Episode 47 - What States Pay For Family Caregivers
Welcome. Today's lesson is on what states pay for family caregivers. I am frequently asked how to get paid to take care of family members.
Are you struggling to care for your elderly family member while juggling work and maybe your own family's responsibilities? You are not alone. Many states offer financial support for family caregivers to help ease the burden. But what if your family member doesn't want a stranger in their home, and you can't afford to take time off work?
The solution may be in home health care services where you get paid to take care of your family member while keeping them comfortable in their own home. It's a win situation. Let's look at your options and take the first steps towards getting paid as a family caregiver. There are programs that compensate family caregivers and adult children, and they're going to differ between states in varying instances.
Not all states make such options available, or they may restrict family caregivers not to be paid. So let's talk about state based non Medicaid programs. Many states provide some sort of program that can give the family caregiver the ability to keep their aging family member at home instead of placement in a nursing facility.
These programs provide assistance to elderly or disabled in the community to help prevent them from being placed into Medicaid supported nursing homes. The state programs also include consumer assistance or self directed care. In other words, program users have the option of selecting their own caregiver.
If you're caring for an elderly or disabled family member, you may be interested in becoming a paid caregiver.
The good news is that all 50 states offer some kind of family caregiver support program to become paid caregivers through a Medicaid waiver program, such as cash and counseling initiative. These programs are known as consumer directed care or self directed care services. Meaning the care recipient can choose and pay their own caregivers.
To find out about Medicaid funded programs with participant directed services in your area, check online. Some states may even combine these programs with private or state level programs, which lets both Medicaid and non Medicaid recipients receive care at no cost to them. You can find more information by contacting your local Department of Aging.
In addition to Medicaid programs, many states offer personal assistance services to help family caregivers. These services are usually provided through a non Medicaid funded program and can provide financial assistance in the form of stipends or reimbursements for certain expenses. For example, you may be eligible for reimbursement for mileage driven to the doctor's office or for specialized equipment used to help with caregiving duties.
Check with your state Department of Aging, Health and Human Services, or Public Benefits offices for more information on personal assistance services available in your state. Caring for an aging family member can be a rewarding experience, but it can also be physically, emotionally, and financially taxing.
A great resource is the Family Caregiver Alliance, F C A. It has a resource locator to help you discover what programs are available to become a paid family caregiver in your state. This is a national resource that will have the most up-to-date information as the aging population grows. So now let's talk about caregiver compensation or programs that pay family caregivers.
Caregiving expenses can add up quickly and with medical supplies. Prescription co pays, therapy co pays, home modifications, and more, it can add up. The average family caregiver spends over 7, 200 a year to support a care recipient in their home. Long distance family members spend over 1, 200 a year or more to provide financial assistance to a care recipient.
Many family caregivers have to quit their jobs or reduce their hours to provide personal care services to a family member with increasing needs. That's why we've identified both Medicaid and non Medicaid funded services that can provide financial relief to family caregivers. While not everyone may qualify, it's worth checking into to ease the financial burden of caregiving.
Let us at Caregiver Relief help you navigate the benefits programs available to you. Discover Medicaid programs that pay family caregivers. Some states offer financial assistance for family caregivers and legal guardians, though not all states provide compensation and some programs do have restrictions, there are still ways to apply for financial assistance and support the care of your family member. After all, family caregivers provide over 600 billion worth of unpaid care in order to avoid an admission to a nursing home or assisted living.
State Medicaid community based services can help provide health coverage to millions of Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. As the largest source of health care coverage and care service in the United States, Medicaid is an essential program for those in need.
Federal law requires states to cover certain groups of individuals, such as low income families, pregnant women, and children, and those receiving supplemental security income, or SSI. Financial eligibility requirements will be assessed by your state Medicaid program guidelines. The requirements are very stringent.
If your aging family member has assets, savings, or other funds, they will have to spend those down first. Helping an elderly parent apply for Medicaid can be a smart financial move, but the Medicaid spend down process can be complex and overwhelming.
Essentially, a spend down is where an individual's income is reduced to meet Medicaid eligibility requirements. However, the income guidelines vary state to state, so the spend down process will look different depending on your location. You can apply for Medicare through your state agency or the health insurance marketplace, but be prepared for paperwork and regulations involved.
Additionally, Medicaid will not cover medical or provide health insurance or nursing home expenses until the spend down process is complete. To learn more, visit Medicaid. gov and reach out to your state agency for guidance. I want to make you aware that there's a look back period in many states. Right now, it's at five to seven years, depending on your state.
With the growing aging population, this look back period is going to be increased to 10 years. Of course, it's not been initiated, but the talk is there, and be aware that it may be increased over the next few years. So what is a look back period? Are you or a family member considering applying for long term Medicaid?
