CDHBC) Program, administered by Maine's Office of Aging and Disability Services (OADS), is a non-Medicaid-funded program offering consumer-directed personal assistance services. Services include nursing services and personal care assistance in addition to funding for assistive technology (i.e. personal emergency response services). These services are typically limited to essential services required to avoid placement in a residential care facility.

Those eligible for MaineCare (Maine Medicaid) have two options: the MaineCare Consumer Directed Attendant Services (CDAS) Program and the MaineCare Elderly and Adults with Disabilities Waiver. The CDAS Program allows consumers to choose their own care providers, which may include adult children who are not also the legal representative of the care recipient. Spouses and parents are currently not able to be hired to provide services; however, there is pending legislation in the state which, if passed, would allow consumers to hire any relative of their choosing under the program – including parents and spouses.

The MaineCare Elderly and Adults with Disabilities Waiver, administered by Maine’s Department of Health and Human Services’ Office of Aging and Disability Services, is also known as the Home and Community Benefits for the Elderly and the Older Adults Waiver. The program includes a Participant-Directed Option under which consumers can hire their preferred care provider, including adult children, other family members, and friends in some circumstances, although spouses are not eligible to receive compensation for providing caregiving services through the program. Participants are required to use a third-party financial management company to facilitate payroll and taxes. The Augusta, Maine VA Medical Center offers a VD-HCBS waiver program for eligible Veterans.

How to obtain financial assistance for caregivers in Maine:

  1. Determine eligibility for MaineCare and submit an application if eligible. Contact your local Department of Health and Human Services District Office for information and assistance.
  2. Contact your local Aging and Disability Resource Center for information on applying for the Elderly and Adults with Disabilities Waiver.
  3. Contact the Office of Aging and Disability Services for information on the CDHBC program, eligibility criteria, and how to apply. You may also reach the agency by calling 207-287-9200.
  4. If your loved one is a Veteran, contact the Maine Department of Veterans Affairs for information on the VD-HCBS Waiver, eligibility, and how to apply. Or, contact the Togus Regional Benefit Office, located in Augusta.

 

Maryland

The Maryland Attendant Care Program (ACP) is a non-Medicaid-funded program offering assistance in the form of financial reimbursement for attendant care services provided to residents with severe physical disabilities age 64 and younger. Administered by the Maryland Department of Disabilities, it’s a consumer-directed program, although spouses are not able to receive compensation for providing care under this program – any other qualified family members over age 18, however, are eligible.

For Medicaid-eligible care recipients, there are several Medicaid-funded programs available, including the Maryland Community Pathways Waiver, the Maryland Community First Choice Program, and Maryland’s Community Personal Assistance Services. The Maryland Community Pathways Waiver is intended for Maryland residents with developmental or intellectual disabilities (not for those with physical disabilities). Funding is provided by Maryland’s Developmental Disabilities Administration (DDA) under the Department of Health and Mental Hygiene. A self-directed option is available, although spouses may not be hired to provide caregiving services under this program.

Maryland Medicaid's Community First Choice (CFC) program is for elderly and disabled Maryland residents who would otherwise require residential or intermediate care. Services may be provided in the home setting, in a group home, or in an assisted living community. The specific level of assistance provided is based on individual needs but typically includes assistance with ADLs and tasks such as meal preparation. The program emphasizes self-directed care and with a few exceptions, family members may be hired to provide caregiving services.

Maryland’s Community Personal Assistance Services, formerly known as Medical Assistance Personal Care, is another Medicaid-funded program under which participants may opt to select their own care providers. Administered on a county-by-county basis, the Community Personal Assistance Services program requires caregivers to be approved, certified in first aid and CPR, and supervised by a nurse monitor. Maryland also offers a VD-HCBS Waiver Program, with services available through the Perry Point, MD VA Medical Center.

How to obtain financial assistance for caregivers in Maryland:

  1. Submit an application for Maryland Medicaid if eligible for benefits.
  2. Contact your local Area Agency on Aging for information on the CFC program and how to apply. You may also contact Medicaid’s Long Term Care and Waiver Services at 410-767-1739 or 1-877-4MD-DHMH (or for MD Relay Service, call 1-800-735-2258).
  3. Contact your county’s Health Department office to inquire about the Community Personal Assistance Services program. Or, to apply by phone or locate your nearest office, you may call Maryland Access Point at 1-844-627-5465, or Medicaid’s Long-Term Care Waiver Services at 410-767-1739.
  4. If eligible, contact Maryland Developmental Disabilities Administration (DDA) to discuss the Community Pathways Waiver. Your local coordinator will advise you when funding is available and let you know when to complete an application for services.
  5. Care recipients age 64 and younger should contact the Maryland Department of Disabilities at 410-767-6025 or 800-637-4113 for information on the ACP. An application can also be downloaded here, which also includes detailed eligibility criteria.
  6. Veterans should get in touch with the Maryland Department of Veterans Affairs to find the nearest office and get information on services and benefits.

 

Massachusetts

Massachusetts offers a Home Care Program (HCP) and an Enhanced Community Options Program (ECOP) for elderly residents through its In-Home Services, both of which provide services aimed at helping seniors remain in their own homes in the community. The ECOP Program is targeted to those with greater care needs. Depending on income, a co-payment may be required for some services, and some services may be self-directed. Participants may hire family members to provide caregiving services with the exception of the recipient’s legal guardian or surrogate. Both programs are managed by the Massachusetts Office on Aging.

Massachusetts Medicaid, known as MassHealth, administers the Medicaid-funded option, the Personal Care Attendant (PCA) program, which provides services for elderly and disabled Massachusetts residents. Consumers are provided with funds for self-directed care, and friends, neighbors, and certain family members (including adult children and former spouses) may be hired as care providers. Current spouses and legal guardians, however, are not eligible to receive compensation for providing services. Adult Foster Care is another Medicaid-funded option available in Massachusetts, in which the state pays caregivers – which may include family members – for providing 24-hour care. The Enhanced Adult Foster Care program is available through Caregiver Homes of Massachusetts. VD-HCBS is available for Veterans in Massachusetts through the VA Medical Centers located in Boston and Bedford.

How to obtain financial assistance for caregivers in Massachusetts:

  1. Determine eligibility for MassHealth and, if eligible, apply for benefits.
  2. Contact the Mass Resources helpline at 800-AGE-INFO for information on HCP and ECOP programs, or visit the Mass Resources website for application information and eligibility criteria.
  3. Contact MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648) for information on the PCA program, including how to apply for services.
  4. Get in touch with Caregiver Homes of Massachusetts to learn more about the Enhanced Adult Foster Care, eligibility criteria, and how to apply.
  5. If your loved one is a Veteran, contact the Massachusetts Department of Veterans Services for information on the VD-HCBS program or inquire directly at the Boston or Bedford VA Medical Centers.

 

Michigan

The Michigan Choice Elderly and Disabled Waiver is one of two Medicaid-funded options in the state. The MI Choice program was formerly known as the Home and Community Based Services for the Elderly and Disabled (HCBS/ED) program and gives participants the option of having the state manage their care or they may self-direct their own care, including hiring and managing the caregivers of their choice. This option is formally known as Self Determination in Long-Term Care (LTC). Family members may be hired, including adult children, although spouses and legal guardians are ineligible to receive payment for providing caregiving services in most cases.

