Florida’s caregiver programs can pay a family member to provide in-home care, most often through Medicaid’s Statewide Medicaid Managed Care Long-Term Care program and its consumer-directed option, with smaller state-funded subsidies available for families who don’t meet Medicaid’s financial limits. Eligibility hinges on the person receiving care, not the caregiver: they must need hands-on daily help and, for Medicaid programs, have limited income and assets.1AHCA. Statewide Medicaid Managed Care Long-Term Care Program
Who Qualifies to Receive Care
Two tests apply. The person who needs care has to meet a medical standard, and for Medicaid-funded options they also have to meet a financial one.
The Medical Standard
Florida requires what it calls “nursing facility level of care.” In plain terms, the person needs regular help with basic daily tasks such as bathing, dressing, eating, toileting, or getting in and out of a bed or chair, at a level that would otherwise land them in a nursing home.2Florida Legislature. Florida Code 409.985 – CARES Program Someone doesn’t have to be bedridden. Daily supervision for cognitive decline counts. So does skilled help managing medications. A state assessment team called CARES makes the call.
The Financial Limits
For SMMC-LTC in 2026, a single applicant’s monthly income cannot exceed $2,982, which is 300% of the federal SSI benefit rate of $994 per month.3Social Security Administration. SSI Federal Payment Amounts for 2026 Countable assets are capped at $2,000, though the primary home and one vehicle don’t count.
Married couples get some breathing room. When one spouse applies and the other stays at home, the at-home spouse can keep up to $162,660 in assets under the community spouse resource allowance, plus a minimum monthly income allowance for living expenses.
Income above the $2,982 cap doesn’t automatically disqualify anyone. Florida allows a Qualified Income Trust, often called a Miller Trust, where the excess is deposited each month. Consistent deposits keep that money from counting against eligibility. The trust must be irrevocable, and whatever remains at the beneficiary’s death goes back to the state up to the total Medicaid benefits paid. An attorney can set one up, though the Department of Children and Families says professional help isn’t required.4Florida DCF. Qualified Income Trust Fact Sheet Miss one monthly deposit and Medicaid coverage can lapse for that month, so this account needs steady attention.
Getting Paid Through Consumer-Directed Care
SMMC-LTC delivers long-term care at home and in the community as an alternative to a nursing facility.1AHCA. Statewide Medicaid Managed Care Long-Term Care Program The program is administered by managed care organizations, and enrollees pick or are assigned a plan.
What matters for families is the Participant Directed Option, sometimes called Consumer Directed Care. The person receiving care becomes the employer. They choose the caregiver, set the schedule, and direct the work. That caregiver can be an adult child, a sibling, or another relative. The state doesn’t hand money to the caregiver directly. A fiscal employer agent holds the funds and cuts the paychecks, handling payroll behind the scenes.5Agency for Persons with Disabilities. Questions and Answers – Consumer Directed Care Plus
Pay in the consumer-directed model generally starts around $15 per hour for personal care and homemaker services, though the rate depends on the managed care plan and the service authorized. That is below the national private-pay average of roughly $17 per hour for home health aides, but it is meaningful money for a relative who would otherwise be providing the same care unpaid.
Can a Spouse Be Paid?
Yes, with conditions. Florida’s participant-directed option allows spouses and parents of minor children to serve as paid caregivers, but the care has to go beyond what would ordinarily be expected in that relationship. The managed care plan has to approve, the spouse has to pass a background check, and a formal work agreement has to be in place. Plans handle spouse caregiving differently, so ask the specific plan early.
Programs Outside Medicaid
Plenty of families don’t qualify for Medicaid. Florida runs several general-revenue programs for people with functional limitations regardless of Medicaid status. These are not entitlements, which means waiting lists are common.
Home Care for the Elderly
HCE is the program that pays a family caregiver directly, though the amount is modest. It provides a basic monthly subsidy of $160 to a qualified adult caregiver who lives with and cares for a person aged 60 or older.6Elder Affairs Florida. Home Care for the Elderly (HCE) Program The caregiver has to be at least 18, share the home, and accept responsibility for the elder’s physical, social, and emotional needs. This isn’t a wage. It’s a subsidy toward housing, food, clothing, and incidentals.
HCE can also authorize special subsidies for medical supplies, home accessibility modifications, or specialized equipment, as long as the cost isn’t already covered by Medicare, Medicaid, or other insurance. To qualify, the elder’s income must fall below the Institutional Care Program standard, and they must be at risk of nursing home placement.
Community Care for the Elderly
CCE serves functionally impaired people aged 60 and older with home-based services meant to delay nursing home placement.7Elder Affairs Florida. Community Care for the Elderly (CCE) Program It covers personal care, homemaker help, home-delivered meals, adult day care, emergency home repairs, and case management. CCE doesn’t typically pay family members. It funds professional services that supplement what family provides.
