Yes, in some circumstances. Certain Louisiana Medicaid home and community-based services allow a qualifying family member to be paid for providing approved care to a person with a disability.
However, being related to someone, or already providing care for them, does not automatically mean Medicaid will pay you as their caregiver.
Whether a family member can be paid depends on several factors, including:
- The Medicaid program or waiver the person receives
- The specific service being provided
- The relationship between the participant and caregiver
- Whether the caregiver lives in the participant’s home
- Whether the service is authorized in the participant’s Plan of Care
- Whether the caregiver meets the program’s employment and screening requirements
- Additional rules that may apply to a spouse, parent of a minor child, or another legally responsible person
Important: This article provides general educational information about Louisiana Medicaid programs. It does not determine whether a particular person or family member is eligible to be paid and does not guarantee Medicaid authorization, employment, hours, or payment.
How Can a Family Member Be Paid as a Caregiver in Louisiana?
One way this can occur is through Medicaid Self-Direction.
Self-Direction is a service-delivery option that gives eligible Medicaid waiver participants greater control over the people providing certain authorized supports.
Instead of a traditional provider agency making all employment decisions, the participant, or an authorized representative when appropriate, takes on employer responsibilities and can choose the Direct Support Professional (DSP) or other eligible worker who will provide the authorized service.
The Louisiana Department of Health (LDH) describes Self-Direction as an option that allows participants to become the employers of the people they choose to hire to provide supports.
LDH maintains Self-Direction resources for Louisiana’s developmental disability waiver programs as well as other HCBS programs.
This does not mean that every relative can automatically become a paid employee. Family relationships and the type of care being provided still matter.
Can a Family Member Be a Paid Caregiver Through OIDD?
Louisiana has a specific process addressing family members and Legally Responsible Individuals (LRIs) who serve as paid caregivers in applicable developmental disability services.
LDH’s published Family/Legally Responsible Individual as Paid Caregiver instructions specifically address family members working as Direct Support Professionals, including family members who live in the participant’s home. The process requires coordination with the participant’s Support Coordinator and includes considerations related to the participant’s best interest and right to self-determination.
Some LDH documents describing this process were issued when the office used the OCDD name; current LDH materials refer to the Office of Intellectual and Developmental Disability Supports (OIDD).
What if the caregiver is legally responsible for the participant?
Additional rules apply.
In its Family/LRI as Paid Caregiver guidance, LDH identifies the following as Legally Responsible Individuals for purposes of this OIDD process:
- A parent of a minor child
- A spouse
- A curator or continued tutor for an adult
LDH states that an LRI may serve as paid staff only when extraordinary care is needed.
That determination is not based simply on the family wanting the arrangement.
LDH’s guidance says the extraordinary-care review considers factors including:
- The availability of other qualified support staff
- The type of support or care needed compared with what would ordinarily be expected of the legally responsible person
- The expectation that some support and interaction within the family relationship will continue without being paid
The participant’s Support Coordinator also has responsibilities related to reviewing the arrangement, including the participant’s best interest and self-determination.
Can a Parent Be Paid to Care for a Child With a Disability?
Potentially, but not automatically.
For an OIDD participant who is a minor child, a parent is considered a Legally Responsible Individual under LDH’s published family-as-paid-caregiver guidance.
Because of that relationship, the additional extraordinary care requirements described above apply.
This is an important distinction.
The fact that a child has a disability or requires significant assistance does not, by itself, establish that a parent can be paid for all care the parent provides.
The Medicaid-funded service must be authorized, the applicable program requirements must be met, and the paid care must be distinguishable from ordinary responsibilities that remain part of the parent-child relationship.
Can a Parent Be Paid to Care for an Adult Child?
A parent of an adult is not automatically treated the same way as the parent of a minor child.
However, other circumstances may affect the rules, for example, if the parent also serves as the adult’s curator or continued tutor.
Because the individual’s age, legal relationship, waiver and service can change the analysis, families should not assume that rules applying to one family arrangement apply to another.
Can a Spouse Be Paid as a Caregiver?
In some Louisiana Medicaid programs and circumstances, a spouse may potentially be involved in a paid-caregiver arrangement, but special rules apply.
For the OIDD family-as-paid-caregiver process, LDH identifies a spouse as a Legally Responsible Individual. As a result, the extraordinary-care requirements apply before the spouse can serve as paid staff under that process.
OAAS programs have their own service structures and requirements, so families should not apply OIDD rules automatically to an OAAS participant.
For example, Louisiana’s Community Choices Waiver (CCW) includes both a Self-Direction option and a separate service called Monitored In-Home Caregiving (MIHC). Under MIHC, a principal caregiver lives with the participant and assists with basic self-care and other supports.
The rules and payment structure for MIHC are different from simply hiring someone as an hourly Self-Direction employee.
What Is Monitored In-Home Caregiving?
Monitored In-Home Caregiving is different from traditional Personal Assistance Services.
Louisiana describes MIHC as a Community Choices Waiver service for a participant living in a private home with a principal caregiver who lives with the participant and assists with needs such as bathing, dressing and other daily supports.
