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Last updated: 27 May 2026
Bottom line: A Maryland senior can sometimes have a family member paid for care, but it is usually not a simple state check. The main path is Medicaid personal assistance. Start with CPAS or Community First Choice if the senior needs help at home. Ask about the Community Options Waiver if the senior also needs assisted living, medical day care, or case management. Ask about facility transition programs if the senior is already in a nursing home.
Emergency help now
- Unsafe right now: Call 911. If there is a mental health crisis, call or text 988.
- Unsafe discharge: Tell the hospital, rehab, or nursing facility social worker, “There is no safe care plan at home.” Ask for a written discharge plan.
- Abuse, neglect, or self-neglect: Maryland says suspected adult abuse or neglect should be reported to Adult Protective Services through the local Department of Social Services or 1-800-917-7383.
- Care needed soon: Call Maryland Access Point at 1-844-627-5465 and ask for long-term services screening.
Quick help box
- Best first call: Maryland Access Point, 1-844-627-5465.
- State long-term services line: Office of Long Term Services and Supports, 410-767-1739.
- Already approved for services: Ask the supports planner to help you use the MyLTSS portal to review service plans, service history, eligibility, and service issues.
- Need more Maryland help: Use our Maryland benefits portals guide for Medicaid, SNAP, energy help, and other state benefit entry points.
Quick-reference table
| Your situation | Best first step | Reality check |
|---|---|---|
| Senior is at home and needs help with bathing, dressing, meals, or moving around | Ask for CPAS screening | Medicaid rules apply, and the care plan controls the hours |
| Senior already has full Medicaid and needs nursing-home-level care at home | Ask about Community First Choice | It is for higher care needs, not light housekeeping only |
| Senior may need assisted living, medical day care, or case management | Join the Community Options Waiver Registry | The registry is large, so do this early |
| Senior is in a nursing home and wants to move home | Ask the facility social worker about waiver, ICS, and MFP | Do not wait until discharge week |
| Caregiver needs a break but not wages | Ask about caregiver support and respite | These may help with relief, not a long-term paycheck |
Contents
- What paid caregiving means in Maryland
- Who may qualify
- Best Maryland programs to ask about
- How much family caregivers may be paid
- How to start without wasting time
- Documents to gather
- Scripts for phone calls
- Reality checks and common mistakes
- If denied, delayed, or overwhelmed
- Backup options while waiting
- Local and official resources
- FAQ
What paid caregiving means in Maryland
In Maryland, “paid family caregiver” can mean a few different things. It may mean a relative is hired as a personal assistance worker under a Medicaid plan. It may mean a worker takes paid family leave from a job in the future. It may mean respite money that helps the caregiver get a break. It may also mean a private caregiver contract paid from the senior’s own funds.
These choices are not the same. Maryland does not have one simple senior caregiver stipend for every family. The strongest path is usually Medicaid long-term services and supports. Families also need to understand how this fits with broader Maryland senior benefits, because the same senior may also need food, utility, housing, tax, or health coverage help.
The main rule is simple: do not promise pay until Maryland approves the senior, the service model, the worker, and the hours. A family member usually cannot start today and get paid back for all past care. The care must be in an approved plan, and timekeeping rules matter.
Who may qualify
Maryland looks at both the senior and the worker. The senior must need help with daily tasks. This may include bathing, dressing, grooming, eating, transfers, mobility, medication support, meals, or safe movement in the home. The senior may also need Medicaid. Some programs require full Medicaid. Others use different Medicaid rules.
The family member must also fit the service model. An adult child may be possible in some self-directed cases. A spouse is much harder because Maryland’s current CPAS self-direction approval says the state does not permit legally liable relatives to be paid as personal assistance providers. That rule is in the federal CPAS self-direction approval, which took effect July 1, 2023.
If the senior has dementia, a stroke history, or another condition that makes it hard to direct care, ask whether a representative can help direct services. The same CPAS approval allows a participant to appoint a representative to direct self-directed personal assistance. The representative may not be the same as the paid worker in every case, so ask before choosing names.
For older adults with disabilities, also review our disabled senior help guide. It covers other Maryland paths that may matter when care needs, transportation, housing, equipment, or disability rights issues overlap.