The Home Help program is another Medicaid-funded option, managed by the Michigan Department of Health and Human Services (MDHHS). Like the MIChoice program, Home Help allows for a self-directed caregiving option. Parents and spouses are not eligible to be paid for their services, although other family members may be hired as caregivers. The Michigan Medicaid Health Link Program & Waiver: Helping the Elderly Remain at Home is another program available to dual Medicare/Medicaid eligible individuals. It is only available in 25 counties throughout the state, however. It includes an Expanded Community Living Supports (ECLS) Waiver program that offers services to enable older adults to delay nursing home placement.

Michigan also offers a VD-HCBS program through several VA Medical Centers in the state, including the Ann Arbor, Detroit, Saginaw, Battle Creek, and Iron Mountain locations.

How to obtain financial assistance for caregivers in Michigan:

  1. Determine Medicare eligibility here (required to participate in the ECLS Waiver).
  2. Contact your local MDHHS County office for Medicaid eligibility and application information, as well as information on the Home Help program and how to apply for benefits.
  3. Determine eligibility for MI Health Link and, if eligible, apply for benefits.
  4. Contact your local Area Agency on Aging to inquire about the HCBS/ED program.
  5. Contact the Michigan Veterans Affairs Agency for information on benefits available to Veterans in the state.

 

Minnesota

The Minnesota Alternative Care (AC) Program is the non-Medicaid-funded program available to eligible Minnesota residents. The program serves nearly 5,000 older adults in Michigan who are at risk of nursing home placement. Some of the services received through the AC program may be self-directed, known as the Consumer Directed Community Supports option. Family members may be hired to provide caregiving services, including adult children. While spouses may also be hired under this program, the services provided by a spouse are limited to personal assistance services. Any family member participating in the program must be registered with the state as a care provider, and participants are required to use a third-party financial management company as an intermediary to facilitate payments. The AC program can also assist with home modifications such as wheelchair ramps. This program serves those who are not otherwise eligible for Medicaid.

The AC program also offers a few services not covered by the Elderly Waiver, including conversion case management for conversion from a nursing home, discretionary services, nutrition services, and a relative hardship waiver.

Those who are Medicaid eligible have several program options administered by the Minnesota Department of Human Services, including the Medicaid Elderly Waiver (EW) Program, the Minnesota Personal Care Assistance Program, the Minnesota Community Access for Disability Inclusion Waiver, and the Minnesota Consumer Support Grant. The EW program includes a self-directed option allowing participants the flexibility to choose their own care providers. The Minnesota Consumer Support Grant provides cash assistance to program participants in lieu of receiving services in the home, but this program may not be used in conjunction with the EW Waiver or the Alternative Care program. It is not available statewide. The Minnesota Personal Care Assistance (PCA) Program is also a self-directed program, allowing family members and adult children to receive compensation for caregiving services. However, spouses and legal guardians may not receive compensation under PCA. The Minnesota Community Access for Disability Inclusion (CADI) Waiver is a similar program that offers assistance for people with disabilities.

Minnesota does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Minnesota:

  1. If eligible for Minnesota Medicaid, apply for benefits.
  2. Contact Minnesota’s Department of Human Services for information on the Consumer Support Grant, availability in your area, and application information, as well as information on the PCA program and the CADI Waiver for those with disabilities under the age of 65.
  3. Determine eligibility for the EW program and fill out an application for services. You can also contact your local Long-Term Care Consultation contact for information and application assistance or call the Senior LinkAge Line at 800-333-2433.
  4. If you’re not eligible for Medicaid, determine eligibility for the AC program by completing the Alternative Care Program Eligibility Worksheet (click here for the worksheet for unmarried individuals and here for those with a community spouse).
  5. For information on the AC program, contact a Long-Term Care Consultation Intake worker at your county social services office. You can also call 1-800-333-2433 to begin the application process.

 

Mississippi

Mississippi does not have a state-funded assistance program for those who are not Medicaid-eligible. However, the state does offer a Medicaid-funded program called the Mississippi Independent Living Waiver (IL). This program is available to anyone who are 16 years of age or older who have neurological or orthopedic impairments. There are several diagnoses that would qualify an elderly Mississippi resident for this program, including Alzheimer’s disease, Parkinson’s disease, Lewy Body Dementia, osteoarthritis or arthritis, and joint fractures.

Participant direction is an option through this program for personal care services, enabling participants or their legal representatives to manage and coordinate services, including hiring and managing care providers of their choice. Certain relatives may be hired to receive compensation for providing services under this program.

Mississippi does not currently have a VD-HCBS program.

How to obtain financial assistance for caregivers in Mississippi:

  1. Determine eligibility for Mississippi Medicaid.
  2. Contact the Mississippi Department of Rehabilitation Services for information on eligibility and how to apply for the IL Waiver program. Find your local office here.

 

Missouri

Missouri does not offer a state-funded program to support older adults and people with disabilities outside of the Medicaid-funded programs, which include the Missouri Medicaid (known as MO HealthNet) Consumer Directed State Plan Personal Care Program and the MO HealthNet Independent Living Waiver.

Through the MO HealthNet Consumer Directed State Plan Personal Care Program, services may be consumer-directed. Family members other than spouses and legal guardians may be hired and compensated for providing care services. Care providers must register as CDS providers with the Missouri Medicaid Audit and Compliance Unit (part of the Department of Social Services).

Personal care assistance is also self-directed through the IL Waiver program. Spouses and legal guardians are ineligible to receive compensation for providing care, although other family members may be hired. Payments and other financial matters are handled through Financial Management Services.

Missouri offers a VD-HCBS program, which is available through the St. Louis, MO VA Medical Center.

How to obtain financial assistance for caregivers in Missouri:

  1. Apply for MO HealthNet if eligible for Medicaid. You can also call 855-373-4636 to speak with a representative from the DHSS.
  2. Contact the Department of Health and Senior Services at 573-751-6400 for more information about the IL Waiver program.
  3. Pre-screenings are conducted to determine eligibility for a face-to-face assessment by the Division of Senior and Disability Home and Community Based Services. Call 866-835-3505 for pre-screenings. You can also find your local Missouri Department of Social Services office here.
  4. If your loved one is a Veteran, contact the Missouri Veterans Commission for information on the VD-HCBS waiver program, eligibility, and how to apply for services.

 

Montata

Montana doesn’t offer a non-Medicaid-funded option, though for those that are Medicaid-eligible, there are two programs: the Montana Medicaid Home and Community Based Services Waiver (Big Sky Waiver) and Montana Community First Choice / Personal Assistance Programs (CFC / PAS). The Big Sky Waiver is administered by Montana’s Senior and Long Term Care Division (part of the Department of Public Health & Human Services). It’s also known as the Elderly/Physically Disabled Waiver. Consumer-directed care is an option under this program, and certain family members (provided they are qualified to provide care) may be hired as care providers – subject to approval by the state of Montana. Spouses are typically excluded, but may be hired under certain circumstances. Adult children may be hired as caregivers, with services limited to personal care or homemaker services.

The CFC/PAS program also includes a self-directed option. Spouses, parents, and legal guardians are ineligible to be hired, while adult children of aging parents and ex-spouses are eligible to receive compensation for providing services. The recipient is responsible for approving timesheets, and timesheets are reviewed and payments issued to caregivers by the state.

Montana’s VD-HCBS program is offered through the Fort Harrison, MT VA Medical Center.

