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Last updated: 14 September 2026
A family member can sometimes be paid to care for an older adult in Maryland, but there is no single caregiver paycheck program for every family. The main route is Medicaid personal assistance. The senior must qualify, the care must be approved, and the proposed worker must meet program rules.
Bottom Line
Start with Maryland Access Point at 1-844-627-5465. Ask for long-term services screening and say, “We want to know whether a family member can be the paid personal assistance worker.” For many families, the first programs to ask about are Community Personal Assistance Services (CPAS) and Community First Choice (CFC). A waiver or nursing-facility transition program may fit when care needs are higher.
Need Help Right Now?
- Immediate danger: Call 911.
- Mental health crisis: Call or text 988.
- Unsafe discharge: Tell the hospital, rehabilitation center, or nursing facility that there is no safe care plan at home. Ask for a written discharge plan and a social-work review.
- Abuse, neglect, self-neglect, or exploitation: Maryland says reports can go to the local Department of Social Services or 1-800-917-7383. See Adult Protective Services.
Start Here
- Call the state entry point. Maryland Access Point can connect older adults and people with disabilities to screening, options counseling, and local long-term care help.
- Name the goal clearly. Say which relative may provide care and what the senior needs help with each day.
- Ask for the exact service model. Find out whether CPAS, CFC, the Community Options Waiver, or a transition program fits before anyone changes work hours or expects pay.
If the household also needs food, energy, health, or cash-benefit entry points, use our Maryland benefits portals guide.
Quick Reference
| Situation | Ask about | Main caution |
|---|---|---|
| At home and needs help with bathing, dressing, eating, transfers, or other daily tasks | CPAS | Full Medicaid and an approved plan are required |
| At home and needs an institutional level of care | CFC | Full Medicaid and level-of-care approval are required |
| Needs waiver services such as assisted living, medical day care, or case management | Community Options Waiver | There is a waitlist for community applicants |
| In a nursing facility and income is too high for the regular waiver | ICS | Referral and facility-stay rules apply |
| In a nursing facility and wants to move back to the community | MFP and waiver transition | Start planning before discharge week |
What Has Changed
- The caregiver-pay section is clearer. Maryland’s approved CPAS self-direction option allows participants to set worker rates, so a Medicaid provider billing rate should not be presented as one statewide family-caregiver wage.
- Paid family leave has a firm start date. Maryland FAMLI says eligible employees can begin taking paid, job-protected leave in January 2028. This is temporary wage replacement from a job, not ongoing Medicaid caregiver pay.
- Maryland added a new backup route. In 2026, the Department of Aging consolidated three state-funded programs into Supporting Older Adults with Resources (SOAR), which can help some older adults who do not qualify for Medicaid or are waiting for Medicaid-funded services.
What Paid Caregiving Means in Maryland
For this guide, “paid family caregiver” means a relative who may become an approved personal assistance worker for an older adult at home. Maryland Medicaid offers self-direction under CPAS.
The current CPAS program page says CPAS is a Medicaid state-plan benefit for people living in the community who need help with at least one activity of daily living. It can include personal assistance, nurse monitoring, and supports planning.
Maryland’s federally approved CPAS self-direction amendment says self-directing participants can recruit, hire, train, supervise, and fire personal assistance providers. It also says Maryland does not permit legally liable relatives to be paid personal assistance providers under this option. That restriction is important for spouses and any other relationship Maryland treats as legally liable.
An adult child or another relative may still be worth asking about because the rule does not ban every family relationship. The program must approve the participant, worker, tasks, and service plan.
Families often have other needs at the same time. Our Maryland senior assistance guide covers broader benefit and service routes that can help with living costs while a care plan is being arranged.
Who May Qualify
For CPAS: Maryland says the person must need help with at least one activity of daily living, live in a community setting, and already have full Medicaid. There is no age limit on the CPAS page.
For CFC: the person must need an institutional level of care, live in the community, and already have full Medicaid. Maryland’s current Community First Choice page also says there is no age limit.
If the senior does not yet have Medicaid, do not assume that ordinary adult Medicaid income limits answer a long-term-care case. Maryland notes that people age 65 or older, people who are blind or disabled, and people who need long-term care can face different financial and medical rules. Start with the state’s guidance on how to apply for Medicaid and ask MAP which application route fits.
