How Does the Medicaid Caregiver Program Work?

Updated

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

As a caregiver, you may understandably need assistance with not only caregiving tasks but also the financial burden of providing that care. Unfortunately, there is no uniform national standard or help for caregivers. Most programs require that you meet financial and or needs-based criteria.

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Family caregivers provide most of the care of someone older or disabled in the US. The reason for this is that paying for care can be expensive and deplete the financial estate of the caregiver and receiver. There are wealthy caregivers to pay for care, care recipients who have a low enough income and asset level to qualify for Medicaid, and then everyone else who is left to figure out how to pay for care.

As arduous and complicated as applying for Medicaid caregiver programs can be, it is worth doing so because it can make a significant difference. We will walk you through the different programs that might be available to you in your state.

What Is the Medicaid Caregiver Program?

First, let’s talk about what Medicaid is in the US. Medicaid is a joint federal and state program that helps with healthcare costs for people with limited income, assets, and resources. Medicaid also offers benefits such as nursing home care and personal care services. Medicaid covers most nursing home residents across the US.

Through specific state programs, Medicaid can reimburse qualified family caregivers for the care they provide. Assistance with personal care is available through most of the state plans. Many of these states will allow the person receiving the care to manage the caregivers they choose. This is called self-directed care, where the recipient can hire and fire caregivers.

In many of these cases, a spouse or other family member is reimbursed by the Medicaid program to provide the care. So, basically, the government is paying you to be a caregiver for your loved one.

Another way that Medicaid pays caregivers is through home health agencies that accept Medicaid reimbursement. Medicare also pays for home health, but for people who don’t have Medicare yet but qualify for Medicaid, this could be an option for short-term assistance.

How Do Medicaid State Plans Work?

Generally, the Medicaid state programs work the same, but with differences in income, asset level, and availability. Some of these programs might have waiting lists since Medicaid funding is finite. Several types of Medicaid programs are available in each state.

Home and Community Based Waiver Programs (1915 C)

When you think of the word “waiver,” you are correct in assuming that some of the Medicaid criteria are “waived” when considering eligibility for home-based services. Medicaid waiver programs consider several factors when deciding. One of the criteria is that the person receiving care would otherwise be eligible only in an institutional setting, such as a nursing home. 

Many of these waivers allow for participant direction. Participants can hire a personal care assistant of their choosing, including friends and relatives. Other available services may also include case management, homemaker services, adult daycare, home health aides, personal emergency response systems (ERS), and respite care. Most states offering the waiver programs will have a cap on the number of recipients they can accept per year, which means there could be long waiting lists. 

In certain states, someone who is in a nursing home for a defined period might be eligible to move to assisted living paid for by Medicaid. Or, a person residing in an assisted living for a specified time period runs out of money and can apply to the state waiver program to cover their costs. 

Home and Community Based Services Plan

The Home and Community Based Services Plan differs from the waiver program in that the recipient does not need to meet a nursing home level of care. The program develops an individualized care plan that determines homemaker and personal care services and a budget to allow the recipient to direct their care from a relative or other individual.

Community First Choice Option (CFC)

The CFC program is another state option for recipients who would otherwise need a nursing home level of care. There is an option in this program for self-directed care to hire a friend or family member who needs assistance with activities of daily living (ADLs). Only a few states currently offer this option.

Self-Directed Personal Assistance Services (PAS) State Plan Option 

The PAS plan allows recipients to hire, train and manage their caregivers. Since the program is budget-based, the amount paid to the caregiver is determined by the recipient's budget. Each state determines eligibility and availability and who can be hired as a caregiver.

Adult foster care

Adult foster care in some states, also referred to as adult family living or adult family care, is another Medicaid option. Room and board are not covered, but costs associated with personal assistance with dressing, eating, housekeeping, supervision, and transportation are. Some families opt for an older parent to move in with them under this program.

Who Typically Qualifies for the Program?

Each Mediciad caregiver program will have slightly different qualifications to participate, depending on the program. But, in general, these are the criteria:

Qualify for Medicaid

All of the programs require Medicaid eligibility, but the Medicaid waiver program will have slightly different criteria. Generally, a person must not have a monthly income that exceeds $2,523. Then there is a complicated assessment of assets.

