Page Reviewed / Updated - Jun. 2018
In Florida, there are several programs that will pay family members to provide non-medical, hands-on assistance for a loved one. However, one should not assume they will be automatically eligible to participate in one of these programs. Factors such as one’s income, savings, marital or veteran status can all impact eligibility. Furthermore, one might meet all of a program’s requirements but still be put on a waiting list for benefits.
This article will describe the different programs that are available in Florida, how they work and their eligibility requirements. Another option for website visitors is 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.
Long term care services from Medicaid in Florida are now part of a managed care program. This program is called the Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC). SMMC LTC provides financially and functionally eligible beneficiaries with certain services to help them remain living in their homes. For example, personal care, adult day care, medication management and chore services are benefits. SMMC LTC also allows beneficiaries to choose their own provider of services for certain services. Given that many services are non-medical in nature (the service provider requires no special medical training to perform the service), friends and family members are qualified and can be hired to perform those services. It is under these rules that family members, even spouses, can be paid as caregivers.
There are certain caveats, of course. Not all services under SMMC LTC can be “self-directed”, but personal care is a benefit that does allow the beneficiary to choose their provider. Family members, hired as care providers, must accept the Medicaid hourly compensation rate. In Florida, this is estimated to be between $9 - $13 per hour. Caregivers typically must past a background check or receive sort level of sign-off from the state that they are legal to work in the USA. Finally, the care recipient must be eligible for Medicaid.
SMMC LTC / Florida Medicaid eligible criteria for 2018 state that the beneficiary, if single, must have monthly income less than $2,250 and their countable assets, not including their home, must be valued at $2,000 or less. If married, the rules are more complicated. If only one spouse of a married couple is applying for Medicaid, the rules are similar to those which apply to single, unmarried and widowed persons. Learn more about SMMC LTC.
Home Care for the Elderly (HCE) is an interesting program in that it provides support directly to the caregiver instead of the care recipient. To be clear, caregivers are not compensated by the hour for the care they provide as they would be with the Florida Medicaid program discussed above. Instead, HCE provides financial support for services that help the caregiver in their efforts, often this support offsets spending that would otherwise have come directly from the caregiver’s pocket. For example, support from HCE can be used for adult day care, incontinence products and home delivered meals.
While the caregivers receive support, most of the eligibility requirements of the Home Care for the Elderly Program apply to the care recipient, not their caregiver. Care recipients must be Florida residents and at-risk for nursing home placement were their caregiver not providing support. They also must be financially eligible. In 2018, the care recipient must have less than $2,250 per month in income and less than $2,000 in countable resources.
Readers should be aware that one cannot concurrently receive support from the HCE Program and SMMC LTC program (discussed above). Also, worth noting is that the HCE Program is not an entitlement, funds are limited, and waiting lists may exist. Read more.
While programs for veterans are not relevant to all Floridians, according to the Florida Department of Veterans Affairs, there are over 1.5 million veterans living within the state’s borders. Therefore, the programs that follow are relevant to many residents.
The Aid and Attendance Pension benefit is another program available in Florida 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, 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 2018, the Maximum Annual Pension Rate (MAPR) for a couple is approximately $25,000. If the couple has $15,000 in income, the VA will give them an additional $10,000.
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 $25,000 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.
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 Florida offers the VD-HCBS program. As of June 2018, there are six VAMCs that offer the program; these are located in Bay Pines, Miami, Gainesville, Tampa, West Palm Beach and Orlando. Even though one of the VAMCs may not be close to the candidate, they can still participate in the program.
Panhandle residents should be aware that they can cross state lines to establish the program with a VAMC in Alabama or Louisiana, should they find that to be more convenient or have family living in those areas. 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 Florida residents because most long-term care insurance policies are too restrictive. In short, a policy must1) 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 Florida, read here.
There are two common misperceptions about programs that pay family caregivers.
1) The Family and Medical Leave Act is a federal program that allows family caregivers to take time off from work to care for a loved one but does not provide compensation. This program requires that employers hold open the position for the caregiver that is taking time off and requires the employer to continue offering health insurance, but it does not pay them. Read more.
2) Four states are currently Paid Family Leave programs; however, Florida is not one of them. If, by chance, the caregiver (not the care recipient) lives in NJ, NY, RI or DC, then these programs might be relevant.