How to Get Paid as a Family Caregiver in Maryland (2026)

Maryland's paid family caregiver programs will pay a relative or friend to provide in-home care. The main route is self-directed personal assistance: your loved one qualifies for Maryland Medicaid long-term care, enrolls in Community First Choice, and then employs and directs their own paid personal assistant.1,2

You don't get a check straight from the state. A financial management agency runs the payroll, withholds your taxes, and issues your paycheck, while the person you care for decides your schedule and supervises your work. On who can be hired, Community First Choice is the open door: under Maryland's approved state plan, a participant in the self-directed model may permit family members, or any other individuals, to provide their CFC services.2 Whether that reaches a spouse depends on the program, and this guide is careful about where it does and where it doesn't.

The Short Version

If you are an adult child, other relative, or close friend of someone who qualifies for Maryland Medicaid long-term care, the fastest route is to become that person's self-directed personal assistant through Community First Choice.2,1 A Supports Planner helps your loved one document the need, Maryland authorizes monthly care hours, and you deliver those hours while a financial management agency pays you.3

If you are a spouse, the answer depends on the program: Community First Choice permits family members with no spouse carve-out, Increased Community Services bars a spouse (COMAR 10.09.81.13B), and CPAS is unsettled in Maryland's published rules.2 Confirm your specific program with the Supports Planner before care begins.

If your loved one is a veteran, check the VA programs first. Veteran-Directed Care and the VA caregiver stipend both allow paid spouses, and the stipend is tax-free.4,5

If your loved one isn't on Medicaid yet but is close, the path runs through eligibility. Maryland's long-term care Medicaid has income and asset tests,6 and a 60-month look-back on gifts, so it's worth getting the application right before money changes hands.7

If your family has enough private assets, a written personal services contract can pay a caregiver now while documenting the arrangement for any later Medicaid planning.7

The rest of this guide walks through each pathway in detail.

What Makes Maryland Different: Self-Directed Personal Assistance

Maryland delivers most of its Medicaid in-home care through self-directed personal assistance, an arrangement where the person receiving care selects, schedules, supervises, and can dismiss their own worker rather than being assigned an agency aide. Under Community First Choice, that worker is the participant's own employee: Maryland's approved state plan offers personal assistance either through a licensed Residential Service Agency or, in the self-directed model, from one or more individuals the participant employs directly.2 That is what makes hiring a family member possible at all, and it's why a relative can earn a real paycheck for care they'd otherwise give for free.2

Two providers make self-direction work, and it helps to know them by name before you start.3

• A Supports Planner (from a supports planning agency) sits down with your loved one to build the plan of service, figures out which Medicaid services they qualify for, and helps them access those services. Think of the Supports Planner as the guide through the paperwork.
• A Financial Management and Counseling Services (FMCS) provider, sometimes called the fiscal or financial management agency, is the one that actually employs the caregiver on paper. It runs the background check, handles the hiring documents, tracks the self-directed budget, runs payroll, and withholds taxes. So the honest answer to "does the state send me a check?" is no: Maryland funds the care, your loved one directs it, and the FMCS provider signs your paycheck. Its monthly fee comes out of the self-directed budget, not your wages.

On who can be hired, the clearest rule is Community First Choice's. Maryland's CMS-approved state plan lets a participant in the self-directed model permit family members, or any other individuals, to provide their CFC services, provided those individuals meet the qualifications the participant sets.2 One limit is worth confirming up front: under Maryland's CFC regulation (COMAR 10.09.84.06C), a personal assistance provider agency may not assign the participant's own program representative to provide that participant's services, so the paid caregiver should not also be the person who makes program decisions on the participant's behalf. If you'd be wearing both hats, paid caregiver and decision-maker, ask your Supports Planner how to separate the roles before you apply.

The Maryland Paid Family Caregiver Pathways

1. Community First Choice (CFC): The Main Medicaid Route

Who pays: Maryland Medicaid, administered by the Maryland Department of Health Office of Long Term Services and Supports.

Who can be hired: In the self-directed model, family members or any other individuals the participant chooses and employs, provided they meet the participant's qualifications and pass the FMCS provider's background check.2 The state plan sets no spouse carve-out, but it also does not name a spouse as eligible in so many words, so a spouse hire is worth confirming with your Supports Planner first. The paid caregiver should not double as the participant's program representative (COMAR 10.09.84.06C).

