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.