How to Be a Paid Caregiver for a Loved One in Washington


Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

When you’re a caregiver for a family member, you may have to take time off work or leave employment altogether. Caregiver burnout is common. Although qualifying for payment through the state may not alleviate some of the psychological stress,  relieving some of the financial burdens is appealing since any kind of compensation can help offset care costs. 

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Every state has a variety of possible caregiver support programs with different names, eligibility criteria, and services. Washington state, like other states, has programs to assist family caregivers. 

The task of finding information and qualifying for benefits can be arduous, but making an effort will be worth it to get some financial assistance. Almost all state plans to assist family caregivers are through the states’ federal Medicaid programs. 

Can a Family Member Get Paid to Be a Caregiver in Washington State?

You can be paid as a family member to be a caregiver in Washington state, but only under specific circumstances. There are two main programs (others are also available) in Washington state that can compensate caregivers. 

The principle behind almost all community-based programs is that offering care for someone at their place of residence is less expensive and more comfortable than a nursing home. You can expect that community and home-based services will grow and expand, so it is always a good idea to keep apprised of any new programs or changes in your state.  

If you’re a family member new to caregiving, consider online caregiver training so you can feel confident in providing the hands-on care you’re paid to do. Caregiving tasks can be challenging, and safety is a priority. 

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Community First Choice Option 

The Community First Choice Option (CFCO) is a Medicaid program that allows for the client to direct their care and pay family members to assist them. However, the family member cannot be a spouse since it’s assumed that a spouse is already providing some care. Eligibility criteria include the following:

  • Medicaid eligible. To be considered for the CFCO program, an individual must qualify for Medicaid, the federal and state program for financially needy people. In 2020 individuals over the age of 65 must have a monthly income under $2,349 and no more than $2000 in assets. Check with the Washington State Medicaid office for more specifics on Medicaid requirements. 
  • Be residing outside of a medical institution. As with most programs that provide payment to family members or others to care for someone, the individual must reside outside of a nursing home. However, part of the criteria is that the recipient of care would qualify for a nursing-home level of care based on the type of care they need.  A nursing-home level of care would require the applicant for the CFCO program to demonstrate they need substantial assistance with daily living activities.
  • Undergo an evaluation by a case manager. A program case manager conducts an assessment to determine whether you meet the nursing-home level of care to qualify for the CFCO program. Assessment and evaluation will include activities of daily living such as bathing, dressing, hygiene, and toileting. Re-evaluations take place yearly to ensure that the person continues to meet the criteria for participation in the program.
  • Types of services to expect. Assistance with medication management
    • Medical tasks such as insulin injections or blood glucose monitoring, and ostomy care
    • Housekeeping
    • Skills acquisition training which allows the recipient to receive training to learn and enhance skills 
    • Transportation assistance
    • In-home respite care
    • Assistive technology up to a certain amount
    • Training for the consumer direction option on how to manage caregivers
    • Personal emergency response systems
    • Community transition services up to a certain amount (to assist with a move from home to assisted living, for example)
    • Referral to other healthcare providers and healthcare coordination
    • Skilled nursing in case of emergency
    • Help with the transition from one living situation to another.

New Freedom Program

The New Freedom Program is a voluntary program also funded by Medicaid. Participants receive services in their home and direct their own care while deciding the best mix of services to meet their needs. Participants have a budget and can hire family members or others. Two counties, King and Pierce, currently offer the New Freedom Program.  Generally speaking, these are the program characteristics and requirements.

  • Determine eligibility. Any person who meets functional and financial eligibility criteria to receive in-home services under Washington’s Medicaid long-term care waiver programs is eligible for the program.
  • Assessment of care needs. A case coordinator conducts an evaluation to identify care needs.
  • Develop a budget. The care consultant helps develop a budget and spending plan based on the participant’s needs and preferences. The budget also includes goods and services. 
  • Financial management.  The financial management services care consultant assists the participant with budgeting, accounting, and reports.

Veterans Aid and Attendance Program

The Veterans Aid and Attendance program is not a Washington state-specific program but a federal program. If you or your spouse is a veteran, it is worth looking into this program since the VA program pays family members to give care. If eligible, you will receive a monthly cash benefit that you can use to pay either a family member or professional.  If you receive a VA pension, you may be eligible for this program if you meet the following criteria.

  • You did not have a dishonorable discharge and can meet other active duty requirements
  • You meet yearly family income and net worth. The income and net worth amounts are set by Congress. If you exceed this amount, you will not be eligible for pension benefits.
  • You need help. One of three of these are required: you need another person to help you perform daily activities like bathing and dressing; you spend much of your time in bed due to an illness; or you have limited eyesight.  
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How Much Do Family Members Get Paid for Caregiving in Washington?

Family members under the CFCO program are paid approximately $15.50 an hour, which is the Medicaid-approved rate for non-medical care.  

3 Steps to Become a Paid Caregiver for a Family Member in Washington State

The steps necessary to become a paid caregiver for a family member can be confusing, but relying on county and state resources to guide you is a good start. Meeting with an elder law estate planning attorney who specializes in Medicaid for Washington state is also an option. To the extent that you can, you want to use every mechanism possible to protect your assets while still qualifying for state program assistance. 

1. See if you Qualify for Washington State Medicaid

Washington State Medicaid is called Apple Health, and applications are made through your local Home and Community Based Services office or online. Your local Area Agency on Aging is another good place to find out about not only paid caregiving but other support services as well.

If you are well above the Medicaid limit and can’t qualify for any spend-down options, you may not be eligible to be a paid family caregiver through the State of Washington. The Council on Aging has a detailed description of Washington State Medicaid eligibility requirements. 

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2. Consider Medicaid and long-term planning

You can get help with Medicaid planning from a variety of different professionals. Consider Medicaid planning even if you think you qualify under Washington State guidelines.

Geriatric care managers, elder law attorneys, AAA benefits counselors, and estate planning attorneys can all help with careful Medicaid planning so that you take advantage of all of the financial benefits you are entitled to. The most appropriate and affordable options depend on your finances, age, health, state of residence, and marital and veteran status.

Long-term care planning for all of the care you might need in the future, and costs associated with that care, will give you some financial stability. When someone qualifies for Medicaid, they have depleted their assets to a very low level. Taking advantage of caregiver pay under Medicaid is beneficial, but don’t forget to look at other caregiving programs in Washington State that can offer you and your family additional support. 

3. Contact your Area Agency on Aging

Contact your local Area Agency on Aging to apply for either the CFCO or New Freedom Program in King or Pierce counties. Make sure you have all the required documentation before applying to either program.

If you cannot get the information you need from your county Area Agency on Aging, consider contacting the program director for the CFCO at the state division.

How to Become a Paid Caregiver for a Family Member in Washington State

As you realize the possibilities of financial and care management help for your loved one in the state of Washington, you now know it is not an easy journey. To qualify and apply for these programs requires energy and tenacity. But ultimately, your purpose is to keep your loved one home, and community-based programs have the same goal. 

  1. “Community First Choice.” Washington State Care Authority.
  2. “What is New Freedom and Who is Eligible?” Washington State Department of Social and Health Services.
  3. “Eligibility for Veterans Pension.” US Department of Veterans Affairs.
  4. “How to Apply for Medicaid.” Washington State Department of Social and Health Services.
  5. “Find Local Services, Information, and Resources. Washington State Department of Social and Health Services.
  6. “Community First Choice Option.” Washington State Department of Social and Health Services.

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