To become a paid caregiver in Maryland, the person you care for first has to qualify for Maryland Medical Assistance and enroll in a home care program that lets them pick their own provider. Once that’s in place, you complete a background check, finish required training, submit tax and employment forms, and register as a provider through the state portal. A Financial Management Services agency then puts you on payroll. From first application to first paycheck is usually one to two months.
Who Qualifies to Be Paid
Maryland’s baseline rules are short. You must be at least 18, authorized to work in the United States, and able to pass a criminal background check.1Medicaid.gov. Maryland Community First Choice Eligibility Pathways You also need to be physically and mentally able to perform the tasks in the recipient’s care plan, which typically means hands-on help with bathing, dressing, eating, and similar daily activities.
Family members can usually be paid, with one important limit: a spouse cannot be paid to care for their spouse, and a parent cannot be paid to care for their own minor child. Maryland treats those duties as part of an existing legal obligation. Adult children caring for a parent, siblings, in-laws, grandchildren, and other relatives are typically eligible as long as they meet every other requirement.
A felony on your record does not automatically disqualify you. The Maryland Department of Health reviews positive background results case by case, weighing the nature of the offense, how long ago it occurred, and the type of care involved.2Maryland Department of Health. Criminal History Records Check If you have a history, gather court documents and any evidence of rehabilitation before applying so you can respond quickly if the state asks for more.
The Medicaid Program the Recipient Needs to Be In
Caregiver pay flows through the recipient’s enrollment, so the first real step is getting them into the right program. Maryland runs three main options, all of which include a self-directed model where the participant can hire and manage their own caregiver.
Community First Choice is the broadest. It covers attendant services at home, at work, or in other community settings for anyone who needs an institutional level of care but wants to stay out of a nursing facility. Assisted living is not included.3Maryland Department of Health. Community First Choice Program
The Community Options Waiver is a separate track for adults 18 and older who need a nursing facility level of care but can live safely in the community with support. Participants cannot be enrolled in another waiver program or PACE at the same time.4Maryland Department of Health. Community Options Waiver
The Increased Community Services Program is narrower. It is designed for people transitioning out of a nursing facility, and the recipient must have lived in a facility for at least six months and been Medicaid-eligible for at least 30 consecutive days.5Maryland Department of Health. Increased Community Services Program
On the money side, Maryland’s waiver programs cap monthly income at 300% of the SSI federal benefit rate. For 2026, that puts the income limit at $2,982 per month for an individual.6Social Security Administration. SSI Federal Payment Amounts for 2026 Countable assets cannot exceed $2,500 as of February 2026.7Maryland Department of Health. Income and Asset Limits by Coverage Group and Program There are exceptions to how income and assets are counted, so call Maryland Department of Human Services if the numbers are close.
Medically, the recipient has to be assessed with the interRAI Home Care tool and shown to need an institutional level of care, meaning they need hands-on help with multiple daily activities.1Medicaid.gov. Maryland Community First Choice Eligibility Pathways The state reassesses at least annually.
Training and Background Check
Every caregiver has to hold current First Aid and CPR certification. It cannot be completed entirely online. A hybrid course where you study materials online and then do a hands-on skills session in person is acceptable, but an online-only certificate does not count.1Medicaid.gov. Maryland Community First Choice Eligibility Pathways
Anything beyond that depends on the care plan. If the plan includes tasks a nurse would normally perform, such as administering medication or wound care, a registered nurse must train you on those specific tasks through a process called nurse delegation, and some delegated tasks require certification as a nursing assistant, medicine aide, or medication technician. The delegating nurse monitors your work at least every 45 days. The recipient (or their representative) can also require additional training tied to their own medical, behavioral, or communication needs.
Maryland also requires both a state and FBI criminal history records check, with fingerprints submitted for each. A mail-in state check runs about $18, the FBI check adds roughly $12, and in-person fingerprinting at a CJIS location carries a $20 service fee.8Maryland State Police. Fee Schedule – Licensing Division9Maryland Department of Health. Background Check Information Budget roughly $30 to $50 total.
Paperwork and Provider Enrollment
Most of what you’ll fill out is standard new-hire employment paperwork, routed through the Financial Management Services (FMS) agency that handles payroll for the self-directing participant. The FMS agency also handles tax withholding and buys the workers’ compensation insurance the law requires, so you do not need to purchase your own coverage.
Have these ready:
- Government-issued photo ID and your Social Security number.
- Form I-9, which every U.S. employer must complete; Section 1 has to be done no later than your first day of work.10U.S. Citizenship and Immigration Services. I-9 Employment Eligibility Verification
- Federal Form W-4 for federal income tax withholding.