This is a government elder care program that funds Medicaid programs that pay for a nursing facility that provides skilled care as well as respite care services. It is important to know about the asset limit and Medicaid's look back period. Any assets above the limit Medicaid can make you ineligible for coverage, and any transfers or gifts of assets made within a 60 month period, five years, it's called the look back period, are reviewed by the Medicaid agency.
If you or your spouse violate the look back rule, you could face a penalty period of Medicaid ineligibility. This applies even if the violation occurs after you've been approved for these support services and benefits. Examples of violations include gifting money to family members, transferring property, or selling assets for less than fair market value.
This means that if your family member is requiring supportive care providers, the family member's gifts of money or property to spend down, the state agency will expect the family member to pay for any personal care services or respite care from their own pocketbooks before the state Medicaid program will start to pay.
I've had many families give a home to a family member as part of an inheritance or gift a family member money. It all sounds wonderful and generous herein lies the problem. If your aging family member declines and needs placement in a Medicaid funded nursing home, your aging family member and the other family members will be responsible to pay that money to a nursing home out of their own pocket to meet the spend down requirements.
I had a client that gifted her daughter a home worth over a million dollars. Three years after the gift, my client with dementia started to wander and became very unsafe at home. The family had to make a choice and pay for care in the million dollar home until their mother died, or privately pay for their mother's care in a nursing home until they met the spend down requirements for Medicaid to begin to pay for their care services.
To avoid penalties and ensure eligible for Medicaid, it's essential to understand that the look back period and any asset transfers could be scrutinized. Speak with a Medicaid expert to ensure that you make informed decisions and protect your benefits. I will address the family caregiver contract or a life care agreement as a way to spend down while family members get paid to provide caregiving services to their family members later in this lesson.
Financial and support services through Medicaid state plans, also called Medicaid waiver programs, may provide financial assistance and respite care for family caregivers, though eligibility and assistance levels vary by state. Most do not provide mental health services for the family caregiver or the care recipient.
To find out if your state offers Medicaid benefits for caregivers, contact your local eligibility office. In select states, self directed Medicaid services may provide added flexibility for caregiving options. Programs such as the Home and Community Based Services Waiver and Self Directed Personal Assistance Services State Plans may be available to you.
These are government programs that pay eligible family caregivers to provide personal care assistance to an adult family member as part of a Medicaid waiver programs. These types of elder care program allow the family members to be paid to provide care for a loved one in their home in lieu of placing them in a Medicaid funded nursing home.
Discover the Community First Choice Program, also known as 1950 K state plan option, which provides Medicaid recipients with home and community based personal attendance services. Created as part of the Affordable Care Act, this program is available in 9 states right now, including California and Texas, in addition to offering long term care, this plan allows for self directed services, meaning personalized care is available for those who require assistance with activities of daily living such as dressing, eating, or bathing. Eligibility requires institutional level of care and Medicaid status. Check out the Community First program to see if this is a program that will work for you and your family member.
So let's understand your options for state directed or self directed care under Medicaid. Medicaid offers health care coverage and care services to millions of Americans, but as a caregiver, you may be wondering which care option is best for your loved one. State directed care offers the involvement of state agencies and health care organizations, while self directed care gives you more control to the caregiver to assess, hire, and manage services.
Weighing the pros and cons of each can help you make an informed decision on the level of care that will benefit your family member the most. Learn more about your paid family options and make the right choice for your family.
State directed care. State directed care providers involve a state agency or health care organization managing your services, often with a designated care management or case manager. This includes community based services like adult family homes, home care agencies, or assisted living facilities. All are paid for with Medicaid funds.
Alternatively, self directed care empowers you to take control of your own services. You'll be trained in managing everything yourself or with a representative and have the authority to make decisions about your care. The process is entirely person centered, meaning it's all about what you need and want.
It also comes with an individualized budget for resources and support, and the freedom to choose how your state plans services are provided. Participation is voluntary, so consider if this is the right option for you. Veterans benefits are government programs that can and will pay family caregivers.
Let's discuss a veteran directed care program. The Veterans Affairs Home and Community Base Services, VD-8CBS. Keep the veterans you love in their own homes with personalized in home care. The Veteran Directed Care Program is a community based services program created to help veterans at risk of nursing home placement by providing caregiving services in their own home to main independence and quality of life.
By allowing Veteran Directed Care Services, patients best meet their needs and budget. Veterans Directed empowers them to manage their own personal care. This includes hiring and paying care providers such as in home care aides, including family and friends as paid caregivers if desired.
This veteran program can also allow for paying caregivers for respite care providers in home care. Do you have a family member with a VA disability rating of 70% or higher who needs at least six months of personal care services? If so, you may be eligible for the program of comprehensive assistance for family caregivers.
