Get Paid to Care for Your Elderly Parent in Maryland
In Maryland, Community First Choice (CFC) lets you self-direct care and hire an adult child as a paid personal assistant. CFC is an entitlement, while the linked Community Options Waiver currently has a waitlist.
This guide covers what Maryland family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
Maryland pays family caregivers $15–$22 per hour through the Community First Choice (CFC) self-direction option within the Community First Choice / Community Options Waiver. Your parent must meet a nursing-facility level of care but prefer to remain at home.
Maryland's Main Program: Community First Choice (CFC) self-direction
Community First Choice (CFC) self-direction is a self-directed option within Maryland's Community First Choice / Community Options Waiver, which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant, and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across Maryland
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Baltimore metro | $16–$22/hr | Higher cost-of-living area; rates set within CFC limits |
| Washington suburbs (Montgomery/PG) | $16–$22/hr | Higher rates reflecting regional wages |
| Eastern Shore / rural | $15–$19/hr | Lower-cost regions; rates negotiated within program caps |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
An adult child or other relative who is not the legal guardian may be hired as a paid personal assistant; spouses and legal guardians are excluded under CFC self-direction. Always confirm the current rules with Maryland Department of Health, Medical Care Programs Administration before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full Maryland Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the Community First Choice / Community Options Waiver (or its self-directed option)
- Live in Maryland in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through a supports planning agency and FMS provider
How to Apply: Step-by-Step
- Apply for Maryland Medicaid. Apply online at www.marylandhealthconnection.gov/how-to-enroll/medicaid or call 1-800-492-5231. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the Community First Choice / Community Options Waiver.
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the Community First Choice / Community Options Waiver and assigned a case manager or care coordinator.
- Request the self-directed (CFC) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with a supports planning agency and FMS provider. Complete enrollment paperwork, W-4, I-9, and background authorization, so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for Maryland's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay Maryland Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable, and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, Maryland's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 1-844-627-5465.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing, see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided, date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What Maryland Caregivers Are Actually Earning
At 30 hours per week and about $18 per hour, you would earn roughly $2,340 per month. At 40 hours per week and $22 per hour, earnings reach about $3,813 per month, around $45,760 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- Maryland Department of Health, Medical Care Programs Administration: health.maryland.gov/mmcp/pages/home.aspx | 1-800-492-5231
- Apply for Medicaid: www.marylandhealthconnection.gov/how-to-enroll/medicaid
- State aging services: aging.maryland.gov | 1-844-627-5465
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Through Community First Choice self-direction, paid personal assistants typically earn roughly $15–$22 per hour, with the exact rate negotiated within state CFC limits and varying by region.
Community First Choice (CFC) is Maryland's Medicaid entitlement offering home and community-based personal assistance, including a self-directed option that lets participants hire and manage their own caregivers.
No. Under CFC self-direction a spouse, legal guardian, or program representative cannot be paid, but an adult child or other relative who is not the guardian may be hired.
Personal assistance under Community First Choice is the main path; participants in the Community Options Waiver also receive CFC self-directed services.
Apply for Medicaid through Maryland Health Connection or myMDTHINK, then request a supports planning agency to set up Community First Choice services and self-direction.
Yes. An adult child can be a paid personal assistant for a parent with dementia through CFC self-direction, as long as the parent qualifies for Medicaid and a nursing-facility level of care.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county, confirm details with Maryland Department of Health, Medical Care Programs Administration. Sources: health.maryland.gov · aging.maryland.gov.