Key takeaway
Maine pays family caregivers through MaineCare (the state's Medicaid program), most commonly the Section 19 Home and Community Benefits Waiver and Section 21 Comprehensive Waiver, combined with Consumer-Directed Attendant Services.
- Section 19 Waiver: For Maine residents 18+ needing nursing-facility level care; pays family caregivers under consumer direction.
- Section 21 Waiver: For Mainers with intellectual or developmental disabilities; family caregivers can be paid in many cases.
- Consumer-Directed Attendant Services: Pays a family member (not a spouse or legal guardian).
- Veterans: Aid & Attendance and Veteran Directed Care can pay family, including spouses under VDC.
Overview
Maine's Medicaid program (MaineCare) is administered by the Department of Health and Human Services (DHHS), with long-term services overseen by the Office of Aging and Disability Services (OADS). Paid family caregiving in Maine runs primarily through MaineCare HCBS waivers. Section 19 (Home and Community Benefits for the Elderly and for Adults with Disabilities) serves adults who would otherwise need nursing-facility care. Sections 21 and 29 serve Mainers with intellectual or developmental disabilities.
Consumer-Directed Attendant Services lets the care recipient hire and supervise their own attendant, including many family members. Spouses, legal guardians, and parents of minors are generally excluded from being paid under MaineCare. Veterans and surviving spouses have separate VA pathways, including Veteran Directed Care which is the only program that can pay a spouse. The Maine ADRC line (211 Maine and Aging and Disability Mainers) helps families identify the right path.
Programs that pay family caregivers in Maine
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Section 19 Waiver (MaineCare 1915(c) waiver) | Maine residents 18+ who need a nursing-facility level of care and meet MaineCare financial limits. | Funds Consumer-Directed Attendant Services that can pay family caregivers; spouses, legal guardians, and parents of minors are excluded. |
| Section 21 Waiver (MaineCare 1915(c) waiver) | Mainers with an intellectual disability or autism who meet ICF/IID level of care; comprehensive supports. | Pays family caregivers as Direct Support Professionals or shared living providers, subject to waiver rules. |
| Section 29 Waiver (MaineCare 1915(c) waiver) | Mainers with intellectual disability or autism needing community-based support services. | Community-based support that can be delivered by family caregivers under waiver rules. |
| Section 12 Home and Community Benefits (MaineCare 1915(c) waiver) | Mainers with brain injury who would otherwise need nursing-facility care. | Personal care and home support services that can be delivered by qualifying family caregivers. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with daily activities and meets VA pension rules. | Increases the veteran's pension to cover care costs; can pay adult children and relatives. Spouses are not paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veterans in VA health care needing nursing-home level care, living in a participating VAMC area. | Monthly care budget the veteran manages to hire caregivers, including spouses. |
MaineCare programs
MaineCare funds paid family caregiving through HCBS waivers organized by "sections" of MaineCare policy. Section 19 covers older adults and adults with physical disabilities. Sections 21 and 29 serve Mainers with intellectual or developmental disabilities. Section 12 covers brain injury. Consumer-Directed Attendant Services is the mechanism that pays a family caregiver under Section 19.
Section 19: Home and Community Benefits Waiver
Section 19 serves adults 18 and older who would otherwise need nursing-facility care. It funds personal care, home support, respite, environmental modifications, and Consumer-Directed Attendant Services.
- Care recipient must be 18+ and meet nursing-facility level of care.
- MaineCare financial eligibility applies (income and asset limits).
- Consumer-Directed Attendant Services lets the participant hire a family member.
- Spouses, legal guardians, and parents of minors are excluded from being paid.
Section 21: Comprehensive Waiver for Adults with Intellectual Disability or Autism
Section 21 is Maine's comprehensive waiver for adults with intellectual disability or autism. It funds a broad set of community-based supports, including shared living and Direct Support Professional services that family members can provide.
- For Mainers with an intellectual disability or autism meeting ICF/IID level of care.
- Family members can serve as paid Direct Support Professionals or as shared living providers.
- Section 21 has historically had a waitlist; ask OADS about current capacity.
Section 29: Support Services Waiver
Section 29 is a less intensive option for Mainers with intellectual disability or autism. It funds community-based support services that can be delivered by family caregivers under waiver rules.
- Lower-intensity supports than Section 21.