A disability can change the best route. Our Maryland disability help guide covers related transportation, equipment, housing, and rights resources.
Maryland Programs to Ask About
| Program | What it may provide | Who may fit | First question |
|---|---|---|---|
| CPAS | Personal assistance, nurse monitoring, supports planning | Full-Medicaid participant needing help with at least one daily activity | Can this case self-direct and hire this relative? |
| CFC | Personal assistance plus other home and community supports | Full-Medicaid participant needing institutional level of care | Does the assessment meet the level-of-care rule? |
| Community Options Waiver | Waiver services, CFC, assisted living, medical day care, case management | Adult needing nursing-facility level of care who can live safely in the community | Should we join the registry now? |
| ICS | Community services for some nursing-facility residents with income above the regular waiver level | Certain adults transitioning after a qualifying facility stay | Can Medicaid refer this case? |
| MFP | Transition planning and help moving from an institution to a community home | Certain Medicaid participants after a qualifying institutional stay | Can we start an MFP referral now? |
Community Personal Assistance Services
CPAS is the most direct program to ask about for an approved personal assistance worker at home. The service plan controls covered tasks and authorized help.
Worker rule: The approved self-direction amendment bars legally liable relatives. It also requires systems for background checks, timekeeping, and financial management. A family worker cannot simply submit informal hours for past care.
Community First Choice
CFC is for people with higher care needs. Maryland says the participant must need an institutional level of care and have full Medicaid. Services can include personal assistance and other home and community supports.
Reality check: CFC is broader than a caregiver wage program. Ask the supports planner exactly which personal assistance model applies and whether the proposed relative can be enrolled under that model.
Community Options Waiver
The Community Options Waiver helps adults who need nursing-facility level of care receive services in the community. Community applicants face a waitlist. A nursing-facility resident for whom Medicaid has paid services for at least 30 days may apply without waiting on the community registry.
Financial rules are more complicated than a simple income test. The state page says monthly income may not exceed 300% of Supplemental Security Income (SSI) benefits and countable assets may not exceed $2,000 or $2,500, depending on the eligibility category. The federal 2026 SSI amount is $994 for one person, so 300% is $2,982 per month. Do not use that figure alone to decide eligibility; spouse, household, and Medicaid counting rules can matter.
If assisted living is part of the care plan, our Maryland assisted living guide explains other payment routes and limits.
Increased Community Services
Increased Community Services, or ICS, can help certain adults move from a nursing facility to the community when income is above the regular waiver level. Maryland says the person must be 18 or older, need nursing-facility level of care, have lived in a nursing facility for at least six months, and have been Medicaid-eligible for at least 30 days in a row.
Reality check: You cannot apply directly to ICS. Maryland says a referral must come from Medicaid’s Eligibility Determination Division, and a monthly contribution toward care can apply when income is above the program threshold.
Money Follows the Person
Money Follows the Person can help eligible Medicaid participants move from a nursing home or certain other institutions into a community setting. Maryland currently says a person generally must have lived in a qualifying institution for 60 days and have at least one day of Medicaid eligibility during the stay.
Reality check: MFP is a transition program, not a family-caregiver salary by itself. Ask how the transition plan connects to CPAS, CFC, a waiver, housing, and approved personal assistance after the move.
How Family Caregiver Pay Works
Maryland does not publish one take-home wage for every family caregiver. Pay depends on the service model, approved budget and hours, payroll, taxes, and program rules.
The approved CPAS amendment says a self-directing participant can set personal assistance provider rates. The rate still must fit the approved arrangement and financial-management system. Agency-managed care uses a different structure.
Do not confuse a Medicaid billing rate with a worker’s wage. A provider reimbursement schedule can include agency costs and does not tell a family member what the person will take home. Ask for the proposed worker rate, approved hours, payroll deductions, and overtime rules in writing before the caregiver leaves a job or cuts work hours.
If the family is choosing between an agency and a family hire, our home care choices guide can help compare control, backup coverage, screening, and payroll responsibilities.
How to Start Without Wasting Time
- Write down the daily care. List bathing, dressing, toileting, meals, transfers, walking, medication help, supervision, and overnight needs. Note how often each task happens.
- Call MAP. Ask for screening and say the goal is to see whether a named relative can be an approved paid worker.
