Thraxulon Kritdel 
Family caregivers in Maryland are navigating one of the most financially demanding roles a person can take on. The combination of out-of-pocket caregiving expenses, lost wages from reduced work hours, and the invisible cost of time means that family caregiving often carries a significant and sustained financial burden. What many Maryland caregivers do not realize is that the state operates Medicaid-funded programs specifically designed to address this burden, programs that pay family members directly for the care they are already providing. These programs exist, they are actively enrolling, and most families who would benefit from them have never heard of them.
The Financial Reality of Family Caregiving in Maryland
AARP research found that the average family caregiver spends $7,242 per year out of pocket on caregiving-related expenses, with many spending significantly more. These costs include housing-related expenses, medical supplies and equipment, transportation, and direct care-related purchases. Beyond direct spending, many caregivers experience indirect financial losses: reduced work hours, passed-over promotions, depleted retirement savings, and in some cases full exits from the workforce. The cumulative financial impact over a multi-year caregiving journey can be substantial and difficult to recover from.
Maryland’s Two Primary Paid Caregiver Programs
Maryland offers two Medicaid programs that allow family members to be paid as caregivers. The Community First Choice program, known as CFC, is a Medicaid entitlement benefit with no waiting list. It covers personal care assistance, household support, nurse monitoring, and in some cases home modifications and adaptive equipment. The Community Personal Assistance Services program, known as CPAS, is a Medicaid state plan program with similar personal care coverage. Both programs include a self-directed option that allows the care recipient to choose their own caregiver, which can be an adult family member including, in some cases, a spouse.
How Self-Direction Works in Maryland
Under Maryland’s self-directed care model, the person receiving care becomes the decision-maker about who provides their care and how. They choose their caregiver, typically a trusted family member, and that caregiver is formally enrolled and paid through the Medicaid program. The care recipient does not pay the caregiver out of pocket. A fiscal intermediary handles payroll, tax withholding, and compliance paperwork, and a licensed home care agency guides the family through enrollment and provides ongoing support. The care recipient directs the care; the administrative structure handles the rest.
What Family Caregivers Can Earn in Maryland
Under Maryland’s CFC and CPAS programs, family caregivers can earn up to approximately $2,900 per month through the Medicaid program, with the specific amount depending on the care recipient’s approved care plan and authorized hours. This compensation is not taxable as a benefit to the care recipient. It is formal employment income for the caregiver, subject to standard payroll taxes. For a family caregiver who has reduced their work hours or left employment to provide care, this income can meaningfully offset the financial losses caregiving has produced.
Who Is Eligible to Enroll
To access Maryland’s paid caregiver programs, the care recipient must be enrolled in Maryland Medicaid or eligible for it, and must meet a functional assessment standard confirming that they need assistance with daily activities. For CFC, the standard is a nursing-home level of care need. Once the care recipient is approved, they indicate their choice to self-direct their services and name their chosen caregiver. The caregiver then completes enrollment, which includes background screening and registration with the state. A licensed home care agency can manage both processes simultaneously to minimize delay.
The Programs Most Caregivers Have Not Heard Of
Despite being well-established Medicaid programs, CFC and CPAS are significantly underutilized by caregivers who would benefit from them. The primary reason is awareness. These programs are not marketed to families the way commercial services are. They are documented in state policy materials, but most families do not encounter that documentation. The caregivers who do access these programs typically learn about them through a hospital social worker, a Medicaid specialist, or a home care agency that actively educates families about what is available.
What the Enrollment Process Involves
Getting a family member enrolled as a paid caregiver in Maryland involves confirming Medicaid eligibility, completing a functional assessment with a state assessor, formally electing the self-directed care option, enrolling the caregiver through a licensed Medicaid personal assistance agency, and setting up payment processing through a fiscal intermediary. The process has multiple stages and can take several weeks from start to first paycheck. Working with an experienced home care agency that specializes in Maryland Medicaid reduces delays, prevents errors, and ensures that families do not lose eligible compensation time to avoidable paperwork issues.
The Policy Context: Why Acting Sooner Matters
Federal Medicaid policy is currently in a period of significant change. The 2025 federal budget reconciliation law is projected to reduce federal Medicaid spending by approximately $911 billion over the next decade, with home and community-based services among the areas most likely to see state-level adjustments. Maryland’s current programs reflect existing federal matching arrangements. Families who enroll now are accessing benefits as they currently exist. The longer-term landscape introduces uncertainty that makes early enrollment a practical consideration, not just a financial one.
Conclusion
Maryland caregivers who are already providing daily assistance to an aging or disabled family member may be leaving significant compensation on the table simply because they do not know these programs exist. The Medicaid home care programs in Maryland were designed for exactly this situation. To learn more about the paid caregiver programs available in Maryland, including eligibility requirements, what the enrollment process involves, and how to get started, visit this Maryland home care resource and connect with a team that guides families through this process every step of the way.
Heather Arranie 