Several VA medical centers offer this home and community based service. To qualify, you must be at least 18 years old and related to or living in the same house full time with the veteran, the eligible veteran may appoint up to three personal care providers or other family members and all may receive education, counseling and travel and lodging assistance if needed.
Eligible primary caregivers or legal guardians may also receive a monthly stipend and access to health care benefits. If you need a break, the Veteran can receive at least 30 days per year of respite care. Contact your local Office of Veterans Affairs to explore all options of an in home care resources for your family member.
In the beginning of this audio cast, I discussed Medicaid programs. I discussed spending down the look back periods. Each state is different, so always contact your local office of aging or the state Medicare programs to learn what you need to qualify for Medicaid programs in your state. Many adult children and even spouses are creating a family caregiver contract to spend down assets and funds.
This is a self directed way to give the care recipient the ability to pay a family member and provide financial assistance as a paid caregiver. As your family member ages and needs increased support, they will require more help in their daily lives, even with personal care.
Signs of this could include difficulty completing everyday activities, memory problems, or trouble with finances and driving. In some cases, full time care becomes necessary. Usually, a family member provides unpaid personal care services as they take up the role of the family caregiver. However, this can come with significant sacrifices, such as giving up their job and employment benefits.
To ensure that this hardworking family member is compensated, a legal document called a Family Caregiver Contract or a Personal Care Agreement can be drawn up. This agreement outlines the tasks the caregiver is expected to perform, days off, vacation time, and even length of time for commitment in providing care.
This is an exchange for caregiver compensation. It's important to discuss this agreement with other family members to avoid conflicts over who will provide care and how much money will change hands. Plus, if your family member is receiving state supported in home care, the agreement will show the state where the money is going and what kind of services are provided.
A family caregiver agreement provides peace of mind to both the caregiver and the care recipient. The family caregiver can avoid undue financial consequences, while the care recipient can have realistic expectations of the care provided. This is also a plus for the family caregiver, as they can put their limits and set boundaries in this contract as well.
This is a contract that can offset any confusion among family members concerned about bequeaths to heirs and to avoid misunderstandings later about the reduction of the amount of money they may have inherited. In short, a family caregiver agreement can provide valuable security for a challenging but rewarding job.
Many family caregivers never received financial compensation for their caregiving services. Many have provided caregiving services such as supporting your family member with activities of daily living and caregiving expenses to avoid placement in a nursing home. Many were trying to save the family house and finances as part of an inheritance.
Then they learn of this family caregiver contract and want to put one in place. Be aware, family members that provide support services cannot go back and charge for care services provided retroactively. You can only get a contract in place as a paid caregiver from the date the contract started to present day.
Now, let's talk about life care agreements. Life care family caregiver contract is a form of life care agreement, but this is a little different. Life care agreements are contracts outlining payment arrangements in the care of elderly individuals. Generally, these agreements are two types, personal care agreements and institutional care agreements.
The institutional care agreements are the contract that continuing care requirement communities put in place. These non Medicare programs promise ongoing care services and respite care until end of life. They will provide care from independent living, assisted living with daily activities, and a nursing facility when needed in exchange for a fee.
Aging in place is a goal for many elderly individuals, and life care agreements can make that a possibility. These agreements allow the care recipient to pay family members and have someone they already trust and have a relationship with them as a caregiver. This type of agreement helps to establish clear expectations and boundaries which can provide Peace of mind to all parties involved.
Furthermore, the compensation provided makes it a business agreement rather than a personal or family obligation. It allows the care recipient to identify their own personal care providers, and this can prevent disputes among family members about fair distribution of assets and inheritance. The payments to the caregiver are considered legitimate expenses to the recipient and not simply a gifted sum of money or property.
Overall, life care agreements are beneficial for elderly individuals who wish to age in place with the help of a trusted family friend or family member while ensuring that the care provided is fairly compensated. Getting paid for caregiving through tax credits and reimbursements. As a caregiver, you may be surprised to learn the array of tax credits and deductions available to you.
If your parent's gross income doesn't exceed 4, 300, excluding Social Security, and you pay for more than half of their support, you can claim them as a dependent. This is called the Dependent Care Credit. Even if you don't meet these guidelines, you may still be able to deduct care expenses. These include everything from health care costs, to transportation, to medical appointments.
While tax credits don't provide a direct payment for caregiving services, they can significantly lower your tax payment or result in a substantial tax refund. However, it's worth noting that some Medicaid family caregiver payment programs prohibit family members from receiving compensation for claiming elderly ones as dependents.
If you're unsure about most financially beneficial option for you and your family member, consult with an accountant, tax attorney, or contact your local office of aging. This lesson has been brought to you by Caregiver Relief.
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Diane Carbo
Diane Carbo
