Families often share the responsibility of caring for a loved one who needs daily support. In many homes, this care includes help with meals, medication, hygiene, transportation, and other activities of daily living. While one person may serve as the primary caregiver, siblings or other relatives may also provide hours of support. This raises an important question: can Medicaid waivers pay multiple family caregivers for their time and employment?

The answer depends on the state Medicaid program, the specific waiver, and how the care plan is set up. With the right approach, families can often use a Medicaid waiver to pay more than one caregiver. Understanding how the waiver system works helps ensure that each family member receives fair payment.

What Is a Medicaid Waiver?

A Medicaid waiver is a policy tool that lets states expand services beyond traditional nursing home care. Without waivers, Medicaid funds would mostly pay for institutional care. With waivers, states can direct Medicaid reimbursement toward home and community based services (HCBS).

These services may include personal care services, respite care, and caregiver pay for family members. A waiver allows Medicaid enrollees to remain at home instead of moving to a nursing home, which is often preferred by both the family and the individual.

How Family Caregivers Get Paid Through Medicaid

Many state Medicaid programs allow family caregivers to be paid for the care they provide. The process usually involves:

Assessment of Need – A nurse or case manager evaluates health needs, such as daily tasks, disease management, and medication support.
Care Plan Creation – The plan outlines how many hours of personal care services Medicaid will cover.
Enrollment in a Program – Family caregivers register through a fiscal intermediary or home care agency. This step often requires a background check.
Employment and Wage Setup – Once approved, the caregiver is treated like an employee and receives a set wage per hour.
Payment and Reporting – Hours are tracked through timesheets or an electronic system. Caregivers are then paid directly, often as cash wages that are reported for tax purposes.

Not every family member qualifies. Some waivers exclude spouses or legal guardians, but adult children, siblings, or parents of adult children with disabilities may often serve as paid family caregivers.

Using a Medicaid Waiver for Multiple Caregivers

In many states, more than one caregiver can be enrolled under the same Medicaid plan. For example, if a waiver approves 40 hours per week of services, those hours could be divided between two caregivers.

This arrangement works well when:

One adult child works during the day and another is available at night.
Parents of a disabled adult child split responsibilities.
Several siblings rotate shifts so care is consistent.

Each caregiver must go through enrollment, meet policy requirements, and pass a background check. Once approved, they can share hours and receive reimbursement based on the number of hours they personally provide.

How to Use a Medicaid Waiver to Pay Multiple Family Caregivers

Steps to Pay Multiple Family Caregivers

1. Review Medicaid Waiver Rules in Your State

Each state Medicaid program sets its own policies. Minnesota, Colorado, Utah, Massachusetts, and Vermont are examples of states with strong community based services that allow flexibility for family caregivers. Always confirm details with your state’s Department of Social Services or Medicaid office.

2. Speak with the Case Manager

A case manager helps align care needs with waiver services. Families should ask if multiple caregivers can be approved under the Medicaid plan.

3. Enroll Each Caregiver

Even if the caregivers are family, each must complete the same employment process. This includes paperwork, training, and background checks.

4. Divide the Hours

The family decides how to split hours fairly. For example, one caregiver may cover mornings, another evenings. Payment is then distributed based on logged hours.

5. Track Services

Most states require electronic visit verification (EVV). Caregivers clock in and out using an app or phone system. This protects Medicaid against fraud and ensures accurate reimbursement.

Benefits of Paying Multiple Caregivers

Prevents Burnout – Caregiving is demanding. Sharing responsibility helps each caregiver maintain income and health.
Improves Accessibility – More than one caregiver means greater flexibility for appointments, work schedules, and emergencies.
Supports Family Stability – Payment can reduce financial stress, especially if multiple adults in the family are balancing employment and caregiving.
Protects Assets and Budget – Medicaid funding for home care can prevent the need for a costly nursing home stay, preserving family assets.
Fair Compensation – Each caregiver is reimbursed for their time, avoiding disputes about who contributes more.