What it is: Community First Choice is a Medicaid state plan home and community-based services benefit (the Section 1915(k) Community First Choice option, governed by COMAR 10.09.84). Because it's a state plan benefit rather than a capped waiver, there is no waitlist: everyone who's financially and functionally eligible gets services.1

What it covers: Personal assistance (hands-on help with bathing, dressing, toileting, transferring, and eating, plus meal preparation, light housekeeping, and similar tasks), nurse monitoring, supports planning, a personal emergency response system, and items that increase independence such as accessibility adaptations, assistive technology, home-delivered meals, and transition services.1

Eligibility, recipient: Full Maryland Medicaid, a need for an institutional (nursing facility) level of care, and living in a community setting. There's no age limit. A Supports Planner helps document the functional need, and Maryland authorizes a monthly block of personal assistance hours.1

Eligibility, caregiver: 18 or older, pass the background check the FMCS provider runs, and complete that provider's hiring requirements.

How you get paid: The FMCS provider is your employer of record. You submit timesheets and are paid on a regular payroll schedule with taxes withheld.3

Best for: A relative or friend caring for someone who qualifies for Maryland Medicaid long-term care and needs help with daily activities.

2. Community Personal Assistance Services (CPAS)

Community First Choice isn't the only Medicaid program that pays a self-directed personal assistant. Community Personal Assistance Services (CPAS), governed by COMAR 10.09.20, is a state plan personal care benefit for people who need hands-on help with daily activities but don't require, or don't yet qualify for, the fuller Community First Choice package and its nursing-facility level of care.8

CPAS covers personal assistance with activities of daily living and instrumental tasks like meal preparation, light housekeeping, and laundry. As with CFC, the participant can choose a licensed agency worker or self-direct and hire their own personal assistant, including a relative or friend. The practical mechanics are the same: a Supports Planner builds the plan, hours are authorized, and an FMCS provider pays the caregiver. The difference is who it's for. CPAS fits a person with lower-level needs; CFC fits someone whose needs rise to an institutional level of care.8 On the spouse question, CPAS is the program where Maryland's published rules are least clear, so a spouse hire under CPAS specifically is one to confirm with your Supports Planner rather than assume.

3. Community Options Waiver and Increased Community Services

Two more Medicaid programs sit alongside CFC, each aimed at a specific situation. Neither pays a family caregiver quite the way families expect, so the details matter.

• Community Options Waiver (also called the Home and Community-Based Options Waiver), governed by COMAR 10.09.54, is Maryland's Section 1915(c) HCBS waiver for adults 18 and older who need a nursing facility level of care, with monthly income up to 300% of the Supplemental Security Income (SSI) benefit rate. The waiver itself does not cover personal assistance or attendant care. Its services are things like assisted living, case management, medical day care, respite, and family training; a waiver participant receives their hands-on personal assistance through Community First Choice, alongside their other Medicaid benefits.9 So if you want to be paid to provide daily personal care for a waiver participant, the paycheck runs through CFC, not the waiver. (The waiver's "family training" is training delivered to a family member, not a way to pay one.) Unlike CFC, the waiver has a waitlist, the Community Options Waiver Registry, which you join by calling Maryland Access Point at 844-627-5465. A person already in a nursing facility for whom Medicaid has paid at least 30 days can apply with no wait.6
• Increased Community Services (ICS), governed by COMAR 10.09.81, helps an adult move out of a nursing facility and back into the community when their income is too high for the Community Options Waiver (above 300% of SSI, with excess applied to the cost of care). It's a small, specific program: you must have lived in a nursing facility for at least six months and been Medicaid-eligible there for at least 30 days. ICS participants can self-direct and hire a participant-employed attendant, paid through a financial management agency.10 One exception to know before you plan: under ICS, the attendant may not be a spouse. Maryland's ICS regulation (COMAR 10.09.81.13B) states that the attendant may not be a spouse, a parent of a dependent child, or an individual with full and unrestricted guardianship powers. So a spouse who could be hired under Community First Choice cannot be the paid attendant under ICS.

The takeaway across Maryland's Medicaid programs: your loved one is assessed, monthly hours are authorized, and personal assistance is delivered by a self-directed worker paid through an FMCS provider, most often under Community First Choice. But who may be hired is not identical program to program, and the spouse question in particular turns on which program pays. Confirm your own program's rule with the Supports Planner rather than carrying an answer over from another.

4. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse. VDC has the most permissive family-hire rules of any program in this guide.4

How it works: A VHA-enrolled veteran who needs help with daily activities and is at risk of nursing facility placement receives a flexible monthly budget, set by their VA care team based on assessed need, and uses it to hire and pay caregivers at a rate they set within that budget. A financial management agency handles the payroll.11,4

Availability in Maryland: Veteran-Directed Care is offered through the VA Maryland Health Care System in partnership with the Maryland Department of Aging, which operates the state's Veteran Directed home and community-based services program. Availability varies by jurisdiction, so ask your VA social worker or Caregiver Support Coordinator whether VDC is open at the facility serving your area.4

Best for: A Maryland veteran with daily-living needs who wants to pay a spouse or to set their caregiver's schedule and rate directly.

5. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, who must be at least 18 and a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran (or someone who lives full time with them).5

2026 stipend: The PCAFC stipend is calculated from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by a level factor (Level 1 is 0.625; the higher Level 2 applies when the veteran cannot self-sustain in the community). Because the rate is tied to the veteran's locality, there is no single national figure and the amount varies by where the veteran lives, so confirm your exact stipend with your VA Caregiver Support Coordinator.5

Veteran eligibility: A VA disability rating (individual or combined) of 70 percent or higher, a need for at least six months of continuous, in-person personal care services, and enrollment in VA health care. The VA sets the exact criteria, so confirm eligibility with your VA Caregiver Support Coordinator.5

Why it stands out: The stipend is federal tax-free, and a spouse can serve as the paid Primary Family Caregiver.5

Best for: Families of an eligible veteran where one person provides substantial daily care.

6. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension directly, and a family caregiver is typically paid out of it under a private arrangement.12

2026 maximums (effective December 1, 2025 through November 30, 2026): a single veteran with Aid and Attendance receives up to $2,424 per month ($29,093 per year); a veteran with one dependent up to $2,874 per month ($34,488 per year); a surviving spouse with Aid and Attendance up to $1,558 per month ($18,697 per year). Confirm current figures on the VA pension rate page before applying.12

Eligibility: A wartime veteran (90 days of active duty including at least one day during a recognized wartime period) or a surviving spouse who also meets the Aid and Attendance functional criteria and whose countable income and assets fall under the limit ($163,699 net worth for 2026).13

How caregivers get paid: The pension goes to the veteran, who then pays the family caregiver, ideally under a written caregiver agreement. Maryland's county veterans service officers and the Maryland Department of Veterans and Military Families can help you file; be wary of for-profit pension consultants who charge a fee for help an accredited service officer provides.

Best for: A wartime veteran or surviving spouse with income and assets under the limit who needs help with daily activities.

7. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, because transfers between spouses are treated differently.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income on their taxes.

Why the format matters: Maryland Medicaid applies a 60-month look-back to asset transfers. Without a written contract, money that flows from an aging parent to an adult child for care is presumed to be a gift and can create a penalty period when the parent later applies for long-term care Medicaid. A properly drafted contract converts the payment into a documented exchange of value. The dollar amount Maryland uses to calculate the penalty period changes periodically, so confirm the current figure with a Maryland elder-law attorney or your local Department of Social Services before relying on it.7

Best for: Families with enough assets to private-pay a caregiver who also want to preserve eligibility for future Medicaid planning. Work with a Maryland elder-law attorney to draft the contract.

Comparing the Maryland Paid Family Caregiver Pathways

How to Choose a Maryland Pathway

Start with the care recipient's situation:

