Page Reviewed / Updated - Jul. 2019
In California, there are several programs that will pay family members to provide non-medical, hands-on assistance for a loved one. What the reader must realize is that not everyone will be eligible to participate in these programs. For example, one’s income, veteran status, marital status, the value of their assets, whether or not they are currently employed, and the type of insurance they have can all impact their eligibility for paid caregiver programs. Another major factor is their blood relationship to the individual who requires care. Some programs only allow certain relatives to be paid and other programs prohibit certain family members from being compensated.
This article will describe the different programs available in California, how they work and briefly touch on their eligibility requirements. Alternatively, readers may want to use the Paid Caregiver Program Search Tool. Doing so, helps caregivers and care recipients find programs for which they are eligible simply by responding to a series of questions.
In-Home Supportive Services (IHSS) is a Medi-Cal program (Medicaid in California is called Medi-Cal). As implied by the name, the In-Home Supportive Services program provides support to persons in their homes such as personal care and assistance with household chores. These support services are largely unskilled, meaning no special medical training is required. California allows IHSS program participants to choose who provides them with assistance. They are permitted to choose family members (or other loved ones) to help them and those family members are compensated by Medi-Cal. In formal language, this flexibility to choose your own care provider is referred to as “participant direction” or "self-direction".
While many states have similar programs to IHSS, California’s program is unusually broad in the range of persons who can be hired. Siblings, adult children, nieces, nephews, friends, and even spouses can all participate in the program.
Of course, IHSS beneficiaries must be assessed to have a need for assistance. They also must meet Medi-Cal’s tight financial eligibility criteria, which is a complex subject. In simplified terms, as of April 2019 through May 2020, applicants must have monthly income less than $1,271, and the value of their “countable resources” cannot exceed $2,000. Many resources, such as a home and car, are not “countable”. Assistance determining eligibility and qualifying for Medi-Cal is available here. More information about IHSS can be found here, and information on Medicaid eligibility in general on this page.
The Aid and Attendance Pension benefit is another program available in California that can be used to pay family members to provide care. At the forefront, it should be mentioned that this program is only relevant for war-time veterans or their surviving spouses who require assistance with their activities of daily living. Spouses cannot be paid as caregivers, but adult children and other relatives can be compensated. How it works is complicated. Therefore, please bear with us or consult with a Veterans Pension Planner for a further explanation.
The Aid and Attendance Pension benefit is a cash benefit and the amount of financial assistance varies depending on the beneficiary’s current income. Annually, the VA sets a maximum amount of income a beneficiary can have and then the VA supplements the veteran’s income up to the point of the maximum benefit. For example, in 2019, the Maximum Annual Pension Rate (MAPR) for a couple is $26,765. (This figure is effective until 11/30/19). If the couple has $15,000 in income, the VA will give them an additional $11,765.
Importantly, the VA allows families to deduct certain expenses from their income, so in practice they can still be eligible even if their income is considerably higher than $26,765 per year. One expense they can deduct from their countable income is their cost of care. Therefore, an elderly veteran can hire their adult child (or another relative or friend) to provide them with personal care, and the amount they pay their caregiver can be deducted from their income. The VA will compensate the veteran an amount equal to what they pay to their caregiver, over and above, their existing pension benefit. It should be noted that since the VA counts a couple’s income together, this technique will not work to pay a spouse for caregiving.
This technique is complicated, and for the purposes of this article, we have oversimplified the details. Learn more about Aid and Attendance eligibility. While not relevant to all Californians, there are currently estimated to be over 2 million veterans living in the state.
Another interesting option veterans can use to pay their caregivers is a program called Veterans Directed Home and Community Based Services (VD-HCBS). For veterans who require the level of care on par with what is provided in a nursing home, this program gives them the option to receive that care at home and to pay family members or friends for providing care. In brief, how this program works is that the veteran is provided with a budget for care instead of being provided with care by the VA. The responsibility for finding the care providers, then falls onto the veteran and / or their family. With control of the budget, the veteran is able to hire family members, friends and even their spouses to provide them with the hands-on assistance with the activities of daily living they would otherwise receive in a nursing home.
Any veteran that participates in the VA Medical Center Care system and requires “nursing home level care” is eligible for this program. Notably, veterans with Alzheimer’s usually meet these criteria. However, not every VA Medical Center (VAMC) in California offers the VD-HCBS program. In fact, as of mid 2019, only the San Diego VAMC was participating. Important, this does not mean veterans outside that area cannot participate, it only means that travel may be required to initiate the program. Northern California residents may find it easier to locate a participating VAMC in Southern Oregon. Read more about VD-HCBS.
If your loved one has long term care insurance and if their policy meets certain requirements, it can be used to hire family members as caregivers. Unfortunately, this option is only relevant to a few California residents because most long term care insurance policies are too restrictive. In short, a policy must 1) pay for personal care provided outside of residential care communities and 2) make the payouts to the policyholder directly instead of to a care provider. If these conditions are met, the policyholder / care recipient can choose from whom they wish to receive care and hire a family member to provide it.
One workaround exists, although the process can present some logistical challenges. The family member who wishes to provide care, can start their own home care agency. The family member who requires care then hires that home care agency and the long term care insurance provider then makes payments directly to the home care agency / family member. To learn more about starting a home care agency in California, read here.
The Paid Family Leave (PFL) Act allows relatives to take time off from their job to care for a family member. They continue to receive a percentage of their salary while doing so. The actual percentage will vary but in 2019, California generously provides up to 70%. While, one is not formally being paid to be a caregiver, they do continue to receive compensation from their job while they are caring for their relative. To be eligible to paid as a caregiver under PFL Act, one must be related by blood or marriage to the individual who requires care. More specifically, eligible relations include parents, parents-in-law, grandparents, grandchildren, children, siblings, spouses, or registered domestic partners. One must also be employed and taking time off from their job to provide care. The program allows caregivers to take up to 6 weeks off. Learn more.