More and more Americans are finding themselves in the role of caregiver for an aging family member or friend. Over the past five years, the number of people caring for an adult 50 or older has increased by 7.6 million to a total of nearly 42 million—about 17% of the population, according to AARP’s Caregiving in the U.S. 2020 study.
Often, unpaid family caregivers find that their caregiving responsibilities take a toll on their finances. The majority of those who work in addition to caring for loved ones report going in late, leaving early or taking time off work, according to the AARP study. One in 10 working caregivers said they have had to quit or retire early to provide care.
Family caregivers need to know, though, that it might be possible for them to get paid by Medicaid for the care they are providing.
How Medicaid pays for long-term care
Medicaid is a joint federal and state program that provides health coverage for low-income people. The type of coverage can vary from state to state because each state manages its own Medicaid program. However, Medicaid programs in all 50 states cover the cost of long-term care in nursing homes for those who are eligible.
All 50 states and the District of Columbia also offer personal care assistance programs so that those who qualify can receive care at home or in the community rather than in a nursing home, according to American Council on Aging’s MedicaidPlanningAssistance.org service. The names of these programs vary by state, as do the benefits and eligibility requirements. However, many offer a consumer-directed option that allows those who are receiving care to choose who will provide that care—which means they may be able to hire family members or friends.
[Find Out: How Medicaid Can Pay for Long-Term Care ]
How to qualify for Medicaid long-term care
To be eligible for Medicaid programs that pay for personal care assistants, applicants must meet two requirements:
Financial requirements: There are limits on both the income and assets an applicant can have to qualify for Medicaid. The income limit varies by state, ranging from less than $1,000 to more than $2,000 per month for an individual. The asset limit is typically $2,000 for an individual, but assets such as a home that is an applicant’s primary residence, an automobile, personal belongings and prepaid funeral expenses are exempt.
Functional requirements: Typically, states require that applicants need assistance with a certain number of activities of daily living, which include bathing, eating, dressing, toileting, and transferring in and out of bed or a chair.
Who can get paid by Medicaid
Depending on the state, family members may be able to get paid through Medicaid to provide care for loved ones. It depends on the programs available in the state and the requirements for those programs. For example, states may require caregivers to become certified Medicaid providers to be paid by Medicaid.
However, in most states, you can’t get paid by Medicaid if you are the legally responsible relative of the person you’re caring for. This rule applies to parents and spouses (only a handful of states allow spouses to get paid through Medicaid, according to research by PayingforSeniorCare.com). It also applies to those who are appointed by a court as a legal guardian, said elder law attorney Tricia D’Agostino, who is a partner at Margolis & Bloom in Massachusetts. But it doesn’t prevent those who have been named power of attorney for the person they are caring for from getting paid by Medicaid, she said.
How to get paid as a caregiver by Medicaid
For family caregivers to get paid by Medicaid, the process begins with the person who needs care applying for Medicaid in the state where he or she lives. If applicants meet the financial and functional requirements, then they’ll have to go through the process of determining whether they qualify for any state programs that offer consumer-directed personal care services. In Massachusetts, for example, you must need hands-on assistance with at least two activities of daily living to qualify for Medicaid-funded personal care attendant services, D’Agostino said.
There also will be an analysis to determine the number of hours that Medicaid will pay for care at home based on the needs of the applicant and budgetary constraints. “Unfortunately, you don’t know what you’re going to get until you go through the process,” D’Agostino said. And the rate of pay for the family caregiver also is determined by the state Medicaid program.
That means family caregivers can’t simply set their own rate and bill Medicaid for as many hours as they want. Also, be aware that it can take a while from the time applicants qualify for Medicaid to the time when they are approved to receive personal care assistant services. Even if family caregivers are providing care during that period, they won’t be paid retroactively because Medicaid home care services are only paid for after they are approved, D’Agostino said.
How to get assistance with the Medicaid application process
Figuring out what sort of Medicaid programs states offer to pay for home care and applying for coverage can be a challenge. “It’s a tough process,” D’Agostino said. “There’s little communication, lots of requests and time sensitive applications. So, typically, you need some help.”
The best place to get help, she said, is from an elder law attorney who knows what programs are available in your state and how to qualify. In particular, an elder law attorney can advise on what steps to take to qualify financially for Medicaid and can help develop a plan to spend down or shield assets to qualify. You can find a Certified Elder Law Attorney through the National Elder Law Foundation.
There also are a variety of other professionals who are certified Medicaid planners and can help families qualify for Medicaid. MedicaidPlanningAssistance.org has a form to connect with a Certified Medicaid Planner.
Another option is to reach out to your local Area Agency on Aging office to find out what free or low-cost services are available in your community to assist with the Medicaid application process.
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