You can get paid to care for a family member in Maryland by enrolling that person in a Medicaid self-directed program — most often Community Personal Assistance Services, Community First Choice, or the Home and Community-Based Options Waiver — and having them hire you as their caregiver through the state’s payroll agent. Veterans’ families have a separate path through the VA. The mechanics are the same across programs: your loved one is the “employer,” you’re the worker, and a Financial Management and Counseling Services (FMCS) provider handles the paychecks and payroll taxes.
The rest of this article walks through which program fits, who qualifies, how to apply, and the two things families most often get wrong: the personal care agreement and the tax treatment of what you earn.
Which Maryland Program Fits Your Situation
Maryland runs three Medicaid programs that pay family caregivers, plus federal options for veterans. They cover different populations and have very different wait times.
Community Personal Assistance Services (CPAS) is a Medicaid State Plan benefit covering personal assistance in the home for people who are chronically ill, elderly, or living with a disability. Under the self-directed option, the recipient chooses their own caregiver, and qualifying family members can be hired.1Maryland Department of Health. Personal Support Services and Personal Assistance Because CPAS is a state plan service rather than a waiver, it has no waiting list.
Community First Choice (CFC) is also a state plan benefit. It funds personal assistance, assistive technology, home-delivered meals, and transition support to keep people out of institutions.2Maryland Department of Health. Community First Choice Program Enrollment is not capped.
Home and Community-Based Options Waiver (HCBOW) serves adults 65 and older and people with physical disabilities ages 18 through 64 who need a nursing-facility level of care. It covers a broader menu — assisted living, medical day care, respite, case management, family training, and nutritional counseling — and its self-direction option lets participants hire family caregivers.3Medicaid. Maryland Section 1115 Demonstration and Waiver List Waiver slots are limited, and Maryland has historically maintained registries with significant wait times.4Maryland Department of Health. Waiver Programs – Waitlist and Registry Reduction (End the Wait Act) If your family member fits both CPAS/CFC and HCBOW criteria, the state plan programs will usually get you paid faster.
If the person you care for is a veteran, two federal options may apply. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to a designated primary family caregiver, calculated from the federal GS-4, Step 1 salary for the veteran’s locality pay area.5Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers (PCAFC) Monthly Stipend Fact Sheet Level One caregivers receive 62.5% of that monthly figure; Level Two caregivers receive 100%. Eligible primary caregivers also get CHAMPVA health coverage, mental health counseling, and respite. Veteran-Directed Care takes a different approach: the veteran receives a flexible budget and hires family members at an agreed-upon rate.6U.S. Department of Veterans Affairs. Caregiver Support
Who Qualifies
Both people — the one receiving care and the one being paid — have to meet requirements.
The Care Recipient
Medically, the recipient needs a documented need for ongoing help. For HCBOW, that means meeting a nursing-facility level of care. A nurse or social worker conducts an in-home assessment covering activities of daily living (bathing, dressing, eating, transferring) and instrumental activities (cooking, medication management, transportation to appointments).
Financially, Maryland’s HCBS waiver programs in 2026 set a $2,500 asset limit for a single applicant.7Maryland Department of Health. Income and Asset Limits by Coverage Group and Program The income limit is 300% of the federal SSI benefit rate; with the 2026 SSI individual rate at $994 per month, that puts the ceiling at $2,982 per month.8Social Security Administration. SSI Federal Payment Amounts for 2026 A primary home and one vehicle are typically excluded. If your family member already receives SSI or Medicaid, a streamlined pathway may apply.
You, the Caregiver
You need to be an adult, pass a criminal background check, and be physically and mentally able to do the work. Adult children are commonly eligible under self-direction. Spouse eligibility varies by program, so confirm with your program coordinator before assuming a spouse can be paid. Legal guardians and other relatives may qualify depending on the program.
How to Apply and Get Set Up as the Paid Caregiver
The starting point is Maryland Access Point (MAP), which routes older adults, people with disabilities, and their caregivers to the right programs. Call 1-844-627-5465 or use the MAP website.9Maryland Department of Aging. Maryland Access Point You can also contact your local Department of Social Services directly.
A nurse or social worker will then schedule an in-home assessment. That assessment drives the individualized service plan — the document that specifies which tasks you’ll perform, how many hours per week, and at what rate.
Gather the paperwork in parallel:
- For the care recipient: medical records supporting the need for care, financial statements, proof of Maryland residency, and identification.
- For you: government-issued ID, Social Security number, and consent for a background check.
The formal application is the Long-Term Care/Waiver Medical Assistance Application, filed with the local Department of Social Services.10Maryland Department of Human Services. Long-Term Care/Waiver Medical Assistance Application If the recipient already receives SSI, use the streamlined version.11Maryland Department of Human Resources / Maryland Department of Health and Mental Hygiene. SSI Recipient/Community-Eligible Long-Term Care/Waiver Medical Assistance Application Respond quickly to any request for follow-up documentation; delays here stall everything downstream. For waiver programs, expect the possibility of a registry period before services begin.