Best Maryland programs to ask about
| Program | What it may help with | Who may fit | Ask this first |
|---|---|---|---|
| CPAS | Personal assistance at home, supports planning, nurse monitoring | Senior needs hands-on help and may use community Medicaid | Can this case use self-direction, and can this relative be hired? |
| Community First Choice | Higher-need home and community services | Senior has full Medicaid and needs institutional level of care | Does the senior meet the level-of-care rule? |
| Community Options Waiver | Waiver services such as assisted living, medical day care, case management, and CFC services | Adult age 18 or older who needs nursing facility level of care | Can we join the registry now? |
| ICS | Transition help for some nursing facility residents with income over the regular waiver limit | Senior in a nursing facility at least six months and eligible for Medicaid at least 30 days | Can Medicaid’s Eligibility Determination Division refer this case? |
| Money Follows the Person | Facility-to-community transition help | Resident who has lived in a nursing home or ICF/IID at least 60 days and had one day of Medicaid | Can the social worker start an MFP referral? |
Community Personal Assistance Services
Community Personal Assistance Services, often called CPAS, is the first program many families should ask about when the goal is paying a family worker. The current CPAS supports rule says supports planning includes helping people self-direct services and coordinate with a fiscal intermediary. In plain words, the senior may have help choosing and managing workers if self-direction is approved.
CPAS can cover personal assistance tied to the approved plan. It is not payment for general family kindness, errands, or being on call all day. The provider side also has rules. The CPAS provider rule requires criminal history checks for direct service workers, including nurses.
Reality check: CPAS self-direction does not mean the state gives the senior a cash envelope. The federal approval says Maryland does not disburse cash prospectively. A financial management system handles pay and records.
Community First Choice
Community First Choice, or CFC, is for people who need a higher level of care. Maryland says the person must need institutional level of care, live in a community setting, and already have full Medicaid. The state also says there is no age limit. Services may include personal assistance, home-delivered meals, nurse monitoring, supports planning, emergency response systems, accessibility changes, assistive technology, and transition services.
Reality check: CFC is not the same as a simple family caregiver wage program. If your goal is to hire an adult child, ask the supports planner how the current plan should be set up and whether CPAS self-direction, CFC personal assistance, or a waiver path fits best.
Community Options Waiver
The Community Options Waiver, also called the Home and Community-Based Options Waiver, helps people get services at home or in the community instead of an institution. Maryland says the person must be age 18 or older, need nursing facility level of care, live safely in the community with waiver services, and meet financial rules. The state 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. In 2026, the federal 2026 SSI amount is $994 for one person, so 300% is $2,982 before Maryland’s own counting rules and deductions.
The waiver matters when personal care alone is not enough. It can add services like assisted living, case management, medical day care, family training, dietitian services, behavioral consultation, and Senior Center Plus. Our guide to assisted living costs may help if the family is comparing home care and assisted living.
Reality check: This waiver has a real registry. Maryland’s 2025 registry report listed 23,461 registrants on June 30, 2025, including 16,277 age 65 and older. If waiver services may be needed, ask to join the registry early.
Increased Community Services
Increased Community Services, or ICS, is a special path for some nursing facility residents. Maryland 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. Assets may not be more than $2,500, and the applicant pays a monthly contribution to care based on income.
Reality check: You cannot apply directly to ICS. Maryland says a referral from Medicaid’s Eligibility Determination Division is required. Ask the nursing facility social worker to help you get the case reviewed.
Money Follows the Person
Money Follows the Person, or MFP, can help a Medicaid long-term care resident move from a facility to a home, apartment, or small group home. Maryland says the person must live at least 60 days in a nursing home or ICF/IID, have one day of Medicaid eligibility during the stay, and sign an MFP consent form. The MFP program line is 410-767-4915.
Reality check: MFP does not create a family caregiver paycheck by itself. It may help with the move home so CFC, CPAS, waiver services, or other supports can be arranged.
