Paid Family Caregiver Programs in Maryland

Last updated: 6 April 2026

Bottom line: Yes, a Maryland senior can sometimes have a family member paid to provide care. But in Maryland, the real path is usually through Medicaid personal assistance programs, not a simple state cash benefit, and the clearest current family-hire path to ask about is Community Personal Assistance Services (CPAS) with self-direction support. For seniors with higher care needs, Community First Choice (CFC) and the Community Options Waiver matter too, but they come with stricter Medicaid and assessment rules, and the waiver has a real registry/wait.

Emergency help now

1. If the senior is unsafe right now, call 911 or 988, or tell the hospital or nursing facility social worker there is no safe discharge plan.
2. Call Maryland Access Point at 844-627-5465 and ask for screening for CPAS, CFC, the Community Options Waiver, or ICS.
3. If abuse, neglect, or self-neglect may be happening, call the local Department of Social Services and ask for Adult Protective Services.

What this help actually looks like in Maryland

In Maryland, “paid family caregiver” can mean several very different things. It can mean a Medicaid personal assistance worker who happens to be a relative. It can mean temporary paid leave from a job. It can mean respite or support funds that help the caregiver but do not pay wages. Or it can mean a private care agreement paid from the senior’s own money.

Those are not the same. The important point is this: Maryland does not have one simple statewide senior caregiver paycheck program. Instead, the real options are split across Community First Choice, the Community Options Waiver, the CPAS regulations, and, in special cases, Increased Community Services. A family worker is usually paid through an agency or a fiscal/payroll system, not through a simple cash grant.

That is why many Maryland families get bad advice online. A site may say “Maryland pays family caregivers,” but it often leaves out the hard parts: the senior usually needs Medicaid, the care tasks must be approved, the worker must be properly enrolled, hours must be tracked, and a spouse is usually not the easy answer.

Maryland option	Is Medicaid required?	Is there a waitlist or registry?	Can a family member sometimes be paid?	Best fit
Community Personal Assistance Services (CPAS)	Yes, community Medicaid	No separate waiver registry is listed publicly	Yes. This is the clearest current family-hire path to ask about first	Senior needs hands-on help at home
Community First Choice (CFC)	Yes, full Medicaid	No separate waiver registry is listed publicly	Sometimes, but ask how Maryland is handling family hires in your case	Senior needs institutional level of care at home
Community Options Waiver	Yes	Yes. Maryland uses a registry/wait process	Sometimes through included personal assistance services, but it is not fast	Higher needs plus assisted living, day care, or case management
Increased Community Services (ICS)	Yes	No open self-referral; referral is required	Sometimes after transition planning, but this is not the usual first stop	Nursing home resident with income too high for the regular waiver
Non-Medicaid caregiver support	No	Varies	Usually no direct wage	Respite, backup help, or worker leave

Quick facts

• Yes, sometimes: a Maryland senior may be able to have a family member paid, but usually through Medicaid personal assistance rules.
• The best first call is statewide: Maryland Access Point at 844-627-5465.
• Medicaid is usually required for the real paid-family-caregiver path.
• CPAS is the clearest current self-direction route because the current CPAS supports-planning rule says supports planners must help people self-direct services and coordinate with the fiscal intermediary.
• CFC is for higher need: the official CFC page says the senior must already have full Medicaid and need institutional level of care.
• The Community Options Waiver has a real backlog: in the latest statewide report I could verify, Maryland had 23,461 people on the registry on June 30, 2025.
• Spouse and adult-child rules are not the same: Maryland’s self-direction materials for CPAS say legally liable relatives cannot be paid. For an adult senior, that usually means a spouse is generally not the paid worker.

Who qualifies

In plain English, Maryland usually looks at four things:

• Where the senior lives: at home, in the community, or in a nursing facility
• How much help the senior needs: help with bathing, dressing, getting around, meals, medications, or other daily tasks
• Whether the senior has Medicaid now: full Medicaid, community Medicaid, or no Medicaid yet
• Whether the family member can legally be the worker: that depends on the program model, the care plan, payroll rules, and the family relationship

For most Maryland seniors, the practical answer is this: if you want an adult child or another relative paid, start by asking whether the senior fits CPAS or CFC. If the senior also needs assisted living, medical day care, or other waiver services, ask for the Community Options Waiver too. If the senior is already in a nursing home and income is too high for the regular waiver, ask about ICS.

Best programs, protections, portals, or options in Maryland

1) Community Personal Assistance Services (CPAS)

What it is: CPAS is Maryland’s community-based personal assistance program for people who need help with daily living at home. The current CPAS supports-planning rule says supports planning must help the participant self-direct services, choose and supervise workers, and coordinate with the fiscal intermediary.