How to obtain financial assistance for caregivers in Montana:

  1. Apply for Montana Medicaid if eligible.
  2. Contact Mountain Pacific Quality Health (MPQH-Montana) at 800-219-7035 for a screening to determine eligibility for the Big Sky Waiver program.
  3. Contact your local Montana Department of Public Health and Human Services (DPHHS), Division of Senior and Long Term Care field office for information on the CFC/PAS program, eligibility, and how to apply.
  4. If your loved one is a Veteran, contact the Montana VA Medical System for information on the VD-HCBS program, eligibility criteria, and how to apply.

 

Nebraska

The Nebraska Disabled Persons and Family Support (DPFS) Program serves the needs of elderly and disabled Nebraska residents who are not Medicaid-eligible. The program is a self-directed model, allowing participants to select their own care providers, including relatives. A legal contract between the care provider and recipient is required, and providers must meet state regulations. The maximum monthly spend amount is $300. Under this program, the state may also provide funding for certain home modifications that support the individual’s independence, such as wheelchair ramps and handicapped-accessible bathroom modifications. The program is managed by the Nebraska Department of Health and Human Services, Office of Medicaid and Long-Term Care.

There are two additional programs available to Medicaid-eligible Nebraska residents: the Nebraska Aged & Disabled Medicaid Waiver and the Nebraska Medicaid Personal Assistance Services (PAS) program. The PAS program includes a self-directed option, allowing recipients to choose their care provider as well as the types of services provided. Family members, other than those who are legally responsible for the care recipient, may be hired to provide services. The PAS program is administered by the Special Services for Children and Adults Division, Office of Aging and Disability Services within the Nebraska Department of Health and Human Services.

Nebraska does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Nebraska:

  1. If not Medicaid-eligible, download an application for the DPFS Program here. You can also reach the Office of Medicaid and Long-Term Care for more information and assistance by calling 1-800-358-8802.
  2. If Medicaid eligible, apply for Nebraska Medicaid
  3. Contact your local DHSS office for information on the PAS program and how to apply. Care providers must also pass the state’s approval process.
  4. If not eligible for PAS, you may inquire about the Aged & Disabled Waiver program; however, keep in mind that this program does not allow for self-direction of services at this time.
  5. Reach out to the Nebraska Aging and Disability Resources Center (ADRC) for information on other programs and services serving the Nebraska aging population.

 

Nevada

Older adults in Nevada who are not eligible for Medicaid may qualify for Nevada's Community Options Program for the Elderly (COPE). Administered by Nevada's Aging and Disability Services Division and funded by the state, COPE provides non-medical services such as adult day care, personal care, and homemaker services, and some services are self-directed. Care providers, which may include certain family members, must be approved by the state, and the hourly rate is regulated.

Those eligible for Medicaid have two programs available, including the Nevada Home and Community Based Waiver for the Frail Elderly (HCBW-FE) and Nevada Medicaid Personal Care Services. Self-direction is possible through both programs, but only to a very limited extent in the HCBW-FE program. Under HCBW-FE, participants may choose from a pre-approved list of care providers. Under Personal Care Services, however, it is possible to hire any qualified caregiver of their choosing. Financial aspects such as payments are handled by an Intermediary Service Organization (ISO). Siblings and adult children may be hired as caregivers, provided they are not the legal representative of the care recipient. Spouses and anyone legally responsible for the recipient are not eligible to receive compensation for providing services.

Nevada’s VD-HCBS program is offered through the Las Vegas, NV VA Medical Center.

How to obtain financial assistance for caregivers in Nevada:

  1. Contact your local Nevada Aging and Disability Services Regional Office for information on the COPE program, how to apply, and how to register as a care provider. You can also reach Nevada Aging and Disability Services statewide by calling (888) 729-0571.
  2. If eligible for Medicaid, apply for Nevada Medicaid benefits.
  3. Call 800-525-2395 (option 1 and then option 4) to submit a request for services under the PCS program. Provider enrollment contact information can be found here.
  4. Contact your Aging and Disability Services Resource Center for information on the HCBW-FE program and how to apply.
  5. Contact the Nevada Department of Veterans Services for information on the VD-HCBS program and how to apply if your loved one is a Veteran.

 

New Hampshire

While New Hampshire doesn’t have a non-Medicaid-funded program, those who are Medicaid-eligible may qualify for New Hampshire’s Choices for Independence Waiver. Formerly known as the Elderly and Chronically Ill Waiver, the Choices for Independence Waiver provides services for those who are clinically eligible for nursing home placement but prefer to remain in their own homes in the community. That said, this waiver also includes those who are residing in non-nursing home settings such as assisted living communities and residential care homes.

The Choices for Independence Waiver provides support and services as long as the costs of those services don’t exceed a certain percentage as similar services provided in a nursing home setting would cost. There is some level of consumer direction offered under this program, which applies mostly to non-skilled and custodial care services. Family members, however, are not able to be hired to provide services under this program. New Hampshire also offers a Social Services Block Grant (SSBG), funded under Title XX of the Social Security Act, which provides home and community-based services for older adults age 60 and older as well as residents between the ages of 18 and 60 who have a chronic illness or disability. It does not appear as though the SSBG includes a self-directed option, but services include adult in-home care, adult medical day services, home delivered meals, homemaker services, and more.

The Manchester, NH VA Medical Center offers the state’s VD-HCBS program.

How to obtain financial assistance for caregivers in New Hampshire:

  1. Unfortunately, there is no program offered presently in New Hampshire that enables family caregivers to receive compensation for providing care to a loved one.
  2. However, if your loved one is a Veteran, you may inquire with the New Hampshire State Office of Veterans Services for information on the VD-HCBS program, eligibility criteria, and how to apply for services.
  3. Determine Medicaid eligibility and apply for New Hampshire Medicaid benefits if eligible.
  4. To inquire about Choices for Independence, call 1-866-634-9412. Keep in mind that while Choices for Independence provides services that can help your loved one continue living independently, family members may not be compensated for providing services. You may also inquire about SSBG at the same contact number.

 

New Jersey

There are a variety of options for getting assistance with personal care services in New Jersey. Non-Medicaid-funded programs include New Jersey Assistance for Community Caregiving (JACC), New Jersey Family Leave Insurance, and New Jersey Statewide Respite Care. Under JACC, family members and friends who meet the program’s requirements may be hired to provide services such as attendant care, household chores, or transportation assistance. Spouses and adult children are also eligible to receive compensation for providing these services in New Jersey, and minor home modifications that support independence, such as wheelchair ramps, may also be offered under this program.

New Jersey’s Family Leave Insurance (FLI) program provides up to six weeks of paid time off for caring for a family member with a serious illness. It can be used in conjunction with the federal Family Medical Leave Act, which requires employers to hold an employee’s job and continue to provide healthcare benefits during this time off. Administered by the New Jersey Department of Labor and Workforce Development, the FLI program is funded by employee wage deductions.

The New Jersey Statewide Respite Care Program (SRCP) offers respite services for unpaid caregivers with the aim of avoiding unnecessary nursing home placement. The SRCP program is managed locally by Aging and Disability Resource Centers and is administered by the New Jersey Department of Health and Senior Services. Caregivers utilizing this program are able to select the agency or individual of their choosing to provide respite care services.

The New Jersey Medicaid Personal Preference Program (PPP) is the state’s Medicaid-funded program, which distributes a budget to recipients that would otherwise be spent on the provision of services. Participants may choose their own care providers, including friends and family members who are 18 years of age or older.

New Jersey’s VD-HCBS program is offered through the Lyons, NJ VA Medical Center.