Assets usually include cash, retirement savings, stocks, bonds, and vacation property. These assets can’t exceed $2,000. Exempt assets include the primary home, personal furnishings, funeral plans, and life insurance plans.

Meet level of care requirements

The level of care can be thought of in two ways: the nursing home level of care for Medicaid waiver program and the other for the Aged, Blind, and Disabled Medicaid programs where the requirement is limited personal care assistance. The nursing home level of care will give you an idea of what the specific functional requirements are:

Physical Function (Activities of Daily Living)

Physical function is a broad term that applies to the activities of daily living that most of us take for granted.

  1. Being able to dress, undress, and choose clothing appropriate for the weather and circumstances 
  2. Being able to move, transfer and get in and out of bed or a chair. Mobility also includes the ability to use a walker or a wheelchair.
  3. Eating by being able to get food to your mouth with proper utensils
  4. Using the toilet and appropriate hygiene

Instrumental Activities of Daily Living (IADLs)

IADLs are not functional but are necessary to live safely and independently.

  1. Shopping for food, essentials, medications, and clothing
  2. Planning and cooking meals
  3. Maintaining a home including housekeeping, laundry, and home repairs
  4. Managing money, including paying bills
  5. Transportation either through driving or accessing other forms of transit
  6. Being able to manage medications safely
  7. Communicating via phone or computer

Have medical or other health needs

In addition to ADLs and IADls, a nursing home level of care usually means needing some assistance with medical tasks. These can include injections, catheter care, and intravenous medications.

Cognitive impairment

Cognitive impairment can result from dementia, Alzheimer's disease, or Parkinson’s. At some point, people with cognitive impairment may be unable to perform ADLs and IADLs safely. Problems with judgment and memory can require supervision and assistance.

Behavioral problems

Not everyone with dementia, Alzheimer's, or mental illness will have behavioral problems. Wandering, aggression, and impulsivity are behaviors that require managing and monitoring. 

Caregiver requirements

Each state determines caregiver requirements under Medicaid self-directed programs. Some require background checks, training and/or licensing, and certification. 

How Much Do the State Programs Typically Pay a Caregiver?

Each state will vary in terms of what they pay a caregiver based on the type of program and funding availability. To give some examples, Florida pays family caregivers between $9 and $13 an hour. Under one Medicaid program, caregivers in the state of Washington are paid approximately $15.50 an hour. 

But, in addition to paying caregivers, some Medicaid programs also pay for durable medical equipment, home modifications for accessibility, Adult Day Care, and meal delivery services. 

How Do You Apply for the Program?

Applying for a Medicaid Caregiver Program is complicated since each state has a different application process and programs. The steps to take could vary depending on the program you apply to. Follow these steps to get started.

1. Contact your area agency on aging

Start here to find out what programs are available in your state and the eligibility criteria. The best way to find your Area Agency on Aging is through Eldercare Locator. Your area agency on aging will have information about Medicaid caregiver programs and, in some cases, can help you apply. 

2. Apply for your Medicaid Waiver Program

If you are applying for a Medicaid Waiver Program, find the program in your state to fill out an application in your state. Most, but not all states, require that you be eligible for Medicaid. As we mentioned, since waiver programs are not considered entitlement programs, there can be long waiting lists.

3. Apply for your state Medicaid

Apply for Medicaid in your state. Some states will allow you to spend down assets to qualify for Medicaid if you are over the income limit. Medicaid has strict requirements on transferring assets to another person to qualify, called a “lookback period,” so make sure you follow your state’s Medicaid rules.

4. Choose your family caregiver

When choosing the person you want to be your caregiver, pick someone with the time and expertise to give you good care. Remember that for some programs you are qualifying for a nursing home level of care, which means a high level of personal and medical care.

Medicaid Caregiver Program

Yes, applying for Mediciaid caregiver programs is complex. But, giving your time to care for a loved one can take a financial toll on you. If you think your family member qualifies for Medicaid, the program can offer several benefits, including paying you to be a caregiver.

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