Who can get it or use it: This is the clearest Maryland option to ask about when a senior needs hands-on help at home and the family wants to know whether a relative can be paid. CPAS uses community Medicaid rules, not the waiver registry.

How it helps: It can cover personal assistance, supports planning, and nurse monitoring under the CPAS regulations. In real life, that means help with bathing, dressing, grooming, meals, and similar daily tasks.

How to apply or use it: Start with Maryland Access Point. Then expect an assessment through Maryland’s AERS system or another state screening process. On the first call, say clearly: “We want to know whether this senior can use CPAS and whether an adult child or other family member can be the paid worker.”

What to gather or know first: Maryland’s official CPAS self-direction public notice says the state does not allow legally liable relatives to be paid, allows the participant to appoint a representative to direct services, and does not send cash prospectively. For an adult senior, that usually means a spouse is generally not the paid worker, while an adult child may be possible if the plan, budget, and payroll rules are met. Also expect worker onboarding. The current CPAS provider rule requires background checks on direct service workers.

2) Community First Choice (CFC)

What it is: CFC is Maryland’s larger home-and-community benefit for people who already have full Medicaid and need institutional level of care. The official CFC page lists personal assistance, home-delivered meals, nurse monitoring, supports planning, emergency response systems, environmental supports, and transition services.

Who can get it or use it: The senior must already have full Medicaid, live in the community, and meet the higher medical standard. Maryland says there is no age limit, so older adults can use it if they meet the rules.

How it helps: For many Maryland seniors with the highest home-care needs, CFC is the core program that keeps them out of a nursing home.

How to apply or use it: Call Maryland Access Point or the state’s CFC line at 410-767-1739 listed on the official page. Expect an in-home assessment and a plan of service.

What to gather or know first: Maryland’s public CFC page is clear on eligibility, but it does not publish a simple “approved family member list.” If you want an adult child paid, ask OLTSS whether your case should be handled through CPAS self-direction, the current CFC personal-assistance route, or a waiver-based plan. Also, Maryland’s provider information page says CFC and CPAS are no longer accepting applications to become an “Independent Personal Assistance provider,” so do not waste time trying to enroll yourself as a stand-alone Medicaid provider without instructions from the program.

3) Community Options Waiver (Home and Community-Based Options Waiver)

What it is: The Community Options Waiver, also called HCBOW, is Maryland’s waiver for adults age 18 and older who need nursing facility level of care. It includes all Medicaid services plus CFC, and may also add assisted living, case management, family training, medical day care, dietitian services, behavioral consultation, and Senior Center Plus.

Who can get it or use it: Maryland says the senior must be age 18 or older, live at home or in the community, not be in another waiver or PACE, meet nursing facility level of care, and fit the financial rules. The official waiver page says monthly income may not exceed 300% of SSI benefits and countable assets may not be more than $2,000 or $2,500, depending on the eligibility category.

How it helps: This waiver is important when personal care alone is not enough. It is also the right question if the senior may need assisted living or medical day care. But it is not the fast way to get a family caregiver paid.

How to apply or use it: Call Maryland Access Point and ask to be placed on the Community Options Waiver Registry. If the senior is in a nursing facility and Medicaid has paid for services for at least 30 days, the official page says you may apply with no wait and should work with the facility social worker.

What to gather or know first: Maryland’s public waiver page calls this a waitlist, but the latest statewide report I could verify says the program technically uses a registry. That report says Maryland had 23,461 registrants on June 30, 2025, mailed at least 700 invitations per month, and prioritized 80% of invitations based on risk of institutionalization and 20% based on time on the registry. The same report says invited applicants get six weeks to return the application, and that beginning May 1, 2025, a denied applicant may submit a reconsideration application within the original six-month application period if updated medical or financial information may change the result. The report also says the waiver remained approved for 6,348 slots and is not scheduled to rise to 7,500 until January 1, 2027.

4) Increased Community Services (ICS)

What it is: Increased Community Services is Maryland’s special community program for people who want to leave a nursing facility but are over the regular waiver income limit.

Who can get it or use it: The official ICS page says the person must be age 18 or older, need nursing facility level of care, live in a nursing facility for at least six months, be eligible for Medicaid for at least 30 days in a row, and be unable to use the regular waiver or PACE. The page also says countable assets may not be more than $2,500, income is based on the applicant only, and the person must pay a monthly contribution to care fee.

How it helps: ICS can cover personal assistance and other community supports for someone transitioning out of a facility.