- Family caregivers may provide community supports as qualifying Direct Support Professionals.
- Used as a step-up or alternative to Section 21.
Maine Area Agencies on Aging and OADS supports
Outside of MaineCare, Maine's five Area Agencies on Aging and the Office of Aging and Disability Services coordinate caregiver supports under the Older Americans Act and state-funded programs. These rarely replace a full caregiver wage but offset the cost of providing care.
Counseling, training, respite vouchers, and supplemental supports for unpaid family caregivers of older adults.
A Maine state-funded option that can provide some in-home support when the participant is not MaineCare-eligible; availability and amounts vary.
Who qualifies
- Family caregivers of adults 60+ or of any age with Alzheimer's/related dementia.
- Mainers who do not qualify for MaineCare but need limited in-home support.
- Availability and stipend amounts vary by AAA and funding year.
Veterans' programs
Maine veterans and surviving spouses can fund in-home care through VA benefits. VA Maine Healthcare System (Togus VA Medical Center) coordinates the Caregiver Support Program, and Veteran Directed Care is available in participating service areas.
Aid & Attendance Pension
A&A increases a qualifying veteran's or surviving spouse's pension to cover care costs when help with daily activities is needed. The veteran can use the boost to compensate a family caregiver.
- Wartime service, ADL need, and income/asset limits required.
- Commonly used to pay adult children and other relatives.
- Spouses cannot be paid directly through A&A.
Veteran Directed Care (VDC)
VDC provides a flexible monthly care budget the veteran manages with help from a financial management service. It is the only VA path that can pay a spouse.
- For veterans meeting nursing-home level of care in VA health care.
- Family caregivers, including spouses, can be hired.
- Availability depends on Togus VAMC and CBOC participation.
Long-term care insurance
A qualifying long-term care insurance policy may pay benefits used to compensate a family caregiver depending on policy terms.
What to check in the policy
- Policy must cover in-home personal care, not just nursing-facility care.
- Cash/indemnity policies that pay the policyholder directly are the most flexible.
If the policy only reimburses licensed agencies, families sometimes have the caregiver hired through a licensed Maine home care agency so the insurer will pay.
How to apply in Maine (step-by-step)
- Identify the path: Section 19 (adults), Sections 21 or 29 (ID/autism), Section 12 (brain injury), VA benefits, or LTC insurance.
- Gather documents: ID, proof of Maine residency, income/asset records, medical history, and (for veterans) DD-214.
- Contact the right agency:
- Section 19: contact the Maine Office of Aging and Disability Services (OADS) or call your local Aging and Disability Resource Center via 211 Maine for an HCBS assessment.
- Sections 21 or 29: contact OADS Developmental Services or your local case management agency.
- AAA supports: call your local Maine Area Agency on Aging for caregiver training and respite.
- VA paths: speak with a VA social worker at the Togus VAMC about A&A and VDC.
- Complete a level-of-care assessment and a MaineCare financial review.
- Choose Consumer-Directed Attendant Services and identify your family caregiver; enroll with the financial management service for payroll.
- Begin services; submit timesheets and care notes; renew annually.
Maine paid caregiver FAQs
Can a spouse be paid as a caregiver in Maine?
No under MaineCare Section 19 Consumer-Directed Attendant Services or Sections 21/29. A spouse can be paid as a caregiver under VA Veteran Directed Care when the veteran qualifies.
How much do caregivers get paid in Maine?
Consumer-Directed Attendant Services wages under Section 19 typically fall in the range of about $15 to $20 per hour, set within MaineCare rate guidelines.
Can I be paid to care for my parent in Maine?
Yes. Adult children are commonly paid as Consumer-Directed attendants under Section 19, or as Direct Support Professionals under Section 21. VA A&A and VDC also allow paying adult children.
What are Sections 19, 21, and 29 in MaineCare?
These are sections of MaineCare policy that authorize specific HCBS waivers. Section 19 covers adults needing nursing-facility level of care. Sections 21 and 29 cover Mainers with intellectual disability or autism (Section 21 is comprehensive; Section 29 is lower-intensity support).
How long does Section 19 take to approve in Maine?
Once you contact OADS and complete the assessment, enrollment typically takes several weeks. Slot availability and MaineCare financial eligibility can add time, so it is worth checking on current capacity.