Challenges of Paying Multiple Family Caregivers

Policy Limits – Some waivers restrict who qualifies. For example, a parent of a minor may not be paid.
Shared Hours – Payment is capped at the number of hours approved. Splitting hours among caregivers does not increase total hours.
Administrative Steps – Multiple enrollments and EVV logs mean more paperwork.
Income and Tax Reporting – Each caregiver must report wages as income, which can affect tax filings.

State Medicaid Program Examples

California IHSS – Allows multiple caregivers, with wages set by county budgets.
New York CDPAP – A paid family caregiver program where nearly any adult relative, except a spouse, can be hired. Multiple caregivers are common.
Minnesota – Medicaid home and community based services allow family caregivers to be reimbursed for personal care services.
Colorado and Utah – Both states have waivers that support paid family caregivers. Families may split hours among several caregivers.
Massachusetts and Vermont – These states run HCBS programs that emphasize accessibility and flexibility for families.

Each Medicaid state plan differs, so families should request updated data from their case manager.

The Role of AARP and Advocacy Groups

Groups like AARP and the Family Caregiver Alliance continue to push for policies that expand caregiver pay. They provide data showing that family caregivers save Medicaid programs billions by keeping loved ones at home instead of moving them to nursing homes. Advocacy also encourages states to adjust wage rates so that caregivers earn fair pay for their employment.

Financial and Tax Considerations

Payment to family caregivers counts as income. Caregivers should budget for taxes and keep records of wages earned through Medicaid reimbursement. Some caregivers may also qualify for a tax credit if they support a dependent parent.

Families should also review how caregiver pay may affect eligibility for other benefits, such as Medicare, disability income, or employee benefits from outside jobs. In some cases, cash wages could shift overall household income.

Why Medicaid Waivers Matter for Families

Medicaid waivers help families:

Avoid premature nursing home placement.
Reduce stress by funding respite care.
Provide fair wages for caregivers balancing employment and family obligations.
Preserve assets by covering services at home rather than draining savings.
Ensure that parents, adult children, and other relatives can continue caregiving without losing income.

For many families, waivers are the difference between affording home care and facing financial crisis.

Final Thoughts

Using a Medicaid waiver to pay multiple family caregivers is possible in many state Medicaid programs. While rules vary, most allow more than one caregiver as long as hours are divided, policies are followed, and background checks are complete.

This option helps families manage health needs, provide personal care services, and maintain financial stability. It supports family caregivers with fair reimbursement and protects Medicaid enrollees by ensuring care remains accessible at home.

If your family is considering this option, start by contacting your state Medicaid office or local Department of Social Services. Review waiver details, confirm eligibility, and request support from your case manager. With planning and cooperation, Medicaid waivers make it possible for multiple caregivers to be paid while keeping loved ones safe, supported, and at home.

FAQs

Yes, many state Medicaid programs allow more than one caregiver to be paid under the same waiver. The total hours authorized in the care plan can be divided between caregivers, such as siblings or parents of an adult child. Each caregiver must complete the employment process, pass a background check, and follow the state’s policy for logging hours. Payment is based on the number of hours each caregiver provides.
No, having multiple caregivers does not increase the number of hours authorized. Medicaid sets the total hours of personal care services based on the individual’s health needs and activities of daily living. The approved hours can then be split among caregivers, but the overall budget and reimbursement amount remain the same under the waiver program.
Wages earned through a Medicaid waiver are considered income. Each paid family caregiver must report earnings for tax purposes. In some cases, caregivers may qualify for specific exemptions, but it depends on state and federal tax rules. Families should keep accurate data on hours, payment, and wages to avoid problems during tax season. Consulting a tax professional or using AARP caregiver resources can also help.
Yes, restrictions vary by state Medicaid plan. Some states exclude spouses or legal guardians, while others allow parents of adult children, siblings, or other relatives to be paid caregivers. Programs in states like Minnesota, Colorado, Utah, Massachusetts, and Vermont often support paid family caregiver options. Always check your state’s Medicaid waiver rules to confirm which relatives qualify for employment and reimbursement.

How to Use a Medicaid Waiver to Pay Multiple Family Caregivers