How to apply or use it: The state says you cannot apply directly. You must be referred by Medicaid’s Eligibility Determination Division.

What to gather or know first: ICS is not a general at-home senior benefit. It is mostly a transition path for nursing home residents whose income blocks the regular Community Options Waiver.

5) Money Follows the Person (MFP)

What it is: Money Follows the Person is Maryland Medicaid’s transition program for people who want to move from a facility back into the community.

Who can get it or use it: Maryland says the person must live at least 60 days in a nursing home or ICF/IID and have at least one day of Medicaid eligibility during the stay.

How it helps: MFP can help with housing, transition planning, peer support, and connection to community-based services after discharge.

How to apply or use it: Ask the nursing facility social worker for a referral, or call the MFP program at 410-767-4915 on the official state page.

What to gather or know first: MFP does not itself create a family caregiver wage. It helps the senior move back home so other community programs can be set up.

6) Non-Medicaid options that may help while you wait

What it is: Maryland also has programs that do not create a long-term family caregiver paycheck but can still make caregiving possible.

• Maryland Family Caregiver Support Program: Run through Area Agencies on Aging. Good for respite, training, support groups, and local caregiver help.
• In-Home Aides Services: State-funded help for adults 18 and older with functional disabilities who need support to remain at home. Maryland says there may be a sliding-scale cost share. This does not pay the family caregiver directly.
• Maryland Respite Care Program: Relief for informal family caregivers. This is help for the caregiver, not wages.
• Maryland FAMLI: This is for workers, not retirees. Many websites still get this wrong. As of March 2026, Maryland is not paying FAMLI benefits yet. The official site says contributions begin January 1, 2027, benefits begin in January 2028, eligible workers may receive up to 12 weeks of paid leave, and weekly benefits may be as high as $1,000. This can help a working adult child take time off, but it is not a long-term caregiver wage program in 2026.

How to apply or use it: Start with the local Area Agency on Aging or local Department of Social Services if Medicaid is not ready yet.

What to gather or know first: Think of these as bridge help, respite, or worker leave, not as Maryland’s main paid-family-caregiver program.

How much do family caregivers get paid in Maryland?

Maryland does not publish one simple statewide family caregiver wage for seniors. The clearest public numbers I could verify are the program billing rates in Maryland’s FY2025 CFC and CPAS rate notice, effective July 1, 2024. Those are provider rates, not guaranteed take-home pay for the family worker. For newer notices, check Maryland’s provider transmittals page.

Service	Latest public Maryland rate I verified	What families should know
CPAS personal assistance	$6.3962 per 15-minute unit, about $25.58 per hour	This is the Medicaid billing rate. A family worker’s actual wage may be lower or set inside an approved budget.
CFC personal assistance	$6.3962 per 15-minute unit, about $25.58 per hour	Same warning. The program billing rate is not the same as take-home pay.
Shared attendant rate	$4.2597 per 15-minute unit, about $17.04 per hour	Used when one worker serves more than one participant in the approved way.
CFC daily personal assistance rate	$329.84 per day	This is a program rate for certain approved daily arrangements, not a promise of what a family member will earn.

The practical rule is simple: do not promise a family member a wage until Maryland approves the senior, the hours, and the service model. In an agency model, the agency keeps part of the billing rate for supervision, insurance, payroll, and overhead. In a self-directed model, the worker rate still has to fit the approved budget and Maryland’s rules.

What tax rules may apply?

If the family caregiver is paid through a Medicaid agency or Maryland’s fiscal/payroll system, payroll taxes are usually handled inside that system, and the caregiver should expect formal pay records. If the family uses a private-pay arrangement instead, do not just hand over cash. Use a written caregiver agreement and get tax advice first.

That matters for two reasons. First, private pay can trigger household-employer tax questions. Second, if the senior may need Medicaid later, undocumented payments can look like gifts instead of wages. This guide is not tax advice, so ask a CPA or elder-law attorney before setting up private payments.

How to apply or use it without wasting time

1. Call Maryland Access Point first. Ask which path fits best: CPAS, CFC, the Community Options Waiver, or ICS.
2. Ask whether the senior already has the right kind of Medicaid. CFC needs full Medicaid. CPAS uses community Medicaid. The waiver has its own financial review.
3. Ask for the assessment. Maryland uses AERS and other long-term services screening tools to measure care needs.
4. Say the family goal out loud. Use plain words: “Can an adult child or other relative be the paid caregiver in this case?”
5. If waiver services may be needed, get on the registry right away. Do not wait until after the CPAS or CFC conversation.
6. If the senior is in a nursing facility, ask the social worker about all three transition options: Community Options Waiver, ICS, and Money Follows the Person.
7. Once approved, use MyLTSS. It can help you track services, plans, and service issues.