How to obtain financial assistance for caregivers in New Jersey:

  1. Determine eligibility for New Jersey Medicaid (NJ Family Care), and apply if eligible.
  2. Apply for the PPP through the New Jersey Division of Disability Services. If you are enrolled in a NJ FamilyCare Managed Care Organization (MCO), contact your MCO to request a PCA assessment for enrollment into PPP. Contact information for MCOs can be found on this page. If you’re not enrolled in a MCO, call 1-888-285-3036 for assistance.
  3. To apply for JACC, contact your local Area Agency on Aging/ADRC by calling 877-222-3737. You can find a list of local offices and contact information here.
  4. To apply for FLI, you must notify your employer in advance. Begin your application for benefits with the state after your leave begins by calling 609-292-7060. You can also visit the New Jersey Department of Labor and Workforce Development for more information.
  5. For SRCP, contact the Statewide Respite Care Program in your county by calling the Aging & Disability Resource Connection (ADRC) at 1-877-222-3737.
  6. Contact the New Jersey Department of Military and Veterans Affairs for information on the VD-HCBS program if your loved one is a Veteran.

 

New Mexico

There is no state-funded (non-Medicaid) program offering support for family caregivers in New Mexico. However, those who are Medicaid-eligible can receive services through NM Centennial Care, the state’s Medicaid program under the Community Benefit program, which focuses on enabling older adults to remain living in their own homes in the community. Services include adult day care, respite care, and personal care services such as assistance with ADLs. It includes a Self-Directed Community Benefit (SDCB) option, allowing participants to select their preferred care providers. Family members and friends may be hired for non-skilled services (including personal care services), although the managed care organization (MCO) makes determinations on whether the selected provider is qualified. New Mexico’s MCOs include Molina Health Care of New Mexico, Blue Cross Blue Shield of New Mexico, Presbyterian Healthcare Services, and United Healthcare.

New Mexico does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in New Mexico:

  1. Apply for NM Centennial Care if eligible. You can start the process at Yes New Mexico. You can also call the HSD Customer Service number at 800-283-4465 or the state’s Medicaid Call Center at 888-997-2583. Find your local Human Services Department field office on this page.
  2. Contact the beneficiary’s MCO to inquire about receiving services through the Community Benefit program. Contact information for New Mexico’s four MCOs can be found here.
  3. Contact the Aging and Disability Resource Center (ADRC) for information on other programs and services you may be eligible for.

 

New York

Older adults who are not eligible for Medicaid in New York may qualify for the New York Expanded In-home Services for the Elderly (EISEP) program. Since 2011, the program allows for Consumer-Directed In-Home Services (CDS), allowing participants to hire their own caregivers, including family members, as long as the care provider meets the state’s requirements. This program varies from county to county, however, so it’s important to reach out to your local Area Agency on Aging to get more information on service availability and requirements. EISEP is designed for adults age 60 and older who live at home and require assistance with ADLs.

Those who are eligible for Medicaid may be able to utilize New York's Consumer-Directed Personal Assistance Program (CDPAP), offered through NY Managed Medicaid Long Term Care and the Community First Choice programs. Participants work with a county caseworker and a medical professional to determine their required level of care and create a personalized care plan, which includes the number of hours of assistance they require each week. Participants are then able to hire their own caregivers to provide services up to the specified number of hours each week. Spouses and legal guardians are ineligible to be paid caregivers; however, ex-spouses, adult children, and siblings may receive compensation for providing services. A third-party financial management agency oversees payment processing and timesheet approvals.

New York offers a VD-HCBS program, available through the Syracuse, NY and Albany, NY VA Medical Centers.

How to obtain financial assistance for caregivers in New York:

  1. Apply for New York Medicaid if eligible.
  2. Contact your local Area Agency on Aging for information on availability and how to apply for the EISEP program.
  3. To apply for CDPAP, contact your local Department of Social Services. Learn more about personal assistant eligibility here. Note that the state’s regulations state, “PAs may not be a spouse, or designated representative.  Any other adult who does not reside with the consumer, unless such residence is necessary because of the amount of care the consumer requires,may be a PA.  This includes individuals who have Power of Attorney but who are not serving as the consumer’s PA.”
  4. Veterans should contact the New York State Division of Veterans Affairs for information on the VD-HCBS program and how to apply.

 

North Carolina

North Carolina In-Home Aide Services is a program available in North Carolina for residents who are not eligible for Medicaid. This program was previously known as Chore, Homemaker, Homemaker-Home Health Aide, Respite, and Personal Care Services. Services are provided to older adults and caregivers to enable participants to avoid nursing home placement. Personal care and chore services are among the broad range of services offered, and these services may be provided by relatives, including adult children and spouses, if the participant chooses. Care providers must be at least 18 years of age, and they must have given up other employment in order to provide care for their loved one. A health care professional and a case manager will screen applicants to determine eligibility and define the services to be provided.

The North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA) is a Medicaid-funded program that offers similar services. The program also covers minor home modifications to support independence in addition to personal care and other services. The CAP/DA includes the Community Alternatives Program for Choice (CAP/Choice), which is a self-directed option allowing participants to select their own care providers, including family members such as adult children. A third-party agency is utilized as an intermediary to facilitate payments. Hourly rates average between $9 and $11.

The Fayetteville and Durham, NC VA Medical Centers offer North Carolina’s VD-HCBS waiver program.

How to obtain financial assistance for caregivers in North Carolina:

  1. North Carolina In-Home Aide Services are administered on the county level, so get in touch with your local Department of Social Services to apply. You can find a list of county offices here.
  2. Apply for North Carolina Medicaid if eligible.
  3. Contact North Carolina’s Division of Medical Assistance for information on the CAP/DA program and the CAP/Choice participant-directed option. Contact your local county agency to inquire about services and begin the application process.
  4. If your loved one is a Veteran, contact the North Carolina Department of Military & Veterans Affairs for information on the VD-HCBS program and how to apply.

 

North Dakota

North Dakota Service Payments for the Elderly and Disabled (SPED and Ex-SPED) Programs are available to eligible North Dakota residents who do not qualify for Medicaid benefits. This program includes two levels of services with different eligibility requirements, with SPED serving those who are more functionally impaired. Both programs offer services to enable older adults and people with disabilities to remain in their own homes, including adult foster care. Both programs allow for self-direction of services, and certain family members may be hired to provide services – including adult children, although the care provider must reside with the recipient.

Medicaid-eligible North Dakota residents are served through the North Dakota Medicaid State Plan Personal Care Services (MSP-PC) program. Services may be provided in several settings, including their own home, the home of a loved one, or in adult foster care or assisted living communities. Services are not provided to residents in nursing homes, hospitals, or intermediate care communities.

This program includes three service levels (Level A, Level B, and Level C) with different eligibility criteria. The number of hours of care available varies based on the participant’s service level. It is consumer-directed, and care providers may include friends or relatives, including spouses and legal guardians. Providers must be at least 18 years old and be qualified to provide personal care services, as well as meet North Carolina Department of Human Services standards. Payment is at a Medicaid-approved hourly rate, typically between $10.50 and $15.50 per hour.

North Dakota does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in North Dakota:

  1. To apply for the SPED program, contact your local county social service office. Alternatively, you can visit the Aging and Disability Resource website here or call 1-855-462-5465. One may also find additional information about SPED hereor Ex-SPED here.
  2. If eligible, apply for North Dakota Medicaid.
  3. Call your local Department of Human Services to apply for the Personal Care Services program, or call 800-472-2622 to get in touch with your local county office. A caseworker will conduct an initial assessment to determine eligibility and care needs, and an annual assessment is conducted thereafter.
  4. Call the Aging & Disability Resource LINK at 1-855-GO2-LINK (1-855-462-5465) or visit https://carechoice.nd.assistguide.net/ for additional information and assistance related to the Personal Care Services program and other programs and services in your area.

