Does Medicare Pay For Family Caregivers?

Introduction

Medicare is a federally-operated medical assistance program for retirees and those with disabilities. You may be wondering, does Medicare pay for family caregivers? The Medicare system doesn’t outright pay family caregivers for providing services for family members. However, older adults needing personal care assistance may qualify for financial assistance with home health care or other services.

State-funded Medicaid programs may offer more options to pay family caregivers, though participants must qualify based on income and other factors. Read on to learn more about Medicare and other options to pay family caregivers.

When Does Medicare Pay for Family Caregivers?

Original Medicare only covers inpatient and outpatient medical care, such as doctor’s visits, immunizations, and surgeries. However, members eligible for and enrolled in Parts A and B and also homebound may qualify for in-home services. Medicare Part A and Part B cover eligible home health services, such as:

• Intermittent skilled nursing care, when medically necessary
• Part-time skilled or intermittent home health aide care (if you’re also receiving skilled nursing care)
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services and case management
• Durable medical equipment (DME), such as wheelchairs and minor home modifications
• Medical supplies, including injectable osteoporosis medications for women

These services may be covered for eligible Medicare beneficiaries as long as the beneficiary is considered "homebound." To be considered homebound, you must meet the following qualifications:

• You’re unable to leave home without help from an assistive device such as a cane or wheelchair
• It’s not recommended for you to leave home due to your medical condition
• You’re generally unable to leave home because of the major effort involved

However, Medicare does not cover 24-hour care, meal delivery, or personal care when it is the only care needed. It also does not pay for long-term care services like in-home or adult day services. You may find these benefits under a Medicare Advantage (MA) plan.

Medicare Advantage (MA) Home Care Options

Medicare Advantage operates more like a traditional health insurance plan, replacing your original Parts A and B (and your 20% copay) with an all-in-one plan that comes with its own premium and deductibles. You would still be responsible for your Part B premium. However, some plans offer a give-back, paying a portion of your monthly Part B premium. All MA plans must offer benefits that are equal to or better than those written in original Medicare Parts A and B.

Remember that Medicare Advantage plans change yearly, offering potentially new and improved benefits. Be sure to contact your health insurance carrier during the annual enrollment period (AEP) from October 15 through December 8, to check what new plans are available. In addition to potential home-care benefits, MA plans can offer benefits such as dental, vision, transportation to medical appointments, over-the-counter (OTC) spending allowances, and healthy grocery allowances (typically for low-income members).

Special Needs Plans (SNPs)

While being dual eligible for both Medicare and Medicaid qualifies you for extra benefits through a Medicare Advantage plan, it also opens up opportunities to participate in home-health services programs. There are special needs programs for people eligible for both programs and those with chronic or disabling conditions.

Medicare pays the brunt of these programs, and participants pay a cost share, depending on what plan they sign up for. Be sure to speak to a Medicare advocate or benefits advisor to ensure you know how the change will affect you regarding the providers you can see and other factors.

State-Funded Family Caregiver Assistance Programs

The Medicaid program, which provides needed medical services to low-income participants who meet other qualifications, may offer family caregivers payment, depending on your state and other factors. Various programs are available nationwide, each with state-specific rules and eligibility qualifications. Medicaid Structured Family Caregiving (SFC) Programs are one type of program that pays family caregivers and provides training and other support.

There are also several waivers offered by Medicaid, with availability varying by state. The Home and Community-Based Services (HCBS) Waivers offer a range of options for people who need help paying for their at-home medical care. Created by the Affordable Care Act (ACA), the Community First Choice waiver, or 1915 (k) state plan, is another Medicaid program for people needing a caregiver. Participants can hire someone, often family members qualify, to provide care and have their wages reimbursed by Medicaid.

Becoming a Medicaid-Approved Care Provider

In many cases, caregivers need to meet agency requirements to become hired by the agency as a contracted care provider. There are usually educational requirements and ongoing certification, as well. Some states may require you to certify your home as a Family Care Home.

States with In-Home Care Payment Waivers

Each state’s Medicaid program has different offerings, so reach out to your local Area Agency on Aging (AAA) to learn more about the programs near you. Here is a short list of some of the most popular states for seniors in the US and some special family caregiver programs outside of Medicare that residents may qualify for.