Checklist of documents or proof

• Photo ID for the senior and the main family contact
• Medicare and Medicaid cards, if the senior has them
• Social Security number
• Proof of Maryland address
• Income proof, such as Social Security, pension, or other benefit statements
• Recent bank statements and other asset proof if Medicaid financial review is needed
• Health insurance information
• Doctor list, medication list, and recent hospital or rehab papers
• Any power of attorney, guardianship, or representative papers
• Name and contact information of the relative who hopes to be the paid worker
• A short written list of the help the senior needs each day, such as bathing, dressing, transfers, meals, or medication support

Reality checks

• Maryland does not pay for “being available” all day. It pays for approved services in an approved plan.
• A spouse is usually not the simple answer for an adult senior because Maryland’s self-direction materials bar legally liable relatives.
• An adult child may be possible, but not automatic.
• The Community Options Waiver backlog is real.
• The provider billing rate is not the same as the caregiver’s wage.
• Family pay usually starts only after approval, worker enrollment, and timekeeping rules are in place.

Common mistakes to avoid

• Assuming Maryland has a simple state caregiver stipend for any senior
• Thinking a spouse and an adult child are treated the same
• Waiting to join the waiver registry until after a crisis gets worse
• Promising a relative they will be paid before the program approves the case
• Ignoring asset paperwork during Medicaid review
• Paying a family caregiver privately with no written contract if Medicaid may be needed later
• Trying to sign up as an “independent provider” without first asking the state which service model applies

Best options by need

If this is your situation	Best Maryland starting point	Why
Senior is at home and an adult child wants to be paid	CPAS screening through Maryland Access Point	CPAS is the clearest current Maryland self-direction path to ask about first
Senior has very high care needs and already has full Medicaid	CFC	CFC is Maryland’s core higher-need home-care benefit
Senior needs assisted living, medical day care, or extra waiver services	Community Options Waiver plus CFC	The waiver adds services beyond basic personal care
Senior is in a nursing home and income is too high for the regular waiver	ICS and Money Follows the Person	These are Maryland’s key facility-to-home transition tools
Caregiver needs short-term relief, not wages	Family Caregiver Support Program, Respite Care, or In-Home Aides	These can keep the caregiving situation stable while Medicaid is pending
Working adult child needs time off from a job	Employer leave now; Maryland FAMLI later	FAMLI benefits do not start until 2028

What to do if denied, delayed, blocked, or waitlisted

1. Read every notice. Maryland denial and reduction notices explain the reason and the next step.
2. Do not miss the deadline. If there is a hearing or appeal deadline, write it down the same day.
3. Fix missing proof fast. Many delays are really missing income, asset, or medical papers.
4. If the issue is the Community Options Waiver, ask whether reconsideration is available. In the latest statewide report I could verify, Maryland says denied applicants may submit a reconsideration application within the original six-month application period if updated information may change the result.
5. Call both MAP and OLTSS. MAP can help you understand where the case sits, and OLTSS can answer program questions at 410-767-1739.
6. If the senior already receives services, use MyLTSS to report a service issue and review the current plan.
7. If the senior is in a facility, ask the social worker whether a no-wait waiver application, ICS referral, or MFP referral makes more sense than waiting at home.

Plan B / backup options

• Create a written private caregiver agreement and get tax and Medicaid-planning advice before money changes hands.
• Use a mix of unpaid family care and agency care while waiting for approval.
• Ask about assisted living or medical day care through the Community Options Waiver if home care is no longer enough.
• Use In-Home Aides, Respite Care, or caregiver support through the Area Agency on Aging while waiting.
• If the senior is a veteran, ask the VA social worker about VA caregiver and pension-related options. Those are separate from Maryland Medicaid and may follow different rules.

Local resources if verified and useful

• Maryland Access Point: statewide entry point for long-term services and supports — 844-627-5465
• Office of Long Term Services and Supports: program questions for CFC and related services — 410-767-1739
• AERS / local health department assessment system: Maryland’s assessment and care-planning entry point for many older adults
• MyLTSS: participant portal for plans, eligibility, service history, and service issues
• Maryland Family Caregiver Support Program: caregiver support through local Area Agencies on Aging
• In-Home Aides Services and Respite Care Program: backup support through the Department of Human Services
• Money Follows the Person: transition help for facility residents — 410-767-4915

Diverse communities in Maryland

Maryland serves many multigenerational families, immigrant families, and families who switch between paid and unpaid caregiving as work schedules change. Maryland’s AERS page says interpretation and translation services are available. Ask for an interpreter on the first call, not the last one.