 

Ohio

Older Ohians who are not eligible for Medicaid may qualify for services through the Ohio Elderly Services Program (ESP). The program allows for consumer direction of some services, and family members may be hired in some cases to provide caregiving services if they work for the provider organization and are qualified to provide the necessary services. ESP is only available in Butler, Clinton, Hamilton, and Warren counties presently. The program is funded by a county tax levy and administered by the Ohio Council on Aging (COA).

Ohio’s Medicaid PASSPORT (Pre-Admission Screening System Providing Options & Resources Today) Waiver is a Medicaid-funded program offering similar services, although the cost of in-home services provided must not exceed 60% of the cost of the same care if it were provided in a nursing home setting. Family members are eligible to be hired to provide caregiving services through PASSPORT, with the exception of spouses, for non-skilled care at the Medicaid standard rate of $10 to $14 per hour. Managed on a local level by the Area Agencies on Aging, PASSPORT is administered by the Ohio Department of Aging.

Note that dual Medicare/Medicaid-eligible residents are unable to receive services through PASSPORT; however, those who live in a county with the Integrated Care Delivery System (ICDS) can receive the same services through MyCare Ohio, which is Ohio’s mandatory managed care program. This program is called the MyCare Ohio Plan (MCOP), or Managed Medicaid Program for Elder Care.

Ohio offers a VD-HCBS waiver program through its Chillicothe and Toledo, OH VA Medical Centers.

How to obtain financial assistance for caregivers in Ohio:

  1. Contact the Council on Aging by calling 800-252-0155 or 513-721-1025 for an initial screening for the ESP program if you reside in one of the four counties in which the program is offered and are not Medicaid-eligible.
  2. Clermont county residents should contact Clermont Senior Services for information on in-home services available in your area.
  3. Apply for Medicaid if eligible.
  4. To apply for PASSPORT, contact your local Area Agency on Aging. You may also call 1-866-243-5678. The program webpageprovides additional details about this waiver.
  5. Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or enroll online here for MyCare Ohio. Find out what plans are available in your local area here.
  6. Veterans should get in touch with the Ohio Department of Veterans Services for information on the VD-HCBS waiver program.

 

Oklahoma

Oklahoma does not offer an in-home support program for family caregivers and older adults who are not Medicaid-eligible. Those eligible for Medicaid, however, can take advantage of Oklahoma’s ADvantage Program Waiver or the Oklahoma Personal Care Program. Care is self-directed, and participants may opt to hire friends, neighbors, and some non-immediate family members to provide caregiving services. Spouses and legal guardians are not eligible to be compensated for providing services, however.

Oklahoma’s ADvantage Program Waiver may opt to self-direct their care, choosing their own care providers which may include family members. In some cases, spouses and legal guardians may be hired to provide services. This is known as the CD-PASS option. Advantage is managed by the Aging Services Division of the Oklahoma Department of Human Services and replaces the former My Life; My Choice and Sooner Seniors programs.

Oklahoma does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Oklahoma:

  1. Apply for Oklahoma Medicaid if eligible.
  2. Contact the Oklahoma Department of Human Services at 1-800-435-4711 for information on the Oklahoma Personal Care Program and the ADvantage Program Waiver and how to apply for services.
  3. Contact your local Area Agency on Aging for information on other programs and services that may be available to you.

 

Oregon

The state of Oregon does not currently offer a non-Medicaid in-home care services program for older adults. However, there are several options serving Medicaid-eligible residents: the Oregon Client-Employed Provider Program, Oregon Independent Choices Program, Oregon Spousal Pay Program, and Oregon K Plan.

The Client-Employed Provider Program (CEP) is a self-directed program allowing participants to hire friends, neighbors, and family members of their choosing to provide services. This includes adult children and spouses. However, an individual who is also serving as the recipient’s Durable Power of Attorney or official representative may not be hired to provide caregiving services. Recipients do not receive cash to compensate their caregivers; they authorize the state to make payments on their behalf under this program.

The Spousal Pay Program, administered by the Oregon Department of Human Services, is similar, but focuses on the spouse as primary caregiver. Through this program, the spouse becomes an official Homecare Worker and joins the Homecare Workers Union. The spouse receives a salary, is taxed on earnings, pays union fees, and is eligible for unemployment insurance.

The Oregon Independent Choices Program (ICP) is also similar in nature to the CEP program. Also a self-directed program, individuals receiving services may hire friends, neighbors, and family members – including adult children and spouses – to provide caregiving services. Under this program, participants receive cash benefits from the state and handle paying their caregivers without the state or another agency serving as an intermediary. Legal guardians are not able to be hired as care providers, however. Participants are also able to negotiate hourly rates with care providers.

The Oregon K Plan – Community First Choice Medicaid Program also offers in-home support services to Medicaid-eligible recipients as an alternative to long-term home and community based Medicaid waivers, which have limited enrollment. The CFC program, by contrast, is an entitlement program and available to any eligible resident who requires services.

Oregon’s VD-HCBS waiver program is offered through the Portland, White City, and Roseburg, OR VA Medical Centers.

How to obtain financial assistance for caregivers in Oregon:

  1. Apply for Oregon Medicaid if eligible.
  2. To apply for the CEP program, Spousal Pay Program, and Independent Choices Program, contact your local Seniors and Persons with Disabilities / Area Agency on Aging office. You may also call 1-800-282-8096 to get in touch with a representative.
  3. For information on the Oregon K Plan, contact your local Seniors & Peoples with Physical Disabilities Office.
  4. Veterans should contact the Oregon Department of Veterans Affairs for information on the VD-HCBS program.
  5. Get in touch with your local Aging and Disability Resources Center for information on other programs and services available in your area. You can also call 855-673-2372 for assistance.

 

Pennsylvania

Pennsylvania's Options Program provides assistance to older adults and family members who are caring for aging loved ones at home. A non-Medicaid funded program, the Options program funds some assistance services through block grants (Aging Block Grants or ABG) provided through local Area Agencies on Aging. Recipients cannot also be receiving services through the Pennsylvania Department of Aging Medicaid Waiver, but those who are not eligible for Medicaid may be able to receive some free or low-priced services through other funding avenues.

Medicaid-funded programs in Pennsylvania include the Pennsylvania Aging Waiver and Pennsylvania Services My Way. The Pennsylvania Aging Waiver (PDA Waiver) serves older adults who are eligible for nursing home placement but wish to remain in the community. Services include personal care services, adult day care, respite care, and more, as well as some funding assistance for home medical equipment and home modifications to improve access, such as wheelchair ramps. Some services may be participant-directed, but consumer direction is limited in this program compared to the Services My Way Program (SMW).

The SMW Program allows recipients to choose their own care providers, and while it’s not technically a distinct Medicaid waiver, it is a program that provides another way for waiver recipients to receive services. Through the SMW program, certain family members may receive compensation for providing services. Participants work with a state case manager to determine care needs and a budget, resulting in an Individual Services Plan – from there, participants can choose providers for obtaining the required goods and services. Adult children, neighbors, and other family members may be hired, although spouses and legal guardians are ineligible for compensation for providing services. An Employer Agent, a fiscal intermediary, handles payments to care providers.