Once eligibility is confirmed, self-direction is the mechanism that puts you on payroll. Your family member (or an authorized representative) acts as the employer, chooses you, and sets your schedule. A Financial Management and Counseling Services (FMCS) provider — the state’s payroll agent — verifies you meet program requirements, processes your paychecks, tracks the budget, and files employment taxes.12Maryland Department of Health. Financial Management and Counseling Services (FMCS) A support planner or case manager builds the service plan and budget that the FMCS pays against.
Put a Personal Care Agreement in Writing Before Any Money Changes Hands
If you are being paid by your family member outside of a Medicaid program, or alongside one, a written personal care agreement is not optional. It is the single most overlooked step in family caregiving, and skipping it can be devastating.
Medicaid has a five-year lookback period. When someone applies for Medicaid long-term care benefits, the state reviews five years of financial records for gifts or transfers made below fair market value. Payments to a family caregiver without a formal agreement can be treated as prohibited transfers, triggering a penalty period during which your family member is ineligible for benefits. This is one of the most common causes of Medicaid penalties for families.
A defensible agreement should spell out:
- The date caregiving services begin.
- The specific tasks you’ll perform: personal care, meal preparation, transportation, housekeeping, and so on.
- The schedule — hours per week and which days.
- An hourly rate that’s reasonable for your area. Inflated rates raise red flags in a Medicaid review.
- Payment by check or electronic transfer. Cash payments are nearly impossible to verify later.
Keep a log of every shift, tasks performed, and hours worked, and issue written invoices that match the agreement. An elder law attorney can draft an agreement that complies with Maryland Medicaid rules; the legal fee is small next to the cost of a penalty period.
Pay, Overtime, and Electronic Visit Verification
What you earn depends on the program, your location, and the complexity of care. Maryland’s statewide minimum wage is $15 per hour, with some counties setting higher local minimums.13Maryland Department of Labor. Maryland Minimum Wage and Overtime Law Medicaid-funded caregiver rates typically land between $15 and $20 per hour, paid through the FMCS on a regular payroll schedule, usually biweekly.
Federal overtime rules cover home care workers. If you work more than 40 hours in a week and don’t live in the care recipient’s home, you’re entitled to time-and-a-half for the extra hours. Live-in caregivers are still owed overtime, but at their regular hourly rate.
Expect to clock in and out electronically. Maryland uses LTSSMaryland to satisfy the federal Electronic Visit Verification requirement under the 21st Century Cures Act, which forces states to electronically verify Medicaid-funded personal care and home health visits.14Medicaid.gov. EVV Requirements in the 21st Century Cures Act The system records the time, date, and location of each visit, and it applies to self-directed services as well as agency care.15Maryland Department of Health. Electronic Visit Verification (EVV) Your FMCS or agency will train you on it at onboarding.
Training You’ll Need
Maryland does not set a specific number of training hours for personal care aides in Medicaid-reimbursed programs, but agencies must verify competency in seven areas under the supervision of a registered nurse.16PHI. Personal Care Aide Training Requirements Individual programs sometimes add CPR and first aid, or specialized training for conditions like dementia. If you’re classified as a Home Health Aide, federal rules require at least 75 hours of initial training with a minimum of 16 hours of supervised practical training, plus annual continuing education.17eCFR. 42 CFR 484.80 – Condition of Participation
How Your Pay Is Taxed
Taxes are where most family caregivers either lose money they shouldn’t or get surprised by a bill they didn’t expect. The rules split by how you’re paid.
Medicaid Waiver Payments
Under IRS Notice 2014-7, Medicaid waiver payments you receive for caring for someone in your home are treated as “difficulty of care” payments and can be excluded from your gross income entirely.18Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income The care has to take place in the provider’s home. If you moved into your mother’s house to care for her and it’s now where you live, that counts as your home for purposes of the exclusion.19Internal Revenue Service. IRS Notice 2014-7 If you maintain a separate residence and travel to the care recipient’s home, the exclusion doesn’t apply and the payments are taxable income.
Social Security, Medicare, and Unemployment Taxes
Even when income tax doesn’t apply, employment taxes might. If your family member (or their representative) is your employer through self-direction, household employment tax rules kick in once your cash wages hit $3,000 in 2026. Above that threshold, your employer owes 6.2% for Social Security and 1.45% for Medicare on your wages, and you owe the same amounts from your paycheck. Federal unemployment tax (FUTA) applies if total cash wages to household employees exceed $1,000 in any calendar quarter.20Internal Revenue Service. Topic No. 756, Employment Taxes for Household Employees
Some family arrangements qualify for FICA exemptions. Domestic service performed by a parent working for their son or daughter is generally exempt, though the exemption disappears if the parent is caring for a grandchild under 18 in the home while the employer-child is a single parent or has a spouse incapable of providing care. Services performed by a child under 21 working for a parent in domestic service are also exempt.21Office of the Law Revision Counsel. 26 U.S. Code 3121 – Definitions These exceptions are narrow; don’t assume they apply without confirming your specific family structure.
If your paychecks come through an FMCS provider, they handle payroll tax withholding, filing, and reporting.12Maryland Department of Health. Financial Management and Counseling Services (FMCS) That’s one of the biggest practical advantages of self-direction over a private arrangement. If your family is paying you privately, your family member is the employer and should file Schedule H with their annual tax return to report household employment taxes.