Key takeaway
Maryland’s Medicaid programs (CFC, CPAS, and CO Waiver) with self‑direction are the main paths to pay family caregivers; PFMLI will add wage replacement starting 2026.
- CFC & CPAS: Personal assistance with self‑direction to hire certain family (not spouses/legal guardians).
- CO Waiver: Helps seniors/disabled remain at home; some family caregivers can be hired.
- PFMLI: Partial wage replacement for family caregiving leave (benefits slated for 2026).
- Veterans: PCAFC and Aid & Attendance provide additional financial support.
Overview
Family caregivers in Maryland can be compensated through Medicaid programs that support in‑home care and through federal veterans’ benefits. Self‑directed services provide flexibility to hire and manage certain relatives as caregivers.
Programs that pay family caregivers in Maryland
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Community First Choice (CFC) (Medicaid) | Medicaid‑eligible; needs assistance with ADLs. | Self‑directed option can hire certain family members (not spouses/legal guardians); state‑set rates. |
| Community Personal Assistance Services (CPAS) (Medicaid) | Medicaid‑eligible with documented need; not nursing home level of care. | Allows certain family caregivers via self‑direction; excludes spouses/legal guardians. |
| Home & Community‑Based Options Waiver (CO Waiver) (Medicaid HCBS Waiver) | Medicaid‑eligible and needs nursing‑home level of care. | Can hire some family caregivers via self‑direction; availability may be limited by slots. |
| Self‑Directed Services (Medicaid self‑direction) | Enrollment in eligible Medicaid programs (e.g., CFC/CPAS/CO). | Lets participants hire, train, and schedule caregivers; payroll handled by a fiscal intermediary. |
| PFMLI (2026) (State wage benefit) | Workers covered by Maryland PFMLI. | Partial wage replacement during caregiving leave (when active). |
| Veterans Programs (PCAFC, A&A) (Federal) | Eligible veterans; program‑specific criteria apply. | PCAFC provides a stipend/training; A&A increases pension for those needing ADL help. |
| Private Pay / Long‑Term Care Insurance (Private) | Policy or private agreement. | Some LTC policies reimburse family caregiving; otherwise use a written caregiver agreement. |
Maryland Medicaid: CFC, CPAS, and CO Waiver
Maryland delivers in‑home personal assistance through CFC and CPAS, and offers broader supports under the CO Waiver. Self‑direction in these programs enables hiring certain family members.
Community First Choice (CFC)
Personal assistance and supports for ADLs; eligibility requires Medicaid and ADL need; family caregivers allowed via self‑direction (not spouses/legal guardians).
Community Personal Assistance Services (CPAS)
For those not requiring nursing‑home level care; allows certain family caregivers via self‑direction.
CO Waiver
For seniors/disabled at nursing‑home level of care; supports aging at home and can pay family caregivers through self‑direction when available.
Caregiver supports (Maryland Department of Aging & AAAs)
Local AAAs provide respite, training, and navigation to Medicaid programs and veterans’ benefits.
Short‑term relief and skills resources for caregivers.
Get assistance finding the right Medicaid program and completing enrollment.
Who qualifies
- Family caregivers of older adults or people with disabilities; availability varies by county and funding.
Veterans’ programs
Veterans can apply for A&A and PCAFC to support family caregiving in the home.
Aid & Attendance Pension
Increases a veteran’s pension to offset care costs (including family‑provided care).
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Monthly stipend, training, and supports to a primary family caregiver.
Private pay and long‑term care insurance
If public programs do not apply, families can use private caregiver agreements or long‑term care insurance benefits when policies allow family caregiving.
What to check in the policy
- Confirm policy covers in‑home personal care and whether benefits pay the policyholder.
How to apply in Maryland (step-by-step)
- Choose the path: CFC, CPAS, CO Waiver, self‑direction, PFMLI (when active), VA programs, or AAA supports.
- Gather documents: ID, Medicaid status, medical records, and provider contacts; income/assets if requested.
- Start with the right agency:
- CFC/CPAS: apply through Maryland Medicaid and complete assessments.
- CO Waiver: apply with Maryland Medicaid; note possible waitlists.
- Self‑direction: ask your case manager about hiring a family caregiver and fiscal intermediary setup.
- PFMLI: check Maryland Dept. of Labor for program timelines and application (2026 benefits).
- Veterans: apply via the VA Caregiver Support Program.
- AAAs: use Maryland Aging Services to find your local AAA for respite/support.
- Complete functional and financial assessments as required.
- If allowed, designate your family caregiver; complete enrollment/orientation and payroll setup.
- Begin services; track hours/claims and maintain documentation for renewals and audits.
Maryland paid caregiver FAQs
Can a spouse be paid as a caregiver in Maryland?
Generally no under Medicaid self‑direction; other relatives may be eligible depending on program rules.
What is the difference between CFC and CPAS?
Both provide personal assistance; CPAS is for those not at nursing‑home level of care, while CFC supports ADLs and certain supports with broader scope.
Is there paid family leave in Maryland?
PFMLI will provide partial wage replacement starting in 2026; check the Maryland Dept. of Labor site for updates.