The Consumer-Directed Personal Assistance Services (PAS) is another option somewhere between the PDA Waiver and Services My Way Program in which the state plays a larger role in helping recipients choose their care providers, although the program does not designate providers for the recipient.

A new program rolled out in January 2018 is the Pennsylvania Medicaid’s Community HealthChoices Program. The program is being rolled out in several phases – by geographic regions – over a two-year period, and some recipients of the PDA Waiver may be automatically enrolled in the program as it becomes available in their area. The Community HealthChocies Program is a Medicaid managed care program serving adults 21 years of age and older who are dual-eligible (eligible for both Medicare and Medicaid), or individuals who require skilled nursing care (would otherwise qualify for nursing home placement).

CHC provides seniors and physically disabled individuals with medical benefits, as well as long-term support services to promote independent living and prevent unnecessary nursing home placements. Benefits include personal care services, such as assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADL), like bathing, meal preparation, and medication management. Enrollment in this program is mandatory for those who meet the eligibility requirements. 

Pennsylvania’s VD-HCBS program is offered through the Philadelphia, Coatesville, and Erie, PA VA Medical Centers.

How to obtain financial assistance for caregivers in Pennsylvania:  

  1. Contact your local Area Agency on Aging for information on the Options program, availability, and eligibility requirements. Your local AAA can also assist you with the application process.
  2. Determine eligibility for Medicaid and apply if eligible. You can apply online using COMPASS.
  3. Call the PA Long Term Care Helpline at 1-866-286-3636 for information on the Services My Way Program or to start the application process.
  4. Contact your local Area Agency on Aging for information on the PDA Waiver and how to apply for services, or your local county assistance office.
  5. Click here to learn more about Community HealthChoices (CHC) and visit Care Coordination to get in touch with a care coordinator to assist you in obtaining services.
  6. Veterans should contact the Pennsylvania Department of Military and Veterans Affairs for information on the VD-HCBS program.

 

Rhode Island

Rhode Island Paid Family Leave, or the Temporary Caregiver Insurance (TCI) Program, is one option for family caregivers of loved ones who are not eligible for Medicaid. This program provides up to four weeks of paid benefits in a 12-month period to care for a loved one (such as an aging parent) who has a serious illness. Caregivers are paid up to a maximum of $817 per week in 2018 under this program, and it requires employers to offer a comparable position to the employee following their leave. It is administered by the Rhode Island Department of Labor and Training.

The Rhode Island Global Consumer Choice Compact Waiver is a Medicaid-funded option administered by the RI Department of Human Services (DHS), with many of the programs for the elderly administered by the RI Department of Elderly Affairs. The program is self-directed, enabling recipients to select their own care providers, which includes adult children and other relatives.

This global waiver now encompasses several former programs, including the Personal Choice Program, Home and Community Care Medicaid Waiver, and the Shared Living Program, and now aims to provide a comprehensive range of services under a single program. Additionally, the program offers some services to older adults who are not fully Medicaid-eligible.

Rhode Island does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Rhode Island:

  1. Visit the Department of Labor and Training website for more information on the TCI program, or download an application here. You may also call 401-462-8420 for information and assistance.
  2. Apply for Rhode Island Medicaid benefits if eligible.
  3. Get in touch with Caregiver Homes of Rhode Island to learn more about the Rite @ Home program, eligibility criteria, and how to apply.
  4. Contact the Rhode Island Division of Elderly Affairs at 401-462-3000 for information on the Rhode Island Global Consumer Choice Compact Waiver and how to apply.
  5. Visit he Division of Elderly Affairs website for more information on additional programs available to older adults.

 

South Carolina

South Carolina offers two Medicaid-funded programs to support older adults in the community and family caregivers: South Carolina Choice and Attendant Care and the South Carolina Community Supports Waiver. The Choice and Attendant Care program, or the South Carolina Community Choices Medicaid Waiver, is also called the Elderly and Disabled Waiver. Under this program, the cost of care provided in the community setting cannot exceed a certain percentage of the cost of comparable services provided in the nursing home setting.

Participant direction is possible for some services, including personal assistance, respite care, and companion services, allowing recipients to select their own care providers. Certain family members are eligible to receive compensation for services, including adult children of aging parents. Care providers are required to pass the state’s background checks and receive approval from the state. Home modifications and some medical equipment and supplies, as well as adult day care, may also be covered through this program.

South Carolina’s Medicaid program is also known as Healthy Connections, although it is sometimes called South Carolina Community Long Term Care or CLTC. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS).

The South Carolina Community Supports Waiver is intended for individuals with intellectual disabilities or a related disability (ID/RD) of any age who are eligible for Medicaid. It’s a self-directed program, and family members may be hired to provide care services – other than spouses or legal guardians.

South Carolina offers a VD-HCBS waiver program through its Charleston and Columbia, SC VA Medical Centers.

How to obtain financial assistance for caregivers in South Carolina:

  1. Apply for Healthy Connections (South Carolina Medicaid) if eligible.
  2. Apply for the Community Choices Medicaid Waiver through your local DHSS office. A complete application and manual is available here, although most people will find it easier to get assistance from a DHSS representative.
  3. To apply for the Community Supports Waiver, contact your local county office of South Carolina Disabilities and Special Needs Board. You can also call 800-289-7012 to reach a service coordination provider for assistance with the application.
  4. Veterans should get in touch with the South Carolina Division of Veterans Affairs for information on the VD-HCBS program.

 

South Dakota

South Dakota offers four Medicaid waivers for residents: the CHOICES Waiver, Family Support 360, Assistive Daily Living Services (ADLS), and the Home and Community Based Services Waiver for South Dakotans. The CHOICES Waiver is for those with developmental disabilities, as is Family Support 360. The Assistive Daily Living Services Program offers services for residents with quadriplegia.

The Home and Community Based Services Waiver for South Dakotans serves older adults (age 60 and older), or those age 18 and older with disabilities. It does not appear that the HCBS Waiver in South Dakota includes self-directed service options, however.

South Dakota offers a VD-HCBS program through the Sioux Falls VA Medical Center.

How to obtain financial assistance for caregivers in South Dakota:

  1. Reach out to the your local Long Term Services and Supports Field Officeto reach a Long Term Services and Supports Specialist. Specialists can “provide information and referral services, assistance to access in-home and community-based services, needs assessments, ongoing case management, care plan development and adult protective services to individuals living in South Dakota communities.”
  2. You can also inquire about other in-home services and local programs that may be available in your area. Keep in mind, however, that the state does not appear to currently offer consumer-directed options for personal care services, other than the program available to Veterans through the VA Medical Center in Sioux Falls.
  3. Contact the South Dakota Department of Veterans Affairs for information on the VD-HCBS program if your loved one is a Veteran.

 

Tennessee

Tennessee residents who are eligible for Medicaid may qualify for the TennCare CHOICES in Long-Term Care Program. Services are provided for elderly and/or disabled residents who would otherwise require or are at risk of nursing home placement, and services are offered in a multitude of settings such as the recipient’s home, a loved one’s or caregiver’s home, adult foster care home, or assisted living communities. In addition to personal care services, the program offers assistive technology, personal emergency response services, and minor home modifications to support independent living.

Adult children of aging parents may be hired as caregivers through the CHOICES program, as well as other friends, neighbors, and certain family members, excluding spouses and legal guardians or anyone who has a Power of Attorney for the care recipient.

Tennessee offers a VD-HCBS waiver program through the Tennessee Valley, TN VA Medical Center.