1. Is your loved one a veteran? Check the VA pathways first. PCAFC pays a tax-free stipend,5 and Veteran-Directed Care lets you pay a spouse.4 Aid and Attendance is a separate program from Maryland Medicaid, with its own income and asset tests: under general federal rules the VA pension counts as income for Medicaid except the portion attributable to unreimbursed medical expenses, and how that lands depends on the Medicaid category and your situation. Confirm the effect on both benefits with Maryland Medicaid or an accredited benefits counselor before relying on either.14 Your county veterans service officer can help.
2. Is your loved one on, or likely eligible for, Maryland Medicaid? Become their self-directed personal assistant through Community First Choice if they need a nursing-facility level of care,1,2 or through CPAS if their needs are lighter.8 Start by calling Maryland Access Point at 844-627-54656 to request an assessment and connect with a Supports Planner.3
3. Does your loved one need the extra services a waiver adds, like assisted living or medical day care? Look at the Community Options Waiver, but get on the registry early, because it has a waitlist, and remember the hands-on personal care is still paid through Community First Choice.6,9
4. Is your loved one leaving a nursing facility with income too high for the waiver? Ask about Increased Community Services, and note that under ICS the paid attendant may not be a spouse (COMAR 10.09.81.13B).10
5. Do you have substantial private assets and want to plan ahead? Talk to a Maryland elder-law attorney about a personal services contract before any money changes hands.7

Tax Considerations

Most Maryland caregiver pay is reportable income. There's one federal exception, and it turns on which program pays you.

• CFC, CPAS, and ICS pay W-2 wages through the FMCS provider.
• VA PCAFC pays a federal tax-free stipend: the VA has stated the monthly personal caregiver stipend is a nontaxable benefit.5
• VA Aid and Attendance is tax-free to the veteran; when the veteran uses it to pay a caregiver, the caregiver receives ordinary taxable income.
• Personal services contracts pay W-2 or 1099 income depending on how the caregiver is classified.

IRS Notice 2014-7: This is the federal rule caregivers hear about most, and in Maryland it matters a great deal which program signs your paycheck. The notice was written for payments made under a Section 1915(c) home and community-based services waiver, which in Maryland is the Community Options Waiver. If the waiver pays you and the home you share with the person you care for is genuinely your own residence, the IRS treats those wages as difficulty-of-care payments excluded from your federal gross income. In Maryland, though, the waiver does not pay for personal assistance at all: that care is paid through Community First Choice, a Section 1915(k) state plan option.9 So the caregiver wages most Maryland families receive come from a state plan program, not a 1915(c) waiver.15

For a state plan program like Community First Choice or CPAS, the IRS has not said the exclusion applies automatically; its guidance says whether it will treat the payments as excludable "will depend on the nature of the payments and the purpose and design of the program." That's a maybe, not a yes. So if CFC or CPAS pays you, don't assume the exclusion applies: take your program's name and your pay records to a tax preparer familiar with the rule before you file.15

Maryland state and local income tax: Unlike a no-income-tax state, Maryland taxes caregiver wages at both the state and the local level. Maryland has a graduated state income tax, and every Maryland county plus Baltimore City levies a local income tax collected on the same return. So a Maryland family caregiver's pay is subject to federal, state, and county income tax, and the IRS Notice 2014-7 exclusion applies only to the federal portion. Check how Maryland treats Medicaid payments for state purposes when you file.7

Common Misconceptions

"Maryland won't let me get paid to care for my husband." Under Community First Choice, Maryland's approved state plan lets a participant hire family members or any other individuals in the self-directed model, and there's no spouse carve-out in that language.2 But the answer isn't uniform: Increased Community Services bars a spouse outright (COMAR 10.09.81.13B), and for CPAS the rules don't settle it. Confirm your specific program with your Supports Planner before you count on a spouse being paid.

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. Paid family caregiving in Maryland comes through Medicaid, the VA, or a private contract.

"The state will send me a paycheck." No. A Financial Management and Counseling Services provider is your employer of record, not the state. You submit timesheets to that provider and it pays you.3

"I can just start drawing from Dad's account to pay myself." Not without a written personal services contract. An informal transfer of a parent's money to a child for care is treated as a gift under Maryland's 60-month look-back and can delay the parent's Medicaid eligibility later.7

"Community First Choice has a waitlist like the waivers do." It doesn't. CFC is a Medicaid state plan benefit, so there's no waitlist once the recipient is found eligible. The Community Options Waiver is the one with a registry.1

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs like Maryland's self-directed personal assistance, where the care recipient directs their own worker.
• HCBS waiver: The federal authority behind the Community Options Waiver; Community First Choice, by contrast, is a state plan benefit, not a waiver.
• Activities of Daily Living (ADLs): The functional basis for authorizing personal assistance hours across all of Maryland's programs.
• Nursing Facility Level of Care: The clinical threshold for Community First Choice and the Community Options Waiver.

Learn More

Find personalized help getting paid as a family caregiver in Maryland 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.