Medicaid's 'Cash and Counseling' Allows Pay for Family Caregivers


Cash and Counseling (also referred to as consumer directed care or self-directed services) allows people who are eligible for Medicaid to manage their health care budget, decide which products and services they wish to receive, and how they receive them. This is a useful alternative to the traditional approach in which agencies manage the provision of personal assistance products and services.

Patients are generally able to hire whomever they choose to provide their care. This program benefits both Medicaid recipients who need care and family caregivers who would otherwise be providing services without pay. The patients are able to remain in their own home or community rather than transitioning to assisted living or other long-term care facilities, while a relative or friend can provide loving care and still manage to bring in some money. This is vitally important since many family caregivers find themselves cutting back on hours at work or quitting entirely in order to provide care for a loved one. These difficult choices have a serious financial impact on multiple generations within these families.

These services are part of the elder's authorized Medicaid care plan and paid for by the state. This means that relatives, adult children, in-laws, grandchildren, or a close friend could be hired and paid for the care they provide. However, spouses are excluded from this program. In other words, family members could become paid caregivers.

Funds received through cash and counseling programs can also be used to purchase items related to the patient’s activities of daily living (ADLs). This could include cleaning services, meal preparation or delivery, laundry services, and transportation for medical appointments.

Eligibility requirements for Medicaid programs vary from state to state. Therefore, each state’s qualifications for individual cash and counseling programs vary as well. Generally, in order to qualify a person must:

  • Be a legal resident in the state where they are applying for benefits;
  • Qualify for their state’s Medicaid program (this includes meeting strict financial requirements);
  • Be at least 65 years of age, blind or disabled; and
  • Require nursing facility level of care (typically, assistance with two or more activities of daily living).

After meeting the requirements for a state’s Medicaid program and its version of patient-managed care benefits, the applicant’s needs will be thoroughly evaluated.

  • An in-depth assessment of the applicant’s needs is conducted with the assistance of their caregiver and the expert authority of their physician.
  • After establishing the specific types of assistance that are medically necessary for the applicant, the physician will create a personalized care plan estimating the amount of care needed. This is usually calculate in hours per week or hours per month.
  • Using this care plan, hourly estimate and the average care costs in the state, a monthly monetary allowance is determined. This care budget can be used to purchase approved care services and products related to daily living.
  • Some states have additional requirements that selected caregivers must meet as well. For example, a family member or friend who is providing care may have to register as a licensed care provider, undergo a background check, and/or be subject to payroll taxes.

For more details on your state's Medicaid program and available consumer-directed options, contact your local Area Agency on Aging.

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thanks for the info carol. i will check into it. and yes, you are so right. it sure doesn't help those who are struggling right now. and just with the little bit that i have looked at on here, it is absolutely so amazing there are so many of us due to similar situations! it is so sad that people like us are over-looked and/or taken for granted! i am so welcome to any other suggestions. thanks!
ok, get this. my daughter comes home yesterday from school and says they are writing president obama a letter on something they feel is a problem that needs taken care of in our country! i am like, honey, i have just the problem! so i helped her put together a small letter on caregivers getting paid to take care of family members. i mentioned some states have programs already in place on this, but many states do not, along with many other details.

now i don't know if these letters will actually reach the president, but hopefully someone with of some importance, etc, will! i did tell my little girl that by far her letter will probably be an original! LOL told her that it is a huge problem, but unless you are one of the many who are faced with this challenge(and many are not) then alot of people are completely unaware that this problem even exists!

just wanted to share this with all of you!! thanks!

hi! new here, and glad i found all of you! you all share so much of the same things!

ok, i live in ohio. ohio is another state who does not have the cash and couseling program. even if it did, my dad doesn't qualify for medicaid, due to assets. we have already checked into that part. i am in the process of applying for some help. even if it might be help with food, as so i can put some of my grocery money other places i need money for.

i am a single mom with a 9 yr old. we moved in with my dad over 2 years ago to care for him right after he was diagnosed with terminal lung cancer. he is in treatment. this diagnosis ahppened right after my mom died, also.

before moving in with him, i babysat full time, and now am unable to do so. i have a 29 yr old who lives very near, and he told me i could babysit at his house, BUT i cannot leave my dad for more than 2-3 hours at the most. so therefore i am stuck! i have no means of income with many financial obligations!

so long story short, does ANYONE know of any kind of program available i can check into! my neighbor dishes $100 a day for her live in help. my dad only brings in right over $1000, and the bills take up that. he doesn't understand i have financial obligations. he feels since i am living under his roof, paying no rent or utilities i have no reason to need income. oh! i also pay for all of me and my 9 yr old's own groceries. dad's are completely separate from ours, right down to the toilet paper! he also thinks i am suppose to "help him out" by picking up and paying out of my pocket, things here and there that he needs. he feels since i live there, and he is my dad, i "OWE" him that! needless to say, there is soooo much more to my story, but the financial burden is half of the weight! i feel completely trapped, and totally stressed! anyone have any ideas! thanks!