- Confirm Medicaid status. CPAS and CFC require full Medicaid. If the senior does not have it, ask which Medicaid pathway matches age, disability, and long-term-care needs.
- Ask for the program name. Do not accept only “home care.” Ask whether the case is being screened for CPAS, CFC, Community Options Waiver, ICS, or a transition program.
- Ask about the worker before onboarding. Give the relationship to the senior. Ask whether that person is allowed, what background checks apply, and which payroll or fiscal-management system will be used.
- Get decisions in writing. Keep notices, assessment results, service plans, worker approvals, and any denial or reduction notice.
For the local aging office that serves the senior’s county or Baltimore City, use our Maryland aging agencies directory.
Documents and Information to Gather
| Item | Why it helps |
|---|---|
| Photo ID and Maryland address proof | Confirms identity and residence |
| Medicare and Medicaid cards | Shows current coverage and Medicaid status |
| Income and benefit letters | Supports financial screening |
| Bank and asset records | May be needed for long-term-care Medicaid or waiver review |
| Medication and diagnosis list | Helps explain health and care needs |
| Hospital or facility records | Supports level-of-care and discharge planning |
| Power of attorney papers | Shows who may help with decisions, if applicable |
| Proposed worker’s details | Lets the planner check relationship and worker requirements |
| Daily care notes | Shows the frequency and type of hands-on help |
Phone Scripts
Maryland Access Point
“My parent needs help at home with daily tasks. We want to know whether CPAS, CFC, or a waiver fits and whether an adult child can be the approved paid worker. What screening should we start?”
Supports planner
“Please tell me the exact service model, approved tasks and hours, worker enrollment steps, and the proposed wage before we choose a family worker.”
Nursing facility social worker
“We want a safe move back to the community. Please review Community Options Waiver, ICS, Money Follows the Person, and the personal assistance plan before discharge.”
Local caregiver office
“We need relief while Medicaid is pending. Can you screen us for respite, SOAR, In-Home Aides, or other local caregiver support?”
Reality Checks and Common Mistakes
- No automatic paycheck: The senior, service plan, worker, and hours must be approved.
- No retroactive promise: Do not assume unpaid care already provided will later be reimbursed.
- Relationship rules matter: Maryland CPAS self-direction does not allow legally liable relatives as paid personal assistance providers.
- Adult children are not automatic: A proposed family worker still needs approval and must follow onboarding and timekeeping rules.
- Waitlists can change the plan: Maryland currently states that the Community Options Waiver has a waitlist for community applicants.
- Private family payments need care: Before a senior transfers money to a relative, get advice if Medicaid long-term-care eligibility may be needed. Informal gifts can create problems in some Medicaid financial reviews.
Maryland has also announced Medicaid eligibility changes affecting some non-citizens beginning 1 October 2026. Maryland says most Medicaid members will not be affected, but a household that may fall in an affected immigration category should confirm coverage before relying on a CPAS or CFC plan.
If the household is facing an urgent bill, shutoff, homelessness, or another crisis while care is being arranged, see our Maryland emergency assistance guide.
If Denied, Delayed, or Overwhelmed
Read the notice first. Find the reason, missing proof, and response or appeal deadline. Ask which rule the agency used.
Do not wait on missing documents. Send requested records by the deadline and keep proof of submission.
Ask for legal help when the stakes are high. Maryland Legal Aid says it assists financially eligible clients with Medical Assistance, Medicare, nursing homes, assisted living, and home and community-based services. Its main intake number is 1-888-465-2468.
For a service cut or disability-access problem, keep the written notice and confirm the deadline. Do not rely on a phone call alone.
Backup Options While Waiting
Not every support program pays a relative. Some can reduce the care a family must cover alone while Medicaid or worker enrollment moves forward.
Caregiver support and respite
The Maryland Department of Aging’s caregiver support program connects families to local caregiver services. Maryland’s Respite Care Program provides short-term relief for eligible families through local Departments of Social Services or participating nonprofit agencies. These supports may help the caregiver rest, but they are not a long-term wage.
For a broader explanation of short-term relief options, see our respite care guide.
SOAR for some older adults
Maryland’s 2026 SOAR program can provide case management and limited help with personal care, chores, meals, transportation, safety repairs, adult day care, emergency response systems, and respite. It serves some adults age 62 or older who meet financial and functional rules, including people who do not qualify for Medicaid or are waiting for Medicaid-funded services. Funding is limited.
