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National question: Can a family caregiver get paid? Official programs decide eligibility.

Medicaid Self-Directed Services

Federal Medicaid authorities allowing beneficiaries to self-direct their home and community-based services, including hiring their own caregivers (including family members). Authorized under Section 1915(j) self-directed personal assistance services and Section 1915(k) Community First Choice option.

Medicaid self-directed services let participants, or representatives when applicable, take decision-making authority over certain services and manage service delivery with available supports. Medicaid.gov describes employer authority as the ability to recruit, hire, train, and supervise service workers, and budget authority as participant direction over how Medicaid funds in an individualized budget are spent. States can offer self-direction through state-plan and waiver authorities including 1915(i), 1915(j), 1915(k), and 1915(c). A person-centered planning process, written service plan, individualized budget when budget authority is used, support broker/counselor assistance, and Financial Management Services are part of the federal self-direction framework. State-specific covered services, worker relationship rules, hourly rates, and budgets vary by state and authority.

Eligibility

  • U.S. citizenship or qualified immigrant status required
  • Care recipient must have a qualifying disability

Questions to ask the program

These are questions to ask the program, not a verdict on your eligibility. Confirm the current rules directly with the program.

  • What are the current income and asset limits, and whose income counts?
  • What counts as a qualifying disability or level of care need, and what documentation shows it?
  • Which citizenship or immigration statuses does the program accept, and which documents show it?
  • Is there a caregiver-specific department, coordinator, or support line? Ask for it by name. — Many agencies have one that isn’t advertised on the website.
  • What documents do you need from us to start an application?
  • Is there a waitlist right now, and how long is it?

Services

Medicaid self-directed services let participants, or representatives when applicable, take decision-making authority over certain services and manage service delivery with available supports. Medicaid.gov describes employer authority as the ability to recruit, hire, train, and supervise service workers, and budget authority as participant direction over how Medicaid funds in an individualized budget are spent. States can offer self-direction through state-plan and waiver authorities including 1915(i), 1915(j), 1915(k), and 1915(c). A person-centered planning process, written service plan, individualized budget when budget authority is used, support broker/counselor assistance, and Financial Management Services are part of the federal self-direction framework. State-specific covered services, worker relationship rules, hourly rates, and budgets vary by state and authority.

How to apply

Use the official program page for application details: official program page.

  • medicaid (depends_on): Must be Medicaid-eligible
  • hcbs-waivers (companion): Self-direction is available within 1915(c) HCBS waivers or as standalone 1915(j)/(k)