How to obtain financial assistance for caregivers in Tennessee:

  1. If eligible, apply for TennCare Medicaid (Tennessee’s Medicaid program) through gov.
  2. Contact your local Area Agency on Aging or visit the TennCare CHOICES website for information and how to apply for the CHOICES program. You can also call 1-866-836-6678 for assistance.
  3. Contact your local Tennessee Area Agency on Aging and Disability for information on other programs and services that may be available to you.
  4. Contact the Tennessee Department of Veterans Services to inquire about the VD-HCBS program.

 

Texas

Several programs exist to serve the needs of Texas residents who are not eligible for Medicaid. These include the Texas: Community Attendant Services Program, Texas CCAD Program / Client Managed Personal Attendant Services, and Texas DADS Services to Assist Independent Living. The Community Attendant Services (CAS) program allows certain family members to be hired as caregivers, with the exception of close relatives and legal guardians. The CAS program requires the use of a financial management agency to serve as an intermediary to facilitate the transfer of funds.

The Texas Community Care for Aged/Disabled (CCAD): Non-Medicaid Services for the Elderly program offers a similar suite of services, but it does not appear as though self-directed care is an option via this program. Likewise, Texas DADS Services to Assist Independent Living is a similar program, and it’s also unclear if this program allows for consumer-directed services – this program, in particular, transitioned from the Department of Aging and Disability Services (DADS) to the Department of Health and Human Services (HHS) in September 2017, so it’s not clear whether changes to the program will occur as a result of this transition.

The Texas In-Home and Family Support Program (Community Services IHFS Grant) offered support for those with physical disabilities through grants of up to $3,600 per year. This program was terminated in August 2017 due to lack of funding.

The Texas Community First Choice Program and Texas STAR PLUS Waiver are Medicaid-funded programs. Both programs are similar, although the Community First Choice (CFC) program is newer. CFC is also an entitlement program, meaning there are no waiting lists – services are available to anyone who is eligible and in need of services, while STAR PLUS is capped and therefore waiting lists may exist.

STAR PLUS is a managed Medicare program, with services provided by a managed care organization (MCO). The CFC program is a consumer-directed program, allowing participants to choose their own care providers, including family members with the exception of spouses.

Texas offers a VD-HCBS program through the state’s VA Medical Centers located in Dallas, Central Texas, and San Antonio.

How to obtain financial assistance for caregivers in Texas:

  1. Contact your local Texas Health and Human Services (HHS) office to apply for the CAS program.
  2. For information on the CCAD program, contact your local Aging and Disability Resource Center.
  3. Visit Independent Living Services for information on in-home support services for older adults and those with disabilities.
  4. Apply for Texas Medicaid if eligible through the Your Texas Benefits website. You can also apply for the STAR PLUS program through this website.
  5. Apply online for the CFC program.
  6. Veterans should contact the Texas Veterans Commission for information on the VD-HCBS program.

 

Utah

Utah's Home and Community Based Alternatives Program is a state-funded program that helps Utah residents avoid having to spend-down their assets in order to qualify for Medicaid. In addition to personal care services, adult day care, and other caregiving services, the program also offers some assistance for minor home modifications to accommodate aging-related impairments. The program allows family members to provide paid caregiving services to loved ones, although spouses are not eligible to be paid to provide services. Adult children and siblings are eligible, although they must obtain a Utah business license. Additionally, the recipient must have attempted to receive care from a provider who was previously licensed without success.

The Utah State Plan Medicaid Personal Care Services program is an entitlement program, meaning there are never wait lists to receive services. It’s not clear whether consumer direction is an option through this program.

This Utah Medicaid Waiver for Individuals Age 65 or Older, also known as a Medicaid Home and Community Based Services (HCBS) Waiver (or the Aging Waiver) does allow for consumer direction of services. Participants are able to hire friends or relatives, with the exception of spouses and legal guardians, to provide caregiving services. Support is also provided for in-home medical equipment, personal emergency response services, and home modifications necessary to support independence, as well as medication reminder systems, respite care, and adult day services. Payments for caregivers are handled by a financial management agency. The Aging Waiver is managed by the Division of Aging and Adult Services (DAAS), a part of the Utah Department of Human Services.

Utah's New Choices Waiver (NCW) is a Medicaid program provides services designed to enable individuals to move from an assisted living community, nursing home, or health care facility back to their own home or into the home of a loved one or caregiver. The NCW provides funds for support services including homemaker services, home modifications required for accessibility, home delivered meals, non-medical transportation, and other services such as attendant care and adult day services. It allows for consumer direction of services, including the option to hire friends or relatives, with the exception of spouses or legal guardians. An open enrollment period applies to this program, and it’s only available for those who are currently residing in a care facility and want to transition back into the community.

Utah’s VD-HCBS program is offered through the Salt Lake City VA Medical Center.

How to obtain financial assistance for caregivers in Utah:

  1. Contact your local Area Agency on Aging for information on the HCBA / Alternatives Program.
  2. Apply for Utah Medicaid if eligible.
  3. Contact your local Department of Human Services office for information on the Utah State Plan Medicaid Personal Care Services program. Keep in mind that this program may not include self-directed services. You can also call 866-435-7414 for information and assistance.
  4. Contact your local Area Agency on Aging for information on the Aging Waiver program and how to apply for services.
  5. Veterans should contact the Utah Department of Veterans and Military Affairs for information on the VD-HCBS program.

 

Vermont

There are a few programs available to Vermont residents who are eligible for Medicaid, including the Vermont Attendant Services Program, the Vermont Global Commitment to Health Waiver, and the Vermont Choices For Care (CFC) program.

The Attendant Services Program (ASP) provides services to those with disabilities who require assistance with ADLs. It’s a self-directed program, and participants are able to hire, train, and manage their own care providers, which includes certain family members such as adult children of aging parents. Spouses, civil union partners, and legal guardians are ineligible to be paid for providing services, however. The hourly rate is a Medicaid-approved rate typically between $14.50 and $18.50 per hour.

Vermont's Global Commitment to Health (GC) Waiver is a Medicaid (Green Mountain Care) program offering a wide range of services to individuals with varying needs, including elderly residents requiring ongoing assistance. In addition to personal care services, adult day services and respite care are available, as well as emergency response services, assistance for assistive technology or medical equipment, and home modifications to support independent living. The self-directed care option allows participants to hire family members, including spouses, to provide caregiving services.

Other programs available in Vermont (without consumer-directed options) include the Vermont Home Sharing Program, which matches older adults requiring assistance with housemates who are able to offer the needed assistance, and the Vermont Home Access Program, which offers assistance with home modifications.

Vermont’s VD-HCBS program is offered through the White River Junction VA Medical Center.

How to obtain financial assistance for caregivers in Vermont:

  1. Apply for Vermont Medicaid if eligible.
  2. Learn more about the ASP program from by visiting the Vermont Department of Disabilities, Aging & Independent Living website. You can also contact an ASP program representative by calling 802-828-0610. You may also download an application here.
  3. Contact Vermont Health Connect via their website or by phone at 855-899-9600 to apply for the GC waiver. You can also reach out to a local assister for help with the process.
  4. Contact your local Vermont Area Agency on Aging for more information on other programs and services that may be available to you.
  5. Get in touch with the Office of Veterans Affairs for information on the VD-HCBS program.

 

Virginia

The Virginia Elderly or Disabled with Consumer Direction (EDCD) Waiver was a program available to Virginia residents who are Medicaid-eligible. However, in July 2017, this program merged with the Technology Assisted Medicaid Waiver into a single, comprehensive program called the Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver.