In-Home Aides
Maryland’s In-Home Aides program can provide personal care, chores, and case management to adults with functional disabilities. The state says people at greatest risk receive priority, funding limits the number served, and some applicants may have to contribute toward the hourly cost.
Paid leave from a job
Maryland FAMLI says eligible employees can begin taking up to 12 weeks of paid, job-protected leave in January 2028, with benefits of up to $1,000 per week. This can help an employed caregiver take time away from work for a loved one’s serious health condition. It is not an ongoing payment for long-term caregiving. Payroll contributions begin in January 2027.
Veteran households
If the older adult is a veteran or surviving spouse, our Maryland veteran benefits guide can help the family identify veteran-specific care, pension, transportation, and local service routes.
Local and Official Resources
- Maryland Access Point: 1-844-627-5465 for long-term services screening, options counseling, and local referrals.
- Office of Long Term Services and Supports: 410-767-1739 for CPAS, CFC, Community Options Waiver, and ICS questions.
- Money Follows the Person: 410-767-4915 for facility-to-community transition questions.
- Adult Protective Services: 1-800-917-7383 for suspected abuse, neglect, self-neglect, or exploitation.
- Maryland Relay: Dial 7-1-1 for relay service.
If Medicare premiums, deductibles, or cost sharing are also straining the household budget, our Maryland Medicare Savings guide explains QMB, SLMB, QI, and QDWI.
Resumen en Español
En Maryland, un familiar puede recibir pago por cuidar a un adulto mayor en algunos casos, pero no existe un cheque estatal automático para todas las familias. La ruta principal suele ser la asistencia personal de Medicaid.
Llame a Maryland Access Point al 1-844-627-5465. Diga: “Queremos saber si este familiar puede ser el trabajador pagado.” Pregunte por CPAS, Community First Choice, Community Options Waiver o ayuda para salir de un centro de enfermería.
CPAS y Community First Choice requieren Medicaid completo. El plan debe aprobar las tareas, las horas y el trabajador. Las reglas son más estrictas para familiares que tienen responsabilidad legal. No prometa salario ni deje un empleo hasta recibir por escrito la aprobación del trabajador y la tarifa.
Si Medicaid tarda o no corresponde, pregunte por respite, SOAR, In-Home Aides y otros apoyos locales. Si recibe una denegación o una reducción, guarde la carta y revise inmediatamente la fecha límite para responder o apelar.
FAQ
Can a Maryland senior have a family member paid to provide care?
Sometimes. The strongest path is usually Medicaid personal assistance. The senior must qualify, the care must be in an approved plan, and the proposed family worker must meet the program’s worker rules.
Can a spouse be paid through Maryland CPAS?
Do not assume so. Maryland’s approved CPAS self-direction option does not permit legally liable relatives to be paid personal assistance providers. Ask the supports planner to confirm how that rule applies before relying on spouse pay.
Can an adult child be paid to care for a parent in Maryland?
An adult child may be possible in an approved self-directed arrangement, but it is not automatic. The senior must qualify, the worker must be approved, and the plan must authorize the tasks and hours.
Does the senior need Medicaid?
Usually, yes for the main paid-family-caregiver routes in this guide. Maryland says CPAS and Community First Choice require full Medicaid, while waiver and transition programs use their own Medicaid financial and medical rules.
How much can a family caregiver be paid in Maryland?
There is no single statewide take-home wage. Maryland’s approved CPAS self-direction option allows a self-directing participant to set a personal assistance provider rate, but the approved service plan, budget, payroll setup, and program rules still control what can be paid.
What is the best first call?
Call Maryland Access Point at 1-844-627-5465. Ask for long-term services screening and say that the family wants to know whether a specific relative can be an approved paid personal assistance worker.
About This Guide
Sources
This guide uses official federal, state, local, and other high-trust nonprofit and community sources linked in the article.
Editorial note
This guide is produced under the GFS Editorial Standards using official and other high-trust sources. GFS is not affiliated with a government agency and is not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Corrections
Despite careful verification, errors may occur. Email info@grantsforseniors.org with corrections.
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, funding, and availability can change. Readers should confirm current details directly with the responsible official program before acting.
Last updated: 14 September 2026 · Next review: 14 January 2027
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