- Maryland Form MW507 for state income tax withholding.11Comptroller of Maryland. 2026 MD Form MW507 Employee Withholding Exemption Certificate
- Medicaid provider enrollment forms linking you to the recipient. You’ll need their Medicaid ID number, and it has to appear consistently on every document.
Missing signatures and an inconsistent Medicaid ID number are the most common reasons new caregivers’ first payments stall. Check every field twice.
The enrollment itself goes through ePREP, the state’s Electronic Provider Revalidation and Enrollment Portal, where you upload your documents.12Maryland Department of Health. Provider Enrollment A paper application through your local Health Department or Area Agency on Aging is also an option.
One timing issue to plan around: Maryland Medicaid is replacing ePREP with a new system called MPRIME (Maryland Provider Registration and Information Management Enterprise) in October 2026, and the transition creates application freezes:13Maryland Department of Health. MPRIME
- July 1, 2026: new applications for moderate- and high-risk provider types go on hold and will be returned without processing.
- August 1, 2026: the hold extends to all provider types, including limited-risk categories.
- August and September 2026: training on the new portal.
- October 2026: MPRIME goes live and the holds end.
If you plan to enroll in mid-to-late 2026, submit before July 1 or expect to wait until October. Missing the window is not a denial, just a months-long delay before anyone looks at your file.
After the application goes in, a Supports Planner assesses the recipient’s home and finalizes the individualized care plan, which specifies how many hours a week you’re authorized to work and what services you can provide. Approval generally takes 30 to 60 days. No payments can be issued for any services you provide before the care plan is officially approved, so do not start billing hours early.
What You’ll Be Paid
Your pay depends on whether you work through a provider agency or under the self-directed model.
For agency employees, House Bill 1129 requires agencies participating in Community First Choice and Community Options to pay personal care aides at least $17 per hour starting July 1, 2026. The same legislation directs the Maryland Department of Health to report on steps needed to raise the floor to $20 per hour by October 2026.14Maryland General Assembly. House Bill 1129 – Maryland Medical Assistance Program – Provider Agencies – Wages and Leave for Personal Care Aides
Under the self-directed model, the participant and the caregiver negotiate an hourly rate within the recipient’s approved individual budget. The FMS agency handles payroll, withholding, and the employer-side costs. You’re paid only for hours documented and approved in the care plan, so the weekly hour cap matters as much as the rate.
Taxes: The Medicaid Waiver Payment Exclusion
This is the detail that most new family caregivers miss. Under IRS Notice 2014-7, Medicaid waiver payments for home care services can be excluded from your gross income entirely if the person you care for lives in your home.15Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income The IRS treats these as “difficulty of care” payments under Section 131 of the Internal Revenue Code, which are not subject to federal income tax.
The living arrangement is the hinge. The exclusion applies only when the care recipient lives in the caregiver’s home under the recipient’s plan of care. If you travel to the recipient’s home instead, the payments are taxable income.16Internal Revenue Service. Internal Revenue Bulletin 2014-4 If you qualify now but reported these payments as income in prior years, you can file amended returns.
You still need to complete the W-4 and MW507 at enrollment either way. If you expect to owe no Maryland tax because of the exclusion, you can claim exemption on the MW507, but talk to a tax professional first.
Logging Hours Once You Start
Once you’re enrolled and working, Maryland requires you to log every visit electronically through the LTSSMaryland EVV system.17Maryland Department of Health. LTSSMaryland Electronic Visit Verification Training EVV captures the type of service, who provided it, who received it, the date, the start and end times, and the location where the service was delivered. The system only records location at the start and end of a visit; it does not track your movements during the day.
In practice you clock in and out on a mobile app. If you don’t have a smartphone, interactive voice response using a landline or cell phone in the recipient’s home works as an alternative. Payment only goes out for pre-authorized hours that match the service plan, so missing or inconsistent EVV entries are the fastest way to have a paycheck delayed or denied. Build the clock-in habit from your first visit.
If You’re Denied
You can appeal if the state denies your enrollment or the recipient’s eligibility, or reduces the authorized hours. Maryland Medicaid provides a fair hearing process for anyone who believes a decision to deny, suspend, end, or reduce eligibility or services is wrong.18Maryland Department of Health. Medicaid – Appeal
For non-managed-care decisions, you have 90 days from the date on your notice to request a fair hearing. If you want services to continue unchanged while the appeal is pending, the deadline is much tighter: 10 calendar days from the notice date, the postmark, or the effective date of the action, whichever is later. For managed care denials, you file an internal appeal with the plan within 60 days first, then request a state fair hearing. Most appeals are not about outright disqualification; they’re about the recipient’s level of care assessment or the number of authorized hours. If the care plan understates what the recipient actually needs, the appeal is the tool to fix it.