Alabama

Residents of Alabama who are at risk of needing nursing home care may qualify for the state’s HCBS waiver. There are medical, financial, and program requirements and limited enrollment availability with a possible waiting period. Participants in the Elderly and Disabled waiver program can direct their own care. Reach out to your local Medicaid office to find out about your family's eligibility and how to become a paid provider.

Alaska

In Alaska, Medicaid-eligible elders may be eligible to receive state-funded caregiver services. The Community First Choice program offers Alaskans who are eligible for nursing-home-level care the opportunity to stay at home, paying a caregiver to attend the activities of daily living (ADLs) and chores.

Arizona

Arizona has several programs that assist family caregivers. To be a wage-earning caregiver, you would need to register with the state and become a home health agency employee. Then, you would be able to sign up as a paid caregiver for your qualified family member (who is already approved and eligible to receive services). This state also offers the Arizona Family Caregiver Reimbursement Program, which provides a one-time reimbursement of $1,000 to modify your home or provide assistive technologies per qualified family member.

Connecticut

Connecticut's programs to pay family caregivers are offered in the form of waivers through the Department of Social Services. The Connecticut Home Care Program for Elders offers assistance such as a homemaker or companion, adult family living, personal care attendants, and more. Reach out to the Connecticut DSS to learn more and apply for Medicaid long-term services and support.

Georgia

The state of Georgia can pay a family caregiver with the Structured Family Caregiving (SFC) program. The state’s Medicaid program, Health Force of Georgia, provides support services and financial assistance to families that provide care for their elders at home. If your relative is Medicaid-eligible, you may qualify. However, spouses and legal guardians are ineligible).

To qualify to be paid as a family caregiver, it must be your only job and you cannot run any businesses (such as an online store). To qualify, you must provide daily assistance in meal prep, eating, dressing, bathing, transportation, mobility, and other ADLs.

Idaho

If you’re looking for ways to get paid as a family caregiver in Idaho, try the Home and Community Based Services waiver. Participants that make less than $2,762 per applicant (in 2023) can receive financial assistance paying for services including:

• A home health aide
• Personal care
• Respite care
• Habitation
• Homemaker services

Paid homemakers and companions need to register with the state and meet specific education requirements, as well as ongoing certification requirements. Reach out to the Bureau of Long Term Care to learn more about how to become a paid caregiver in Idaho.

Indiana

Indiana offers one Medicaid waiver for seniors, the Aged and Disabled (A&D) Medicaid Waiver. The program pays for several supportive services including structured family caregiving, vehicle modifications, and adult day services. To get paid as a family caregiver in Indiana, you must register and certify with the IHCP (Indiana Health Coverage Programs).To apply, locate your nearest Agency on Aging office by calling 1-800-986-3505.

Iowa

In Iowa, family caregivers can be paid for their services with the HCBS Elderly Waiver. This waiver, which provides self-directed care under the Consumer Choices Option (CCO), lets participants choose their own employees as well as goods and other services. Participants also work with case managers and financial planners to help develop individual budgets. This program doesn’t pay for room and board, childcare, or entertainment services, but only for services that would otherwise be covered by the state’s Medicaid plan.

Kentucky

If your family member is over 65 and qualifies for nursing home level care, you might qualify for HCB waiver services. These include attendant care and respite care, which may be able provided by a friend or family member of the participant's choosing. Reach out to the Kentucky Department for Aging and Independent Living to find out more.

Louisiana

Louisiana provides a range of support for older adults and their families, including the Program for All-Inclusive Care for the Elderly (PACE). This program has age and income limitations. The Long-Term Personal Care Services Program and the Community Choices Waiver are also included. Reach out to the Louisiana Aging and Adult Services Department to find out about these programs, how to apply for Medicaid, and how to certify as a care provider for the state.

Maryland

Maryland offers the Community First Choice Waiver, allowing residents to either stay in their homes or live in an assisted living facility while receiving caregiver services. Participants must meet medical and financial requirements to qualify for this waiver. Services offered under this program include ADL help, household services, transportation to medical appointments, and personal grooming and hygiene.