The CCC Plus Medicaid Waiver recently rolled out statewide on January 1, 2018, so while services are expected to remain largely the same to beneficiaries, there may be some differences in specifics. Under the previous EDCD program, some family members were able to be compensated for providing care services.

Virginia’s VD-HCBS program is offered through the Richmond and Hampton VA Medical Centers.

How to obtain financial assistance for caregivers in Virginia:

  1. Apply for Virginia Medicaid if eligible.
  2. Contact Commonwealth Coordinated Care Plus (CCC Plus), Virginia’s Medicaid managed long-term services and supports program, for information on in-home services available to you.
  3. Veterans should contact the Virginia Department of Veterans Services for information on the VD-HCBS program.
  4. For information on other programs and services for older Virginians, contact your local Area Agency on Aging.

 

Washington

Medicaid-eligible Washington residents have several programs available to obtain support and services including Washington COPES, the Washington Medicaid Personal Care (MPC) Program, Washington Medically Needy In-Home Waiver, Washington New Freedom Program, and the Washington Community First Choice Option.

COPES is a Washington State Medicaid (Apple Health) waiver program offers supports and services including personal care, home modifications, emergency response services, and transportation assistance. The program is administered by the Health Care Authority and the Washington State Department of Social and Health Services.

The Washington Medicaid Personal Care Program is administered by the Home and Community Services (HCS) and Developmental Disabilities (DDA) administrations. A CARE assessment is completed by a case manager, nurse, or social service specialist from DDA, HCS, or Area Agency on Aging (AAA) to determine eligibility and required services.

The Washington New Freedom Program is self-directed. After an individual budget and spending plan is created, based on assessed needs and preferences, the participant is able to use their budget to hire their own personal care attendants and purchase items and services that enable them to live independently. The Washington Community First Choice Option offers similar services, although it’s not clear if consumer direction is an option through this program.

Washington’s VD-HCBS program is offered through the VA Medical Centers located in Puget Sound, Walla Walla, and Spokane, WA.

How to obtain financial assistance for caregivers in Washington:  

  1. Apply for Washington Medicaid if eligible.
  2. Residents in King County can call 1-800-346-9257, while residents in Pierce County can call 1-800-442-5129 for eligibility and enrollment information for the New Freedom Program. A self-assessment and other forms can be downloaded here.
  3. Visit Washington Connection, a fast and simple way to apply for a variety of services.
  4. Contact your local Area Agency on Aging for information on additional programs and services that may be available to you.
  5. The Washington State Department of Veterans Affairs is the point of contact for Veterans interested in the VD-HCBS program.

 

West Virginia

The West Virginia Ron Yost Personal Assistance Services program and the West Virginia Lighthouse Program are two options for West Virginia residents who are not eligible for Medicaid.

The Ron Yost Personal Assistance Services program (RYPAS) is modeled after the Medicaid Cash and Counseling model (although it is not a Medicaid-funded program). It is a consumer-directed program, allowing participants to hire friends, neighbors, and certain family members to provide caregiving services.

The Lighthouse Program offers four levels of support for older adults – age 60 and over – in their homes, including personal care services, nutrition, mobility assistance, and homemaker services. Like the RYPAS program, certain family members may be hired to provide services (though not in all counties) for a maximum of 60 hours per month; however, the specific hours of care permitted will be determined by the Plan of Care, developed by a county caseworker and a medical professional. Adult children may be hired as caregivers; spouses may not. Caregivers are hired and provided training by the county.

West Virginia’s Aged and Disabled Waiver is a Medicaid-funded program offering services ranging from non-medical personal care assistance to non-medical transportation and homemaker services. Family members may receive payment for providing care services through this program, with the exception of legal guardians and spouses. The hourly rate is capped by Medicaid and is typically between $8.75 and $13.00 per hour (or 60% to 70% of the state average for home care providers).

West Virginia does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in West Virginia:

  1. Apply for West Virginia Medicaid if eligible.
  2. Residents must apply for WV Medicaid's Aged and Disabled Waiver and Personal Care Services programs before applying to non-Medicaid-funded programs.
  3. If ineligible for Medicaid-funded programs, apply for RYPAS here.
  4. Contact the Bureau of Senior Services or your local county aging provider for information on applying to the Lighthouse Program.
  5. Contact the West Virginia Department of Senior Services by calling 304-558-3317 or 877-987-3646 for information on the Aged and Disabled Waiver program.

 

Wisconsin

Wisconsin’s Family Care and Family Care Partnership Programs are available for eligible Wisconsin residents who do not qualify for Medicaid. Both programs are managed care programs, while the Family Care and Partnership program is a self-directed program called SDS or Self-Directed Supports. The Family Care program is designed for non-medical care while the Partnership program provides more comprehensive services, including complete medical care and prescription drugs. The Community Options Program Waiver (COP-W) and the Community Integration Program II (CIP-II) have transitioned into the Family Care and Family Care Partnership Programs.

Participants in the SDS program are provided with funds that would otherwise be spent on their care services in a residential setting such as a nursing home, which they may then utilize to pay for goods and services that support independent living. Participants may hire friends, neighbors, and certain family members as caregivers, which may include adult children but generally excludes spouses and legal guardians.

Wisconsin Medicaid offers the Include, Respect, I Self-Direct (IRIS) Program, a waiver program that includes self-directed care (Self Directed Personal Care or SDPC). After a Service and Support Plan is developed, the participant is provided with a budget that they may spend on any goods or services outlined in the plan. They may also select their own care providers, including family members (adult children, spouses, and other family members are eligible). Caregivers must pass background checks and be qualified to provide the services. They are also taxed on their wages.

Wisconsin offers a VD-HCBS program through the state’s VA Medical Centers located in Milwaukee and Tomah.

How to obtain financial assistance for caregivers in Wisconsin:

  1. Apply for Wisconsin Medicaid if eligible.
  2. Contact your local Aging and Disability Resource Center (ADRC) for information on the Family Care and Family Care Partnership programs, including how to apply.
  3. Your local ADRC office can also assist with IRIS applications. You may also call 1-888-515-IRIS (4747) for information on the program.
  4. Veterans should contact the Wisconsin Department of Veterans Affairs for information on the VD-HCBS program.

 

Wyoming

The Wyoming Community Choices Home & Community Based Services Medicaid Waiver (CCW) is a Medicaid-funded program offering services including personal care assistance, home meal delivery, adult day services, respite care, and other services to help individuals remain in their own homes and avoid nursing home placement.

Administered by the Wyoming Department of Health’s Division of Healthcare Financing (DHCF), CCW offers an In-Home Participant Directed Option enabling participants to select their own care provider, called a direct service worker. Family members including adult children may be hired to provide caregiving services, although spouses, legal guardians, and anyone with a Power of Attorney for the care recipient are ineligible to receive compensation for services.

Caregivers are limited to a maximum of 40 hours per week and are paid at a rate typically ranging between $10 and $12 per hour. It is not an entitlement program, so there may be wait lists.

Wyoming does not currently offer a VD-HCBS program.

How to obtain financial assistance for caregivers in Wyoming:

  1. Apply for Wyoming Medicaid if eligible.
  2. Contact the Division of Healthcare Financing Long Term Care Unit at 855-203-2823 for information on applying for the CCW program.
  3. An assessment will be arranged to determine eligibility. Applications are typically approved or denied within 45 days.
  4. Contact your local Area Agency on Aging or the Wyoming Department of Health Aging Division for information on additional programs and services available in your area.