Does a family member have to be "hired" by company who holds waiver to be paid by Medicaid?

It all depends on the waiver so this is a question for Medicaid. Your state has several waivers and some do require you to be employed by an agency in order to be the paid caregiver

I wonder what I have to do to be paid directly my Medicaid.

How PA has “waiver” programs set up will be the determining factor as to just how any waiver services is done. The state should have on its website descriptives on waiver programs and how administered. You are going to have to just do your state specific research as to which waivers are which. Your local Area on Aging should have oodles of info on this as well.

Realize that waivers are actually drawing a % of $ dedicated to LTC programs and shifting it to others programs for the same at risk population; and waivers are NOT on a permanent paid program (like LTC NH would be) but are done on 3-5-7 yr cycles. Medicaid is really very much done state by state but within overall federal guidelines. If PA has it set up that waivers for in-home programs must be done by outside firms who in turn hire employees to do the in-home then you will have to apply to whatever companies that have been approved to be a state contractor and work wherever agency needs you to.

If your state is going to PACE waivers for the “wanna stay living at home” elders, then your elder is going to need to be enrolled at a PACE first & foremost and if that can’t meet elders needs then going to in-home program can be done. For those you’d apply to the contractor for PACE. In my area, Catholic Charities Health Care division has most PACE contracts and you’d apply to them for employment.

looking at your profile, you have degrees in & experience in health care, right? Your elder could hire you. They get a professional caregiver agreement drawn up and they use their SS$ and savings to pay you. If those matching your education & experience get paid $38.95hr, then they could pay you that and all legit with FICA etc done. No Medicaid involved.

But if you want state to pay you, then you have to go along with whatever the state requires. Based on what others have posted on this site, for state supported in home health programs for family living with elder, the pay is low.... like slightly above whatever your state or county has as minimum wage. And the # of hours will be determined by a needs assessment & tend to be in the 20-25 hrs a week range. Like $12 hr for 22 hrs a week with deductions taken out.