MaineCare Section 19 family caregiver pay can reach an adult child or other relative under Maine's proposed 2026 waiver text, through an agency or as a self-directed Attendant. The route for a spouse is narrower: under a rule Maine adopted in 2021, a spouse can be paid as a Personal Support Specialist only for extraordinary care. Approval of the 2026 text isn't confirmed, so check with MaineCare first.

In This Guide

Which Family Caregivers Can Be Paid Under MaineCare Section 19?

Whether you can be paid turns first on how you're related to the person you care for. MaineCare Section 19 is MaineCare's Elderly and Adults with Disabilities Waiver (ME.0276), a 1915(c) waiver for people 65 and older and adults 18 and older with physical disabilities who meet a hospital or nursing facility level of care.

Your relationship Can you be paid under Section 19?
Adult child or other relative Yes, as an agency-employed Personal Care Attendant or Personal Support Specialist, or as a self-directed Attendant
Spouse Only as a Personal Support Specialist employed by a Personal Care Agency, for extraordinary care
Legal guardian Not as a self-directed Attendant; yes through an agency if you meet the aide qualifications
Representative who directs services No
Relative who lives with the participant No rule on where a relative lives; ask MaineCare
Person holding power of attorney Not addressed; ask MaineCare

These rules come from a draft Section 19 waiver amendment the Maine Department of Health and Human Services posted February 26, 2026, proposed to take effect June 30, 2026; its summary of changes doesn't mention family-pay rules. As of October 2026, our sources don't show that CMS approved it, so confirm with MaineCare, the Office of Aging and Disability Services or your case manager. The spouse route is the exception: Maine adopted it in 2021.

Two Ways a Relative Gets Paid Under Section 19

If you're already doing the bathing and dressing unpaid, the proposed 2026 waiver text offers two ways to be paid.

Through an agency. A family member who qualifies as a Personal Care Attendant or Personal Support Specialist and works for a Personal Care Agency or Nursing Facility may be paid for personal care or in-home respite. The draft also proposes updated direct care worker training requirements, so ask the agency what training you'll need.

Through self-direction. A family member may also be reimbursed for Attendant Care Services or respite when the participant self-directs, except a spouse, or a parent or stepparent caring for a minor child. Section 19's Participant-Directed Option comes with a Financial Management Service and Skills Training.

The Section 19 Spouse Rule: Extraordinary Care Only

Caring for a husband or wife works differently. Under Maine's 2021 MaineCare Section 19 rule, a spouse may be reimbursed as a Personal Support Specialist only when the member needs extraordinary care. The proposed 2026 waiver text also states that the spouse must work for a Personal Care Agency, and that extraordinary care includes activities of daily living (ADLs) but not instrumental activities of daily living (IADLs).

Under that text, expect your need to give extraordinary care to be identified, documented and regularly evaluated in Person-Centered Planning, then authorized by the Service Coordination Agency. See our Maine spouse caregiver pay guide.

How Many Hours Can You Be Paid For?

If you hope to make this a full-time job, know the ceilings first. Maine's proposed 2026 Section 19 waiver text caps personal care and Attendant Care Services at 86.25 hours a week each. One Personal Care Attendant or Personal Support Specialist may be paid for no more than 40 hours a week per participant, though participants at risk of institutionalization may seek an exception.

Your actual hours are the ones documented in the member's Plan of Care. Every service needs prior approval. The member's projected monthly Section 19 costs must also fall within the dollar limits in Section 19.06, so that cost limit, not the 86.25-hour ceiling, may decide your hours. Maine's February 2026 amendment notice proposed updating the monthly and annual caps on combined services, so ask MaineCare which limits apply.

How Much Is MaineCare Section 19 Family Caregiver Pay?

We haven't found a published Section 19 wage for family caregivers. Typical pay: about $18.55 an hour (estimate based on home care aide wages in Maine, BLS, May 2025), a statewide median, not a Section 19 rate. The same February 2026 notice proposed clarifying that Section 19 service rates depend on available funding and legislative approval. Ask the agency or your case manager what you'll actually be paid before you give up other work.

If you live with the person, IRS Notice 2014-7 can exclude your Medicaid waiver pay from income. See whether waiver payments are taxable and who sends your W-2 or 1099.

How to Get Hired, Step by Step

1
Step 1

Apply for MaineCare

Apply at My Maine Connection or through the Office for Family Independence. The 2026 monthly income limit for MaineCare's Waiver coverage group is $2,982. Over the income or asset limits but meeting the medical need? A deductible (spend-down) may still work; see how to apply. The asset limit for one person is $2,000, and up to $8,000 of savings can be excluded.

2
Step 2

Get the medical assessment

Section 19 requires nursing facility medical eligibility, established through a face-to-face Medical Eligibility Determination assessment.

3
Step 3

Expect a possible wait

Section 19 services depend on available funding, and members are accepted first-come, first-served from a wait list kept by the Office of Aging and Disability Services. Waiting while you already do the care is hard; the FAQ below covers respite help meanwhile.

4
Step 4

Build the Plan of Care

Ask the Service Coordination Agency to name you as the caregiver in the member's Plan of Care, since services are delivered as that plan documents.

5
Step 5

Pick your route

Under the proposed 2026 text, find a Personal Care Agency to employ you, or, if you're not the spouse, ask about self-directed Attendant work. Ask your Service Coordination Agency which agencies serve your area.

6
Step 6

Wait for authorization

from the Service Coordination Agency, which the proposed 2026 text requires.

Frequently Asked Questions

Can I be paid for respite hours, and is there a limit?

Yes, if you're not the spouse: under the proposed 2026 text, both routes cover respite. MaineCare Section 19 caps respite each annual eligibility period at the cost of 30 days of nursing facility respite care, which counts against the member's monthly program cap. Our Maine respite care guide covers other ways to get a break.

Is there any help while my mother waits for a Section 19 opening?

Some, though it isn't a paycheck. Maine's five Area Agencies on Aging run a state-funded Caregiver Respite Program for dementia caregivers, plus the National Family Caregiver Support Program, offering respite in and out of the home, adult day services, homemaker help, counseling and support groups.

What if MaineCare denies services or cuts the hours?

In most situations the member can ask for a Fair Hearing up to 60 days from the date of the letter by calling MaineCare Member Services at 1-800-977-6740. Ask within 10 days and current services continue until a decision, though MaineCare may seek repayment for them if the decision goes against you.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in MaineGetting paid as a family caregiver in Maine: what MaineCare Sections 19 and 21 cover, VA's PCAFC stipend for spouses and family, and Aid & Attendance limits. CaregiverHow to Get Paid to Care for Your Spouse in MaineCan you get paid to care for your spouse in Maine? MaineCare's Section 19 waiver can pay a spouse for extraordinary care; the VA may also pay. CaregiverCaregiver Programs in Maine: A Complete DirectoryMaine caregiver programs: who MaineCare Section 19 can pay (relatives, and spouses in narrow cases), where to find respite, VA caregiver help, and how to apply. MedicaidYour Guide to Maine Medicaid HCBS WaiversMaine Medicaid HCBS waivers pay for home and community care through the Section 19 waiver. See who qualifies, what it covers, and how to apply. MedicaidHow to Apply for Maine MedicaidHow to apply for Maine Medicaid (MaineCare) in 2026: online via My Maine Connection, by mail, e-mail, or fax, or in person. Documents, spend-down, and appeals.

Find personalized help getting hired and paid as a family caregiver under MaineCare Section 19 at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.