How much family caregivers may be paid
Maryland does not publish one simple statewide take-home wage for family caregivers. The latest public rate notice this guide could verify is the FY2025 rate notice, effective July 1, 2024. These are Medicaid program rates, not a promise that the worker takes home the full amount.
| Service rate | Public rate verified | What it means |
|---|---|---|
| Personal assistance | $6.3962 per 15-minute unit, about $25.58 per hour | Billing rate for CFC and CPAS personal assistance |
| Shared attendant | $4.2597 per 15-minute unit, about $17.04 per hour | Used only when shared care is approved |
| Daily personal assistance | $329.84 per day | Program rate for certain approved daily arrangements |
The worker’s actual pay can be lower. It depends on the approved model, budget, payroll setup, agency costs, taxes, and any state rule that applies to that case. Ask for the worker wage in writing before the family member changes work hours or quits a job.
How to start without wasting time
- Call MAP first. Ask for screening for CPAS, CFC, Community Options Waiver, or nursing facility transition help.
- Say the goal clearly. Use the words, “We want to know if a family member can be the paid worker.”
- Ask what Medicaid status is needed. CFC needs full Medicaid. Waiver and ICS have their own financial rules.
- Request an assessment. Maryland’s AERS program helps frail, aged, and disabled adults with care plans, resource connection, and home evaluations in many local health departments.
- Ask about the registry. If waiver services may be needed, do not wait to ask about the Community Options Waiver Registry.
- Use the right local guide. For local aging offices, see our aging agency guide.
Documents to gather
| Document or detail | Why it helps |
|---|---|
| Photo ID and Maryland address proof | Shows identity and where services would be delivered |
| Medicare and Medicaid cards | Shows current health coverage and Medicaid status |
| Social Security, pension, and benefit letters | Needed for income review |
| Bank statements and asset proof | Needed for Medicaid or waiver financial review |
| Medication list and doctor list | Helps the nurse or assessor understand care needs |
| Hospital, rehab, or nursing facility papers | Supports level-of-care review and safe discharge planning |
| Power of attorney or guardianship papers | Shows who can help with decisions, if any |
| Name of proposed family worker | Needed to ask whether that person may be hired |
| Daily care notes | Shows what help is needed each day and night |
Scripts for phone calls
| Who to call | What to say |
|---|---|
| Maryland Access Point | “My parent is a Maryland senior who needs help at home with daily tasks. We want to know if CPAS, CFC, or the Community Options Waiver fits, and whether an adult child can be the paid worker.” |
| Supports planner | “Please explain the service model, approved hours, worker enrollment steps, and the wage before we choose a family worker.” |
| Nursing facility social worker | “We want a safe plan to return home. Please review Community Options Waiver, ICS, Money Follows the Person, and home-care assessments before discharge.” |
| Local DSS or caregiver office | “We need caregiver relief while Medicaid is pending. Can you screen us for respite, In-Home Aides, or caregiver support?” |
Reality checks and common mistakes
- No automatic paycheck: Maryland must approve the senior, the plan, the service model, and the worker.
- No payment for vague care: Programs pay for approved tasks, not “being around” all day.
- Spouse rules are strict: A spouse is usually a legally liable relative, so ask before relying on spouse-pay claims.
- Adult child is not automatic: The worker still needs approval, onboarding, timekeeping, and background checks when required.
- Registry delays are real: The Community Options Waiver Registry is large. Get on it early if waiver services may be needed.
- Billing rate is not wage: The Medicaid rate is not the same as take-home pay.
- Private pay can cause problems: If the senior pays a relative without a written agreement, Medicaid may later treat payments as gifts.
If housing is part of the care problem, our Maryland housing help guide may help you look at rent, housing search, and stability resources. For urgent bills, also see emergency assistance options in Maryland.
If denied, delayed, or overwhelmed
- Read the notice. Look for the reason, missing proof, appeal deadline, and contact name.
- Ask for the rule in plain English. Say, “Which rule does this denial rely on, and what proof could change it?”
- Fix missing paperwork fast. Many delays are missing bank statements, medical notes, or signatures.
- Ask about reconsideration. For the Community Options Waiver, Maryland’s 2025 report says denied applicants may submit updated information within the original six-month application period when it could change the result.
- Use MyLTSS if enrolled. Report service issues and review the plan with the supports planner.
- Ask for legal help if needed. If a cut, denial, discharge, or Medicaid problem could harm the senior, contact legal aid or a benefits advocate quickly.