Missouri

There are several 1915(c) Home and Community Based Services (HCBS) waivers in Missouri. For example, Consumer Directed Services is a program offered in Benton, Henry, Lafayette, Pettis, and Saline counties. This program allows participants to choose and train their own paid caregiver, who can earn up to $13 an hour for their service. Participants must be eligible for Medicaid (MO Healthnet) and be able to direct their own care according to their needs.

There are other waivers that may help your loved one pay for senior care in Missouri, such as the aged and disabled waiver, independent living waiver, the medically fragile adult waiver, and the structured family caregiving waiver (SFCW), created for those with Alzheimer’s disease or another related disorder. Contact the Missouri Department of Social Services or call 211 for more information on these and other programs.

Mississippi

The Family Caregiver Support Program offers Mississippi family caregivers support and supplemental services when available. The state also offers HCBS waivers, both the Assisted Living Waiver and the Elderly and Disabled Waiver.

Nevada

Nevada pays family caregivers who live with their loved ones who meet 300% of federal poverty levels. In 2023, this means a max income of $2,742 for a single applicant. The Family Support Services program offers services including:

• Quarterly vouchers for respite care on an ongoing or emergency basis
• Emergency Purchases of Services vouchers that can help pay for items such as food, out-of-pocket medical services, adaptive equipment and utilities

Contact a Regional Center near you to learn more about these Nevada caregiver programs and your eligibility.

Oregon

The Family Caregiver Assistance Program is one way to get paid as a family caregiver in Oregon. This program offers eligible individuals up to $500 a month to pay for supportive services, including in-home personal care and support, minor home modifications, and assisted transportation. To qualify, you must not be receiving other Medicaid services and must have assets totaling no more than the average cost of a 6-month stay in a nursing facility.

Pennsylvania

Pennsylvania family caregivers might qualify for assistance through the Community HealthChoices (CHC) program. Participants must receive both Medicare and Medicaid and a determined nursing home eligible by a healthcare provider. Your loved one might also qualify if they are already receiving long-term services and support.

If ineligible for CHC services, you could try the Pennsylvania Caregiver Support Program. In this program, caregivers are given case managers who perform an assessment of the participants' living situation. They then create a person-centered care plan, which includes reimbursement for needed medical items purchased out-of-pocket. The caregiver doesn’t have to live with the recipient for this program.

Vermont

The Choices for Care program, which is for Vermonters over the age of 18 who need nursing home care, is one option to receive in-home care. This program offers a package of long-term care services, with participants choosing whether they receive services in their home or somewhere else, such as a Family Care home or nursing facility.

The Attendant Services Program provides help to residents who have severe, permanent disabilities. Participants must be able to direct their own care and can choose a care provider to help with their activities of daily living (ADLs).

If you live in or are considering moving to Vermont, you can call 211 to learn about applying for these and other programs. If you’re over 60, call the Senior HelpLine at 1-800-642-5119. If you’re under 60, call the Vermont Center for Independent Living at 1-800-639-1522.

West Virginia

In West Virginia, family caregivers can get paid with the help of an Aged and Disabled Waiter (ADW). This waiver provides case management, non-medical transportation, a personal emergency response system (PERS), and personal attendant services. Participants can either choose a home-care agency to send out a care provider or their own staff who would work directly for them.

You’ll first need a Medical Necessity Evaluation Request (MNER) form to apply for services. Once you’ve gotten the form completed and signed by your healthcare team, you’ll need to verify your financial and medical eligibility, and there may be a waiting period.

Where Family Caregivers Can Find Help For Coverage

Reach out for advice and support with Olera's family caregiver support groups. In our real-time forums, you can find uplifting and inspiring stories about family caregivers just like you. Find people in your situation to help you navigate the complicated world of paying for senior care as a family caregiver. Alternatively, check out the government website for Medicare.

Author Bio

TJ Falohun, co-founder and CEO of Olera, is a trained biomedical engineer passionate about developing novel digital health and medical technologies. His passion for innovative solutions drives him to write about the cost of healthcare in America and to revolutionize the senior healthcare industry.