If one adult child is doing most of the paperwork, keep that same person listed as the main contact on MAP, Medicaid, and provider forms. If the senior has dementia or cannot manage employer duties, ask whether a representative can direct services in the self-directed model. That point matters because Maryland’s CPAS self-direction materials say a representative may direct services on the participant’s behalf.

FAQ

Can a senior in Maryland have a family member paid to provide care?

Yes, sometimes. In Maryland, the usual route is Medicaid personal assistance, not a simple caregiver stipend. The clearest current path to ask about is CPAS. Seniors with higher needs may use CFC or the Community Options Waiver. The family member must fit the approved service model, and the senior must meet Medicaid and care-need rules.

Can a spouse be paid to care for a senior in Maryland?

Usually, no. Maryland’s official CPAS self-direction materials say legally liable relatives cannot be paid. For an adult senior, that usually means a spouse is generally not the paid caregiver. If a website tells you “Maryland pays spouses,” treat that claim carefully and ask the program directly before relying on it.

Can an adult child be paid to care for a parent in Maryland?

Sometimes, yes. Adult children are usually the first relatives families ask about because Maryland’s self-direction materials bar legally liable relatives, not all relatives. But an adult child is still not automatic. The senior must qualify, the tasks and hours must be approved, and the worker must complete the required enrollment steps.

Does the senior need Medicaid to qualify?

For the real long-term paid-family-caregiver path, usually yes. CFC needs full Medicaid. CPAS uses community Medicaid. The Community Options Waiver and ICS also depend on Medicaid rules. Non-Medicaid programs in Maryland may help with respite or support, but they usually do not create a long-term family wage.

What is the difference between CPAS and CFC in Maryland?

CPAS is the clearest current Maryland path to ask about when a senior needs hands-on help at home and a family-hire option may be needed. CFC is the larger higher-need program for people who already have full Medicaid and need institutional level of care. In short, CPAS is usually the first family-hire question; CFC is usually the higher-need home-care question.

Is there a waitlist for paid family caregiver help in Maryland?

For CPAS and CFC, Maryland does not publicly describe a waiver-style waitlist. The Community Options Waiver is different. Its public page calls it a waitlist, and the latest statewide report I could verify says it is technically a registry with a large backlog. If waiver services may be needed, put the senior on that registry right away.

How much do family caregivers get paid in Maryland?

Maryland does not publish one simple statewide family caregiver wage. The latest public rate notice I could verify lists CPAS and CFC personal assistance at $6.3962 per 15-minute unit, or about $25.58 per hour, but that is the Medicaid billing rate, not guaranteed take-home pay. A family worker’s actual pay depends on the service model, budget, and payroll setup.

What is the best first phone call to make?

Maryland Access Point at 844-627-5465. That is the best first call because it is statewide, it connects families to long-term services and supports, and it can help you sort out whether the right question is CPAS, CFC, the Community Options Waiver, ICS, or a non-Medicaid support program.

Resumen en español

En Maryland, sí puede existir una forma para que un familiar reciba pago por cuidar a un adulto mayor, pero casi siempre pasa por Medicaid y no por un cheque sencillo del estado. La ruta más clara para preguntar primero es CPAS. Para personas con necesidades más altas, también importan CFC y el Community Options Waiver.

En general, el cónyuge no suele ser la persona pagada. Un hijo adulto puede ser más posible, pero no es automático. El adulto mayor tiene que calificar, las horas deben ser aprobadas y el trabajador familiar debe completar el proceso del programa.

La mejor primera llamada es a Maryland Access Point al 844-627-5465. Tenga listos la identificación, tarjetas de Medicaid y Medicare, prueba de ingresos y bienes, lista de medicamentos y el nombre del familiar que quiere cuidar.

About This Guide

Editorial note: This guide is written for Maryland seniors, caregivers, and adult children who need practical steps, not hype. It focuses on what Maryland actually offers and where families most often lose time.

Verification line: This article was checked against official Maryland program pages, regulations, provider notices, and state reports available through March 2026. Some statewide numbers, especially waiver registry counts, are published with a delay, so the newest official report may reflect earlier data.

Corrections line: If you find a broken link, outdated rule, or new Maryland guidance, please send a correction request to the GrantsForSeniors.org editorial team so this guide can be updated.

Disclaimer: This article is for general education only. It is not legal, tax, financial, or benefits advice. Medicaid eligibility and caregiver pay rules can change and can depend on the senior’s exact facts.