Backup options while waiting
Not every caregiver support program pays wages. Some help the caregiver stay afloat while Medicaid or waiver steps move forward.
- Caregiver support: Maryland’s caregiver support page says the Family Caregiver Support Program can help adult caregivers of people age 60 or older, and certain older relative caregivers.
- In-home aide help: The In-Home Aides program may help adults with functional disabilities who need personal care or chore help to remain home. Funding limits and a ranking scale apply.
- Respite: The Respite Care Program may reimburse short-term temporary care so an informal caregiver can rest.
- Paid leave later: Maryland FAMLI benefits are scheduled to start in January 2028, with up to 12 weeks and up to $1,000 per week for eligible workers. This is job leave, not long-term caregiver wages.
- Veteran households: If the senior is a veteran or surviving spouse, check Maryland veteran benefits and ask a VA social worker about caregiver and pension-related options.
- Care arrangement choices: If the family is comparing an agency worker and a family hire, our home care choices guide can help.
Local and official resources
- Maryland Access Point: 1-844-627-5465 for long-term services screening and local aging help.
- Office of Long Term Services and Supports: 410-767-1739 for CFC, CPAS, waiver, and ICS program questions.
- Money Follows the Person: 410-767-4915 for facility transition questions.
- Adult Protective Services: Local Department of Social Services or 1-800-917-7383 for suspected abuse, neglect, self-neglect, or exploitation.
- Maryland Relay: Dial 711 if phone access support is needed.
- Medicare costs: If the senior needs help with Medicare premiums or cost sharing, our Medicare Savings Programs guide explains Maryland QMB, SLMB, QI, and QDWI basics.
Resumen en español
En Maryland, un familiar puede recibir pago por cuidar a un adulto mayor en algunos casos, pero casi siempre depende de Medicaid y de un plan aprobado. No es un cheque simple para cualquier familia.
La primera llamada debe ser a Maryland Access Point al 1-844-627-5465. Pregunte por CPAS, Community First Choice, Community Options Waiver, o ayuda para salir de un nursing home. Diga claramente: “Queremos saber si un hijo adulto u otro familiar puede ser el trabajador pagado.”
No prometa pago a un familiar hasta que el programa apruebe el caso, las horas, el modelo de servicio y el trabajador. En general, las reglas para cónyuges son más difíciles que las reglas para hijos adultos.
FAQ
Can a Maryland senior have a family member paid to provide care?
Sometimes. The usual path is Medicaid personal assistance through CPAS, CFC, or a waiver-related service. The senior must qualify, the care tasks must be approved, and the worker must fit the program rules.
Can a spouse be paid to care for a senior in Maryland?
Usually, no. Maryland’s CPAS self-direction approval says legally liable relatives cannot be paid as personal assistance providers. For an adult senior, a spouse is usually a legally liable relative. Always confirm the rule with the program before relying on spouse-pay claims.
Can an adult child be paid to care for a parent in Maryland?
Sometimes. An adult child may be possible if the senior qualifies, self-direction or another approved model fits, the plan approves the tasks and hours, and the adult child completes worker enrollment steps.
Does the senior need Medicaid?
Usually, yes for the main paid-family-caregiver path. CFC requires full Medicaid. CPAS uses Medicaid personal assistance rules. The Community Options Waiver and ICS also depend on Medicaid rules.
How much are family caregivers paid in Maryland?
There is no single take-home wage. The latest public CFC and CPAS personal assistance rate this guide verified is about $25.58 per hour as a Medicaid billing rate, effective July 1, 2024. Actual worker pay may be lower.
What is the best first call?
Call Maryland Access Point at 1-844-627-5465. Ask for screening for CPAS, CFC, the Community Options Waiver, or facility transition help. If services are already approved, ask the supports planner for the next step.
About This Guide
This guide uses official federal, state, local, and other high-trust nonprofit and community sources mentioned in the article.
Editorial note: This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Verification: Last verified 27 May 2026, next review 27 August 2026.
Corrections: Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we will respond within 72 hours.
Disclaimer: This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.
Last updated: 27 May 2026
Next review: 27 August 2026
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