Frequently Asked Questions

Click on the questions below for insights and answers to your questions on how to get paid for the care you provide.

What is the difference between Medicare and Medicaid? Can my care recipient have both?

If you’re caring for a loved one who’s over 65, there’s a good chance they already have Medicare, a federal health insurance program. To get Medicare, a person needs to be 65 or older or have certain diseases or disabilities.

Medicaid is a state health program that gives health insurance to people of all ages who are living with very low income. States set their own rules about who qualifies for Medicaid and which services are available.

If your loved one qualifies for Medicaid in their state and is over 65, they can be “dual eligible,” which means they can have both Medicare and Medicaid. You can read more about the differences between Medicare and Medicaid at this link.

What is a Medicaid Waiver?

Medicaid waivers are special rules that allow states to provide Home- and Community- Based Services (HCBS) to certain people.
These services let your care recipient stay at home or in your community while getting the care they need, instead of going to a nursing facility.
Almost every state offers these waivers to people who qualify and want to receive personalized care at home.
Your loved one might qualify based on their age or a specific health condition, like autism, epilepsy, cerebral palsy, traumatic brain injury or HIV/AIDS.

What Services Are Included?

These waivers cover a range of services:
- Personal Care: Assistance with eating, bathing and using the restroom.
- Some Medical Services: For example, help managing health conditions.
- Respite Care: Giving caregivers like you a break so you can recharge.

What are Home and Community Based Services (HCBS)?

Home and Community-Based Services (HCBS) are a type of care that happens right where your loved one lives — in their home and in their community. Let’s explore what this means:

What is HCBS?
- HCBS is like a helping hand for people who need some extra support.
- Instead of going to a nursing facility, your care recipient can get the care they need while staying at home.
What kind of care does HCBS pay for?
- Some of the services that might be available include:
  - Help with talking, moving around, or doing everyday tasks.
  - Helping your loved one find a job and manage their money better.
  - Paying family caregivers to help with personal care like eating, bathing, getting dressed, and going to the restroom.
  - Some programs provide tools and technology to help your loved one live independently.
Who pays for HCBS?
- Usually, the Medicaid program in your state covers these services.
- Keep in mind that not all programs offer the same services — it depends on where you live.

What is Self Direction?

Self-direction means the individual who receives services decides how, when, and from whom those services will be delivered. This is different from receiving services from a worker employed by a home care agency. People who choose self-directed programs can hire family, close friends, or neighbors as paid caregivers. This way, they can be cared for by someone they already know and trust. This can make a big difference when it comes to helping with intimate tasks like going to the restroom, bathing and dressing.

Agency-Directed Care	Self-Directed Care
Agency sets the schedule	“I set my own schedule.”
Care might not be available late at night	“I decide what time I go to bed.”
Care recipient might not like the agency employee	“I get to hire, train and manage the people I want.”
Meals are on a set schedule	“I can eat when I’m hungry.”
Bathroom visits on a schedule	“I can use the bathroom when I need to.”

Once my care recipient is approved for a Medicaid waiver, how do I get paid?

When a care recipient chooses to pay a family caregiver through a Medicaid Waiver Self-Direction program, everyone gets a new name! The care recipient becomes the employer, and the family caregiver is called the provider. The care recipient may also be called the member or the beneficiary. Sometimes the family caregiver is called a personal care assistant.

If your loved one chooses self-direction with a Medicaid waiver, they will have lots of help to learn how to become an employer. (If they aren’t able to manage their own care schedule, or hire caregivers, they can have a representative take care of it on their behalf.) They’ll use a financial management services company to process payroll, and their case manager will help them create a plan that meets their needs. If they choose to hire their family caregiver, the state may require the caregiver to have a background check or training. The family caregiver will need to use the timesheet program approved by the state. Once the care recipient approves the timesheet, the caregiver is paid directly by Medicaid.