MIHC is provided through qualified Medicaid providers approved for that service.
Because MIHC has its own eligibility, provider and service requirements, families interested in this option should have the particular participant’s circumstances reviewed under the current OAAS rules rather than assuming that any live-in caregiver will qualify.
Are There Rules for Family Members Who Live in the Same Home?
Yes, and the rules can vary by program.
For example, the OIDD Self-Direction attestation currently published by LDH states that family members who live in the participant’s home and work as Self-Direction employees must complete the required family-caregiver attestation process.
That OIDD form also states that services delivered by family members living in the home are capped at 40 hours per week, Sunday through Saturday, under the requirements addressed by that attestation. Hours beyond that limit may not be billed to Medicaid under that process.
That 40-hour provision should not be assumed to apply to every Louisiana Medicaid caregiving program. Different waivers and services may have different limitations.
Does the Family Caregiver Have to Pass a Background Check?
For OIDD Self-Direction family caregivers, LDH’s published guidance states that background checks are required for family members working as Self-Direction employees.
Other employment and program requirements may also apply.
Family status does not eliminate the requirements associated with being a paid Medicaid worker.
Can the Same Person Be the Employer and the Paid Caregiver?
Under the OIDD Self-Direction process described in LDH’s current published attestation materials, the employer and employee cannot be the same person.
The participant or authorized representative serving as the employer has responsibilities such as supervising workers, reviewing payroll information, approving time worked and ensuring services comply with the Plan of Care and Medicaid requirements.
Self-Direction therefore involves more than simply choosing a family member and submitting hours for payment.
What Rules Apply Once a Family Member Is Being Paid?
Paid caregiving is a Medicaid service and must follow Medicaid requirements just like services provided by a non-relative.
For example, LDH’s OIDD Self-Direction attestation requires applicable workers and employers to follow requirements involving:
- Documentation of services
- Electronic Visit Verification (EVV)
- Authorized service hours
- The participant’s Plan of Care
- Health and welfare safeguards
- Reporting of critical incidents
- Employee screening requirements
The same guidance makes clear that Medicaid-funded time must actually be spent providing the authorized service to the participant.
A family relationship does not turn ordinary household activities, personal errands or unrelated responsibilities into Medicaid-billable services.
Can a Family Member Get Paid for Care They Are Already Providing?
Families should not assume that past or informal caregiving will be reimbursed simply because a family member later qualifies to become a paid worker.
Under the OIDD Self-Direction process, the required steps are completed before an effective employment start date is established. The Support Coordinator, employer and Fiscal Employer Agent may all have roles in completing the process.
Payment should therefore be based on an approved Medicaid service and an established employment arrangement—not simply on the fact that caregiving has already been occurring.
How Much Does Louisiana Medicaid Pay a Family Caregiver?
There is not one statewide amount that every family caregiver receives.
Compensation can depend on the Medicaid program, service, authorized hours, current reimbursement structure and method through which the caregiver is employed.
For that reason, online claims such as “Louisiana pays every family caregiver $___ per month” should be treated cautiously.
A more accurate question is:
Which Medicaid service is authorized for this participant, and what compensation rules apply to the worker providing that particular service?
How Do I Find Out Whether a Family Member Can Be Paid?
If the person already receives Louisiana Medicaid HCBS or waiver services, the appropriate starting point is to determine:
- Which Medicaid program or waiver the participant receives
- Which services are currently authorized
- Whether the applicable service permits a family member to serve as the paid worker
- Whether Self-Direction, Monitored In-Home Caregiving, or another applicable service option is available
- Whether the particular family relationship creates additional requirements
A participant receiving Support Coordination can ask their Support Coordinator for information about the options available under their specific program and the official process that applies.
The Support Coordinator does not simply “approve a family member to get paid.” Their role is to assist with the applicable person-centered planning and Medicaid process while following LDH requirements.
The Bottom Line
Louisiana Medicaid can allow certain family members to be paid caregivers, but there is no blanket rule that pays anyone who cares for a relative with a disability.
The participant must be enrolled in an applicable Medicaid program, the service must be authorized, and the caregiver must meet the rules associated with that service.For some family relationships, particularly a parent of a minor child, spouse, curator or continued tutor, additional requirements may apply because the person is considered legally responsible for the participant.
The safest approach is to identify the participant’s specific Medicaid program first and then review the current LDH rules for that program and service.
Important Information: This article is provided for general educational and informational purposes only. It is not legal, financial, employment, medical, Medicaid eligibility, or benefits-planning advice. Nothing in this article guarantees that an individual will qualify for a Medicaid program, that a family member may serve as a paid caregiver, or that any particular service, number of hours, rate of pay, or caregiving arrangement will be authorized.
Louisiana Medicaid and applicable state authorities establish program eligibility, service authorization and caregiver requirements. Rules may differ by Medicaid program, waiver, service, family relationship and individual circumstances and may change over time.
Our agency is an independent Louisiana Support Coordination Agency and is not the Louisiana Department of Health, Louisiana Medicaid, or another government agency. References to government programs are provided solely for educational purposes.
