How can I get paid to care for an elderly family member in Georgia?

Is there really a way to be paid for this?

Sometimes. Not always, and rarely quickly. The honest version of the answer has four parts, and it is worth reading all four before deciding you have found yours – or that there is nothing.

Almost every route runs through the same gate first: the person being cared for has to qualify for Georgia’s Elderly and Disabled Waiver Program. That means meeting a nursing-home level of care and Medicaid’s financial rules. If they do not qualify, most of the doors below are shut, and the last section deals with that case.

Route 1: Structured Family Caregiving

This is the route most people are looking for when they search this question.

Structured Family Caregiving pays a stipend to a family caregiver who lives with the person receiving care. The caregiver provides the day-to-day help – bathing, dressing, meals, medication reminders, supervision – and a contracted provider agency supports and monitors the arrangement.

The rules, briefly:

• The member must be enrolled in the waiver, and the case manager must write Structured Family Caregiving into the care plan. Enrollment alone is not enough.
• The caregiver must live in the same home as the member.
• Spouses, legal guardians and conservators are excluded. Adult children, grandchildren, siblings and in-laws can qualify.
• The caregiver must be 18 or over, related by blood or marriage, and pass a background check.
• The stipend is roughly $80 a day, and when the caregiver is co-resident it is generally not treated as taxable income under IRS Notice 2014-7.
• The Structured Family Caregiving provider is a separate contracted agency from the case management agency.

None of that makes payment automatic. Eligibility for the waiver, the level of need in the assessment, slot availability and the content of the care plan all sit between a family and a stipend, and any of them can end it.

The full detail – how the assessment feeds the amount, what the provider agency does, what the caregiver is responsible for, and what happens when the member is hospitalized – is on the Structured Family Caregiving page.

Route 2: Being hired as a paid personal support worker

The waiver also pays for personal support delivered by provider agencies, and in some cases an agency will hire a family member as the worker who serves their own relative.

This is a different animal from the stipend. It is a job. The agency is your employer. You are trained, scheduled, supervised, and paid a wage with tax withheld. There is documentation to complete for each visit, and there are hours you are expected to work.

Things to know before you count on it:

• Whether a family member can be hired depends on the individual provider agency, not on the case management agency. Agencies set their own policies.
• Relationship exclusions still apply in many cases, particularly for spouses and legally responsible relatives.
• The hours are the hours in the care plan, which are set by the assessment, not by what the family needs financially.
• It is a wage, which means it is taxable, but it also means it builds employment history and Social Security credits in a way a stipend does not.

Families are entitled to choose which provider agency delivers their services and to change later; see choosing your provider.

Route 3: Veterans’ programs

If the person needing care is a veteran, or in some cases a surviving spouse, the VA runs programs that are entirely separate from Medicaid and are worth checking in parallel:

• Veteran-Directed Care, which gives an eligible veteran a budget to arrange their own services, and can in some cases pay a family caregiver.
• The Program of Comprehensive Assistance for Family Caregivers, which supports caregivers of veterans with serious service-connected injuries, and has narrow eligibility.
• Aid and Attendance, an increase to a VA pension for veterans or surviving spouses who need help with daily activities. It goes to the veteran, not to the caregiver, but families often use it to pay for care.

Eligibility for all three is set by the VA, and the rules are strict and different from Medicaid’s. The VA, or an accredited veterans service officer, is the right place to ask.

Route 4: Sometimes none of these apply

This has to be said, because most pages on this topic never say it.

If your relative does not meet nursing-home level of care, or does not meet Medicaid’s financial rules, or is on a waiting list with no slot yet, then there is no Medicaid route to paying you today. If you are their spouse, Structured Family Caregiving is closed to you regardless of everything else. If you cannot live with them, it is closed too.

What is left in that case:

• Long-term care insurance, if a policy exists. Some policies pay family caregivers; many do not.
• Paying from the person’s own funds under a written family caregiver agreement. This can be legitimate and sensible, but it has real tax consequences and can affect future Medicaid eligibility if it looks like a gift rather than a fair-value arrangement. Get advice from an elder law attorney before money moves.
• Unpaid, with support around it. Adult day health, respite and home-delivered meals through the waiver do not pay you, but they change what the week costs you. For many families that is the realistic win.

Where to start

The state’s front door is the Area Agency on Aging; in metro Atlanta that is the Atlanta Regional Commission and its Empowerline service. A case management agency can also talk through whether the waiver looks like a fit and what the assessment involves. Medicaid pays the case management agency directly, and no bill for case management reaches the member or the family.

Expect two to six months from first contact to services starting, and expect a waiting list. Nothing on this page is a determination of eligibility or a promise of payment.