To become a paid caregiver in Maryland, you work through one of the state’s Medicaid self-directed care programs: the person you’ll care for enrolls in the program, hires you as their employee, and a state-approved payroll company pays your wages and handles taxes. You’ll need to be at least 18, legally authorized to work in the U.S., and cleared through a criminal background check. From the day the care recipient applies, expect 45 to 90 days before the first paycheck.
Step 1: Get the Person You’ll Care For Enrolled
You can’t be paid until the care recipient is approved for a program that allows self-directed services. Maryland’s main options are Community First Choice, which is the broadest and covers personal assistance and health-related tasks; the Community Options Waiver, for people who medically qualify for a nursing home but want to stay home; and Increased Community Services, for people whose income is too high for the waiver or who are moving out of a nursing facility after at least six months there.1Maryland Department of Health. Community Options Waiver2Maryland Department of Health. Increased Community Services Program Veterans enrolled in VA health care have a separate path called Veteran Directed Care, which runs through the VA rather than Maryland Medicaid and has its own eligibility rules.3U.S. Department of Veterans Affairs. Veteran-Directed Care – Geriatrics and Extended Care
Whichever program fits, the recipient has to meet three tests. Medically, they need a nursing-facility level of care, meaning regular help with things like eating, bathing, dressing, toileting, or moving around.4Maryland Department of Health. Am I Eligible for Medicaid? Financially, as of February 1, 2026, the countable asset limit for adults 65 or older, blind, disabled, or enrolled in a home and community-based services program is $2,500 for an individual and $3,000 for a couple.5Maryland Department of Health. Income Limits Income limits vary by program.
How the Recipient Applies
Adults aged 20 to 64 can apply online through the Maryland Health Connection, by phone at 1-855-642-8572, or in person at a local health department or Department of Social Services office.6Maryland Department of Health. How to Apply Seniors and people with disabilities outside those categories can mail an application to their local Department of Social Services, and Area Agencies on Aging will help walk them through it.7Maryland Health Connection. How to Enroll in Medicaid
Have the supporting documents ready before you file: a physician’s report or History and Physical documenting the medical need, bank statements to verify assets, and recent tax returns or pay information. Incomplete applications are the biggest source of delay.
The Home Assessment
Once the application is in, a registered nurse from the local health department comes to the home. The nurse confirms the medical picture, checks that the home can support self-directed care, and builds a personalized plan of care.8Maryland Department of Health. Assessment, Evaluation and Review Services That assessment sets the number of paid care hours authorized, which is the same number of hours you’ll be able to bill.
Plan for 45 to 90 days from application to approval. Use the wait to get your own paperwork in order.
Step 2: Meet the Caregiver Requirements
The bar to work as a paid caregiver under these programs is lower than most people expect. You don’t need a nursing license, a certificate, or a degree to provide personal assistance.
Age and Work Authorization
You must be at least 18 and legally authorized to work in the United States. When you’re hired, the care recipient or the payroll company will complete a Form I-9. You’ll need either one document from federal List A (a U.S. passport, for example) or a combination of one List B document (like a driver’s license) and one List C document (like a Social Security card).
Criminal Background Check
Maryland requires criminal history records checks on all direct service workers providing personal assistance, under Health-General Article, Title 19, Subtitle 19 of the Annotated Code of Maryland.9Maryland Department of Health. COMAR 10.09.20 Community Personal Assistance Services Fingerprint-based checks through Maryland’s Criminal Justice Information System run roughly $57, though the exact fee varies by program. Budget for the cost and allow time for processing before your start date.
Family Members: Who Can Be Paid
Most family members can be paid caregivers under Community First Choice; federal rules let the participant set the qualifications and hire relatives who meet them.10Medicaid.gov. Community First Choice State Plan Option Technical Guide The one firm limit: the person acting as the participant’s designated representative — signing the service plan, serving as legal guardian, or otherwise making care decisions for them — cannot also be the paid caregiver.11Code of Maryland Regulations (eLaws). COMAR 10.09.20.05 Specific Conditions for Provider Participation – Personal Assistance Under COMAR 10.09.20, “representative” covers legal guardians, parents or foster parents of minor children, and anyone making service-plan decisions on the participant’s behalf.9Maryland Department of Health. COMAR 10.09.20 Community Personal Assistance Services
Under the Developmental Disabilities Administration waivers, spouses and legally responsible individuals are generally excluded from paid personal supports, respite, and similar services. If you’re a spouse or legal guardian, confirm the rules with the specific program before you count on being paid.
