Answer: In some cases and some places.
As of October 2015, all 50 states and the District of Columbia offer Medicaid waiver self-directed long-term services and supports (LTSS) programs that allow qualified individuals to manage their own care — meaning that people can hire and fire their own caregivers. Some states permit the care recipient to hire a family member to provide care.
- Eligibility, benefits, coverage and rules differ from state to state. Some programs pay family caregivers but exclude spouses and legal guardians. Others will pay care providers only if they do not live in the same house. Medicaid home care benefits also depend on the Medicaid program in which you are enrolled.
- Program names also vary. What is called Consumer Directed Care in one state is called Participant Directed Care in another. Among the many names: Self-Directed Care, In-Home Supportive Services, Cash and Counseling.
- To qualify for Medicaid the recipient must not exceed the program’s annual income and countable assets, not counting home value.
Step by Step
Step 1: If your family member qualifies and is ready to join the more than 1 million people already participating in self-directed care plans, contact your state Medicaid office to begin the process.
Step 2: The applicant (with assistance, if desired or needed) is assessed for risks, need, strength, capacities and preferences as required by Centers for Medicare & Medicaid Services.
Step 3: Your family member and any chosen representatives create a written service plan detailing the daily living assistance required — including bathing, dressing, moving from bed to wheelchair, light housekeeping, meal preparation, feeding, laundry, supervision, shopping, transportation and medication compliance. There should be contingency plans for coverage when the care provider is off, and instructions on how fill-in caregivers should address risks.
If the assessment shows need, a budget for goods and services will be provided.
Step 4: When the care plan is set, the participant (or surrogate, if needed) chooses a caregiver.
Veteran Directed Home & Community Based Care is available in 37 states, Washington, D.C., and Puerto Rico for veterans of all ages enrolled in the Veterans Health Administration standard medical benefits package who need the high level of care a nursing facility provides, but who want to live at home or the home of a loved one. A flexible budget — average is $2,500 monthly — enables them to choose the goods and services they find most useful, including a caregiver to assist with everyday tasks such as bathing, cooking, feeding, dressing, using the bathroom and adjusting prosthetic devices. The caregiver is chosen by the veteran and may be any physically and mentally capable family member — including spouse, sibling, child or grandchild.
Aid and Attendance (A&A) benefits are available to veterans who qualify for VA pensions and have served a minimum of 90 days active duty and at least one day during a wartime period and other requirements. The program supplements the VA pension to help cover the cost of a caregiver, who may be a family member. A surviving spouse of a veteran may also qualify.
To qualify, you must meet one of the following conditions:
- Be confined to bed due to disability
- Be in a nursing home due to physical or mental incapacity
- Have corrected vision that is 5/200 acuity or less in both eyes or concentric contraction of the visual field that is 5 degrees or less.
- Require the aid of another person in order to perform personal functions required in everyday living — such as bathing, feeding, dressing, using the bathroom, adjusting prosthetic devices or protecting yourself from the hazards of your daily environment
Step by Step
Step 1: Find the Pension Management Center (PMC) to locate your state office address. You may also visit your local regional benefit office to file your request. Find your local regional benefit using the VA Facility Locator.
Step 2: Write your state PMC. Explain why a caregiver is needed, ideally including an attending doctor’s report. Be specific about the disease or injury that caused physical or mental impairment, and walk the PMC through a typical day. Note how well you get around, if you have a loss of coordination, or any inability to manage basic daily needs without assistance.
Veterans who are substantially confined to their immediate premises because of permanent disability who also are receiving a military pension can apply for an increased monthly pension. The application process is the same as above.
The Program of Comprehensive Assistance for Family Caregivers offers needed services for primary caregivers of veterans who sustained a traumatic injury in the line of duty on or after Sept. 11, 2001. Benefits include a monthly stipend to primary caregivers of injured veterans, and lodging and travel expenses while accompanying vets going through care. Also available: comprehensive caregiver training, access to health insurance, mental health counseling and services, and up to 30 days of respite care per year.
To qualify, the veteran under care must:
- Enroll for VA health services, if not enrolled previously
- Need one or more personal care services necessary in daily living or require supervision or protection based on symptoms or enduring effects of injury or neurological damage
The caretaker must:
- Be 18 or older
- Be the spouse, son or daughter, parent, stepfamily member, extended family member, or someone who lives with the veteran full time
Additional Resources for Veterans
- Vet Call Center: Call 877-WAR-VETS (877-927-8387), a 24-hour confidential call center where combat veterans and their families can call to talk about their military experience or any other issue they are facing in the adjustment to civilian life.
- Caregiver Support Line: 855-260-3274
- Iraq and Afghanistan Veterans of America (IAVA) has a Rapid Response Referral Program (RRRP) that “rips through the bureaucracy — it’s help without the hassle.” Transition navigators and advocates help vets find and access military and private benefits.
Long-Term Care Insurance
Some long-term care insurance policies will pay family members for caregiving. Some exclude spouses or family members living in the home. Ask your family member's insurance agent for specifics. Request a written confirmation of benefits.
Getting Paid by a Family Member
If the family member needing assistance is mentally sound and has enough money and assets to pay a caregiver, your loved one can choose to pay you or another family member for the same services that would be provided by a professional.
A proactive, employer-employee approach will help minimize stress and family tension.
Step by Step
Step 1: Put any awkward feelings aside to discuss needs, wages and paydays, health risks, schedule, and how respite care and caregiver sick days will be handled.
Step 2: Draw up a contract that includes the hourly wage and services to be provided.
Step 3: Consult an eldercare lawyer to review your contract to make sure it meets tax requirements, deals with inheritances and is approved by all other interested parties (siblings, for example).
Step 4: Beware of emotional pitfalls. If family members seem uncomfortable with the arrangement or disagree with the plan, consider a session with a family therapist who specializes in eldercare, a family mediator or other neutral party.
Step 5: Caregiver and care recipient both sign the contract.
Step 6: Keep professional records:
- Specify services performed, dates and amount paid. This paperwork is essential if your family member later applies for Medicaid. During the qualification process a caseworker will examine records for the last five years.
- Report income. As with every paid job, caregivers are legally required to report wages as taxable income. If, at a later date, your family member becomes Medicaid eligible but taxes have not been paid, Medicaid will consider the money a gift — not an expense. This could prevent your loved one from qualifying for Medicaid. The IRS, on the other hand, is clear: When services are provided all money received is a wage, not a gift.
More Resources for Caregivers
- Care Guide: Help for first-time caregivers
- TOOL: AARP Foundation Benefits Quicklink - Find programs that help pay for caregiving, utilities, prescription drugs and other needs
- ADVOCACY: Fighting for family caregivers
- DISCUSS: Get advice and support from AARP's caregiving community
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