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Medicaid

Medicaid caregiver programs

If your loved one gets Medicaid, their state may let them hire a family member or friend as a paid caregiver. Many states call this a consumer-directed program, and rules and pay vary by state.1

  • Official sources
  • Last verified Oct 20, 2026
  • Independent site, not a government agency
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Key facts

Who pays
State Medicaid1
Who hires
The person receiving care or their representative2
Common names
Self-directed, consumer-directed, participant-directed2
Who pays: State Medicaid. Who hires: The person receiving care or their representative. Common names: Self-directed, consumer-directed, participant-directed.
Source: usa.gov, cms.gov

Programs by state

Family caregiver pay programs, 50 states and DC
StateMain programSpouse can be paid?Published pay
AlabamaPersonal Choices (self-directed waiver services)Not stated on the official pageSee state page
AlaskaConsumer-Directed Personal Care Services (CDPCS) and Community First ChoiceYes, through Community First Choice PCSSee state page
ArizonaALTCS Self-Directed Attendant Care (SDAC) and spouse attendant careYes, through an agency, max 40 hrs per weekNot published
ArkansasIndependentChoicesNoSee state page
CaliforniaIn-Home Supportive Services (IHSS)Yes, under program rulesSee state page
ColoradoConsumer-Directed Attendant Support Services (CDASS)Yes, for extraordinary careNot published
ConnecticutCommunity First Choice (CFC)NoSee state page
DelawareSelf-Directed Attendant Care (DSHP Plus)Yes, up to 40 hrs per weekSee state page
District of ColumbiaEPD Waiver: Services My WayNoSee state page
FloridaSMMC Long-Term Care Participant Direction Option (PDO)Check with your LTC planNot published
GeorgiaStructured Family Caregiving (CCSP and SOURCE waivers)NoNot published
HawaiiQUEST Integration self-direction (Personal Assistance)Yes, in extraordinary circumstancesSee state page
IdahoMedicaid Personal Care and Attendant CareNo (ended July 2025)See state page
IllinoisHome Services Program (HSP), Personal AssistantYes, extraordinary care onlySee state page
IndianaStructured Family Caregiving (SFC)Not stated on the state fact sheetNot published
IowaConsumer Choices Option (CCO)Possibly, under the Elderly WaiverSee state page
KansasKanCare HCBS self-directionVaries by waiverSee state page
KentuckyParticipant Directed Services (PDS)Yes, with DAIL approvalSee state page
LouisianaCommunity Choices Waiver Self-Direction OptionYes, extraordinary care onlySee state page
MaineMaineCare Consumer Directed Attendant ServicesCheck with OADSSee state page
MarylandCommunity First Choice (CFC) self-directed personal assistanceNot stated on the official pageSee state page
MassachusettsMassHealth PCA program and Adult Foster Care (AFC)NoSee state page
MichiganHome Help programNo (Home Help)See state page
MinnesotaPCA Choice and Community First Services and Supports (CFSS)Yes, since Oct 2024See state page
MississippiElderly and Disabled Waiver, relatives as direct care workersNoSee state page
MissouriConsumer Directed Services (CDS)NoSee state page
MontanaSelf-directed Community First Choice and Personal CareYes, under CFCS rulesSee state page
NebraskaMedicaid HCBS waiver independent providers and LRI Personal CareYes, LRI Personal Care onlySee state page
NevadaPersonal Care Services, self-directed through an ISONoSee state page
New HampshireChoices for Independence (CFI) participant-directed servicesGenerally noSee state page
New JerseyPersonal Preference Program (PPP)Not stated on the state pageNot published
New MexicoSelf-Directed Community Benefit (SDCB)Yes, with MCO approvalSee state page
New YorkConsumer Directed Personal Assistance Program (CDPAP)NoSee state page
North CarolinaCAP/DA consumer directionNot stated on the official pageSee state page
North DakotaFamily Personal Care and Family Home CareYesSee state page
OhioPASSPORT Participant DirectionYes, under OAC 5160-44-32See state page
OklahomaADvantage Consumer-Directed Personal Assistance (CD-PASS)Only by exceptionSee state page
OregonIn-Home Services (homecare worker) and Spousal Pay ProgramYes, Spousal Pay ProgramSee state page
PennsylvaniaCommunity HealthChoices (CHC) participant-directed servicesNoNot published
Rhode IslandPersonal Choice ProgramNoSee state page
South CarolinaCommunity Choices Waiver participant-directed Attendant CareCheck with SCDHHSSee state page
South DakotaHOPE Waiver Structured Family CaregivingNot stated on the official pageSee state page
TennesseeTennCare CHOICES Consumer DirectionNo (consumer direction)See state page
TexasConsumer Directed Services (CDS) optionOnly in CMPASNot published
UtahAging Waiver self-administered servicesExtraordinary care onlySee state page
VermontChoices for Care self-directed servicesYes, for personal careSee state page
VirginiaConsumer-Directed ServicesYes, since July 2025See state page
WashingtonIndividual Provider (DSHS long-term services)No (Medicaid LTSS)See state page
West VirginiaAged and Disabled Waiver Personal OptionsNoSee state page
WisconsinIRIS Self-Directed Personal CareYesSee state page
WyomingCommunity Choices Waiver participant directionYes, with conditionsSee state page

How to apply

  1. Contact your state Medicaid office.1
  2. Request a home care assessment.2
  3. Choose the self-directed option.2
  4. Enroll the caregiver with the payroll agency.2
Steps to apply: 1. Contact your state Medicaid office. 2. Request a home care assessment. 3. Choose the self-directed option. 4. Enroll the caregiver with the payroll agency.
Source: usa.gov, cms.gov

Frequently asked questions

Is there one Medicaid caregiver program?

No. Each state runs its own programs, often called self-directed or consumer-directed services.

Does my loved one need Medicaid?

Yes. These programs pay caregivers only when the person receiving care is enrolled and approved for services.

Who handles payroll?

Usually a financial management services agency or fiscal intermediary chosen through the program.

Sources

  1. USA.gov: https://www.usa.gov/disability-caregiverOfficial
  2. CMS, Self-directed HCBS: https://www.cms.gov/files/document/hcbs-consumer-directed-care-booklet-102815pdfOfficial

Last verified