Training
There is no single required course. Federal rules give the care recipient the right to train you on the specific tasks they need help with and to set whatever qualifications they think necessary.12eCFR. Subpart K – Home and Community-Based Attendant Services and Supports State Plan Option (Community First Choice) One exception: if the care plan calls for administering medications, you’ll need to become a certified medication technician.
Step 3: Get Hired and Paid Through the Payroll Company
Once the recipient is approved, they hire you as their employee. You don’t receive a personal check from them. Every payment runs through a Financial Management and Counseling Services (FMCS) provider, a state-approved payroll company that handles wages, tax withholding, and employment paperwork. The FMCS provider also verifies you meet all qualifications before releasing your first paycheck and tracks spending against the recipient’s approved budget.
You submit a timesheet every two weeks through the FMCS provider’s system. Each timesheet lists the dates worked, start and end times for each shift, and a checklist of the tasks you completed. The care recipient (or their designated representative) reviews and approves it before payment is processed.13Maryland Department of Health. DDA Self-Directed Services Manual Taxes come out based on the withholding forms you complete at onboarding.
Maryland’s minimum wage is $15.00 per hour, which sets the floor for your pay. The actual rate depends on the recipient’s approved budget and what the two of you negotiate.
Taxes You Should Know About
Because the care recipient is your employer under this model, household employment tax rules apply. The FMCS provider handles most of the mechanics, but a few points affect your bottom line.
If you earn $3,000 or more in cash wages from one household employer in 2026, Social Security tax (6.2%) and Medicare tax (1.45%) are withheld from your pay, with the employer paying a matching share. Wages paid to a spouse, a child under 21, or a parent are generally exempt from these taxes.14Internal Revenue Service. Topic No. 756, Employment Taxes for Household Employees Federal unemployment tax kicks in on the employer’s side if they pay $1,000 or more in cash wages in any quarter, and wages to a spouse, child under 21, or parent don’t count toward that threshold either.15Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
The biggest tax break is for live-in caregivers. Under IRS Notice 2014-7, Medicaid waiver payments to a caregiver who lives in the same home as the care recipient are treated as “difficulty of care” payments under Section 131 of the Internal Revenue Code and can be excluded from federal gross income.16Internal Revenue Service. Notice 2014-7 It applies whether or not you’re related to the person you care for. The exclusion covers up to five people age 19 or older (or ten under age 19) at any one time. If you live with the person you care for, ask the FMCS provider or a tax preparer how to report it on your return.
Your Wage and Hour Protections
Paid caregivers are covered by the Fair Labor Standards Act. You’re entitled to at least the minimum wage for every hour worked, and Maryland’s $15.00 rate is the effective floor. Overtime rules depend on whether you live with the person you care for. Live-in caregivers who reside permanently in the recipient’s home are exempt from overtime but must still receive minimum wage for all hours worked.17U.S. Department of Labor. Fact Sheet: Application of the Fair Labor Standards Act to Domestic Service, Final Rule If you don’t live with the recipient, you’re entitled to overtime at 1.5 times your regular rate for hours over 40 in a workweek. The live-in exemption applies only because the care recipient is your direct employer under Maryland’s self-directed programs; if a third-party staffing agency employs you instead, they must pay overtime no matter where you live.
What Counts as Fraud
Falsifying records to obtain Medicaid benefits carries criminal liability for both caregivers and care recipients. If fraud involves less than $500 in services or payments, it’s a misdemeanor with fines up to $50,000 and up to three years in prison. At $500 or more, it becomes a felony with fines up to $100,000 and up to five years in prison. Fraud that causes serious bodily injury carries up to 20 years; fraud causing a death can carry life imprisonment. Courts can also order full restitution.18msa.maryland.gov. 2000 Laws of Maryland Ch. 259
The scenarios that get people in trouble are inflating hours on timesheets, billing for services never provided, and misstating the recipient’s medical or financial status. The FMCS verification process is designed to catch these, and program spending is audited. Record only the time you actually worked, and describe the tasks accurately.