Respite Through the Alzheimer’s Disease Initiative
ADI covers respite care for caregivers of people 18 or older with Alzheimer’s or a related dementia. It comes as in-home care, facility-based care, emergency respite, or extended care up to 30 days.8Elder Affairs Florida. Alzheimer’s Disease Initiative (ADI) The program doesn’t pay the family caregiver. It pays for substitute care so the primary caregiver can take a break.
VA Aid and Attendance
Veterans and surviving spouses who need help with daily activities may qualify for the VA’s Aid and Attendance benefit, a monthly pension supplement. The VA doesn’t restrict how the money is spent, so recipients can pay a family member with it. Eligibility requires help with daily activities like bathing, dressing, and eating, or being housebound or in a nursing home due to disability, plus qualifying wartime service and income limits.9U.S. Department of Veterans Affairs. VA Aid and Attendance Benefits and Housebound Allowance
Background Screening Comes First
A family member hired through consumer-directed Medicaid cannot start paid work until they pass a Level 2 background screening, which is a state and national fingerprint-based criminal history check.10FLHealthSource. What Is a Level 2 Background Screening Florida Statute 435.04 lists the disqualifying offenses, including kidnapping, human trafficking, sexual offenses, abuse of a vulnerable adult, and other violent or exploitative felonies.11Florida Legislature. Florida Code 435.04 – Level 2 Screening Standards
Florida does not require certification or licensure for a family member providing personal care or homemaker services through the consumer-directed option. A signed work agreement between the care recipient and the caregiver has to be in place before any services begin. The managed care plan provides the paperwork and fingerprinting instructions. The screening usually takes a few weeks.
How Caregiver Pay Is Taxed
Medicaid waiver payments may be federally tax-free, but only under specific conditions. IRS Notice 2014-7 lets caregivers exclude payments from a state Medicaid home and community-based services waiver as “difficulty of care” income, so long as the caregiver provides care in their own home where the care recipient also lives.12Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income If the care recipient lives in a separate home, the exclusion doesn’t apply. Vacation pay from the state isn’t excludable either.
Employment tax is a separate question. When the care recipient is the employer, Social Security and Medicare taxes may not apply if the caregiver is the recipient’s spouse, a child under 21, or in certain cases a parent. Other family relationships generally face standard employment taxes. Caregivers treated as independent contractors face self-employment tax unless caregiving isn’t their regular trade or business.13Internal Revenue Service. Family Caregivers and Self-Employment Tax
State-funded program payments like the HCE subsidy may not automatically qualify for the Notice 2014-7 exclusion, which specifically covers Medicaid waiver payments. The IRS has said whether other state program payments can be excluded “will depend on the nature of the payments and the purpose and design of the program.” A tax professional is worth the appointment before filing.
How to Apply
Almost every long-term care program in Florida runs through a single point of entry: the Aging and Disability Resource Center, operated by one of 11 Area Agencies on Aging. The statewide Elder Helpline at 1-800-963-5337 will connect you to the center for your area.14Elder Affairs Florida. Aging and Disability Resource Centers (ADRCs) Staff there screen the care recipient, explain which programs might fit, and start the application.
The CARES Assessment
For Medicaid programs, the medical determination is next. The Comprehensive Assessment and Review for Long-Term Care Services team evaluates the type and frequency of care the person needs and whether that care requires supervision by a nurse or other health professional.2Florida Legislature. Florida Code 409.985 – CARES Program If home-based care is appropriate, the person is recommended for community placement instead of a nursing facility.
Financial Verification and Plan Enrollment
Financial eligibility runs through the Department of Children and Families, which verifies income, assets, and whether a Miller Trust is needed. Both the CARES medical determination and the DCF financial approval have to be complete before enrollment. Once approved, the applicant picks or is assigned to a managed care plan under SMMC-LTC. The plan develops a care plan, authorizes service hours, and walks the family through consumer-directed care if they want to hire a relative.
State-funded programs like CCE and HCE go through the Area Agency on Aging for both the needs assessment and program placement. Because these programs run on limited general revenue, placement depends on open slots. Applicants get priority based on nursing home risk, severity of functional limitations, and whether the current caregiver is in crisis.
If You Are Denied
A denial or reduction in Medicaid services can be appealed through a fair hearing. The deadline is 90 days from the date on the Notice of Case Action.15Florida DCF. Appeal Hearings Filing before the effective date of the reduction may keep benefits in place at the current level while the appeal moves through.
For fights over service hours, care plan disagreements, or issues with a managed care organization, start with the plan’s internal grievance process. If that doesn’t resolve it, the Florida Long-Term Care Ombudsman Program can investigate and advocate on the care recipient’s behalf, with authority to pursue administrative and legal remedies. Reach the Ombudsman through the Elder Helpline at 1-800-963-5337.