If you are helping a family member stay at home, you may already be doing real care work. This can include bathing, dressing, preparing meals, managing medications, and helping with mobility or appointments.

Many families do not know that some public programs may offer support. These programs work differently depending on the type of coverage and the state. This guide explains what Medicare, Medicaid, and veterans programs may offer, how they work, and where to start.

The key difference between the two programs

Medicare is focused on medical care and short-term recovery. It covers hospital care, doctor visits, and limited home health services after illness or injury. It does not pay family members for ongoing daily care at home.

Medicaid is focused on long-term care. In some states, it may allow a family member to be paid as a caregiver through self-directed care programs or Home and Community-Based Services (HCBS) waivers. Medicaid is the main program to explore if someone needs ongoing help at home and may qualify based on income, assets, and care needs.

What Medicare offers: limited caregiver training

Medicare does not pay family caregivers. In some cases, it may include training or education as part of a medical care plan.

Training through home health services

Home health is available when a person is considered homebound and needs skilled care. Homebound means leaving home requires considerable effort or help due to illness or injury.

When eligible, a Medicare-certified home health agency may send nurses or therapists into the home. They may teach family members how to help with tasks such as wound care, medication support, safe movement, and basic health monitoring. This training is only provided when it is part of a provider-ordered care plan.

More information:
Centers for Medicare & Medicaid Services
https://www.medicare.gov/coverage/home-health-services

What Medicaid offers: possible pay for family caregivers

Some Medicaid programs may allow a family member to be paid as a caregiver. This is not available in every state. It depends on program type, eligibility, and local rules.

Self-directed care programs

Some states offer self-directed care, also called consumer-directed services or HCBS waivers. These programs allow the person receiving care to help choose their caregiver and manage their care plan. In some cases, this includes hiring a family member.

Who can be paid

Many programs allow adult children, siblings, grandchildren, and other relatives to be paid caregivers. Spouse rules vary by state and program. Some states allow it under certain waiver programs, while others do not. You should always confirm rules with your state Medicaid office.

What paid caregivers do

Paid family caregivers help with daily activities that support safety and independence at home. These include non-medical daily living tasks.

• Bathing and dressing
• Meal preparation
• Light housekeeping
• Medication reminders
• Transportation
• Mobility support

How payment works

Pay rates vary by state and program. Caregiver pay is usually set by state rules. Approved hours are based on a needs assessment and care plan. Most programs use a payroll service or Financial Management Service to handle taxes, timesheets, and payments.

Caregiver support through Medicaid

Some Medicaid programs include respite care. Respite care provides temporary relief so caregivers can rest or manage personal needs. Availability and limits vary by state and program.

How to qualify for Medicaid paid caregiving

Eligibility applies to the person receiving care.

Care needs

A state assessment looks at whether the person needs help with daily activities such as bathing, dressing, cooking, or moving safely at home. This helps determine if long-term care services are needed.

Financial eligibility

Medicaid has income and asset limits. These vary by state and program type. In many cases, individuals must meet strict asset limits. Some assets, such as a primary home or vehicle, may not count depending on rules and situation.

Caregiver requirements

Requirements vary by state and program, so make sure to check with your state programs. Caregivers usually must:

• Be at least 18 years old
• Pass a background check
• Complete training in some programs
• Track and submit hours worked

Other ways families may receive support

Veterans benefits

If the person receiving care is a veteran, the U.S. Department of Veterans Affairs offers programs that may support family caregiving.

Aid and Attendance provides extra monthly payments for veterans or surviving spouses who need help with daily activities. These funds are paid to the beneficiary and may be used to help pay for care.

Housebound benefits provide increased monthly payments for veterans or surviving spouses who have a permanent disability that significantly limits their ability to leave home.

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) may provide:

• A monthly caregiver stipend
• Caregiver training and education
• Mental health counseling
• CHAMPVA health coverage (if eligible)
• At least 30 days of respite care per year
• Access to VA caregiver support services

Veteran Directed Care (VDC) provides a care budget that may allow eligible veterans to hire a family caregiver, depending on program availability.

Personal care agreements

A personal care agreement is a written contract between a care recipient and a family caregiver. It outlines duties and payment for caregiving services. These agreements are used when care is paid privately. They help clarify expectations and document that payment is for services provided. An elder law attorney can help create one. Records of hours worked and payments should be kept.

Long-term care insurance and paid leave

Some long-term care insurance policies may allow payment to family caregivers, but coverage varies and must be confirmed with the insurer. Some states and employers also offer paid family leave. These programs may allow time off work to care for a family member. Eligibility and pay vary by state and employer.

Where to start

For Medicaid paid caregiving, contact your state Medicaid office. You can also reach the Eldercare Locator, a free referral service from the Administration for Community Living.

Eldercare Locator, Administration for Community Living
Website: eldercare.acl.gov
Phone: 1-800-677-1116
Hours: Monday through Friday, 8:00 AM to 9:00 PM ET

For Medicare caregiver training, start with the doctor or care team of the person you are supporting. Ask whether caregiver training may be included in their care plan through home health services or other Medicare-covered services. Medicare caregiver training options depend on the care plan and provider participation, so availability varies.

For veterans benefits, start with your local County Veterans Service Officer, who can help identify eligibility and connect you to programs.

You can also visit VA.gov or contact a local U.S. Department of Veterans Affairs medical center for assistance.

The American Legion also provides benefits navigation support through its national service officer program and local posts.

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This guide provides general information about caregiver support programs, including self-directed care options. It is not legal, financial, or medical advice. Program rules vary over time and by state and situation. For help with your specific circumstances, contact a social worker, benefits counselor, or elder law attorney.

Sources

• Medicaid / Medicare
  • Centers for Medicare & Medicaid Services (CMS.gov)
  • Medicaid state Medicaid agencies (each state site)
  • Medicare official Medicare.gov guidance
• VA programs
  • U.S. Department of Veterans Affairs (VA.gov)
  • VA Caregiver Support Program pages (PCAFC, VDC, Aid & Attendance)
• Eldercare / aging services
  • Eldercare Locator, Administration for Community Living (ACL/eldercare.acl.gov)
• Paid family leave (if included)
  • U.S. Department of Labor:
    • U.S. Department of Labor (dol.gov)
  • Individual state labor departments