You may be able to get paid to care for your parent

You drive your mother to her appointments, sort her medications, and help her in and out of the shower. You are not paid for any of it, and you have assumed that is simply how it works.

For many families it does not have to be. Most states run Medicaid programs that let the person receiving care hire their own caregiver instead of accepting one the state assigns. In many states, that caregiver can be the care recipient’s adult child.

How much unpaid care do families provide?

AARP estimates that family caregivers in the United States provided about $600 billion worth of unpaid care in 2021, according to its 2023 Valuing the Invaluable report.¹ That is AARP’s estimate of what the same hours would cost if families had to buy them.

Almost none of that work is reimbursed, and most of the people doing it never learn that a payment program exists. They assume caregiving is what family does, so they never ask. The government has already taken the other view, and funded it.

How do self-directed care programs work?

The programs go by different names depending on the state: self-directed care, consumer-directed services, or structured family caregiving. Medicaid.gov describes the model as self-directed services.²

The structure is the same everywhere. A person who qualifies for Medicaid long-term services is approved for a certain amount of in-home help. Under a self-directed program, that person, or a representative acting for them, chooses who provides the help and sets the schedule. The caregiver is paid through the program rather than out of the parent’s pocket.

Whether an adult child can be the paid caregiver depends on the state. Many allow it. Some exclude spouses or legal guardians. Your state Medicaid office can tell you the rule that applies to your family.

Does your parent have to qualify for Medicaid first?

Your parent generally has to qualify for Medicaid first. These are Medicaid programs, so your parent’s income and assets must fall within your state’s limits for long-term services, and the state must find that they need help with daily living. If your parent has Medicare only, the program is not available until Medicaid eligibility is established.

That is the step to start with, and it is the step where families give up too early. State income and asset limits vary widely, and several states treat income above the limit as a contribution toward care rather than a disqualifier. If your parent is close to the line, or you are not sure, ask before you assume.

Be careful about who you ask. Companies advertise help “enrolling” families in these programs for a fee. Applying is free, and the agencies below will walk you through it at no charge.

What should you do next?

1. Find out whether your parent already has Medicaid, or could qualify. Call your state Medicaid office and ask about eligibility for long-term services and supports.
2. Search your state’s name plus “Medicaid self-directed care.” The program may also appear under “consumer-directed services” or “structured family caregiving.”
3. Call your local Area Agency on Aging and ask for the program by name. The Eldercare Locator at eldercare.acl.gov will find the agency for your county.³
4. Ask the specific question: “Can an adult child be the paid caregiver under this program, and what training or screening is required?”
5. Never pay a company to enroll you. Applying is free.

You are already doing the work. Find out whether your state will pay you for it.