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Getting paid to care for a parent in Maryland

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: Maryland's door is Community First Choice (CFC) — with its sister program Community Personal Assistance Services (CPAS) for people who need help but not nursing-home-level care. Both let the participant pick their own personal assistant, including most family members. Hours are logged by phone through the In-home Supports Assurance System (ISAS)., run by Maryland Department of Health (MDH), Medicaid Office of Long Term Services and Supports; local intake through Maryland Access Point (MAP) and county health departments. Pay: Two different numbers here -- don't mix them up. (1) What Medicaid pays the AGENCY: Maryland's published rate for Community First Choice and CPAS personal assistance was $6.2099 per 15-minute unit -- about $24.84 an hour -- effective January 1, 2024 (MDH provider transmittal PT 40-24; billing codes W5519 for CFC, W5527 for CPAS; a lower shared-attendant rate of $4.1356 per unit applies if the assistant covers two people at once, and a daily rate of $320.23 applies above 12 hours). MDH then raised CFC rates 3% for services on or after July 1, 2024, putting the rate near $6.40 a unit, roughly $25.58 an hour. COMAR 10.09.84.24 says rates go up 3% every July 1 'subject to the limitations of the State budget,' but as of August 2026 MDH had not posted a newer CFC/CPAS rate sheet we could find -- so treat any figure above about $26/hr as unconfirmed. (2) What YOU take home: the agency, not the state, sets your wage out of that rate. Caregiver sites put Maryland family caregivers at roughly $15-$20/hr in 2026, most often $15-$18 -- that range is from secondary sources, not from MDH. Your legal floor is Maryland's minimum wage, $15.00/hr statewide, with higher local floors (Montgomery County $18.00/hr for employers with 51+ workers as of July 1, 2026; Howard County $16.00; Prince George's County $15.30 as of January 1, 2026). There is no official public table of caregiver wages -- only the agency billing rate is published -- so call several Residential Service Agencies, tell them Medicaid pays about $25 an hour for this, and ask what share you get before you sign anything.

One or more details on this page could not be fully confirmed against official sources at publish time — confirm specifics with the agency below.

Who can be the paid caregiver

Adult children, siblings, other relatives, and friends can be the paid personal assistant. You must be at least 18, pass a criminal background check, and be hired as a W-2 employee of a licensed Residential Service Agency (RSA) -- Maryland no longer takes applications from independent personal assistance providers, so going through an agency is the only path now. The hard exclusion, in both the CFC rules (COMAR 10.09.84) and the CPAS rules (COMAR 10.09.20): an agency 'may not assign the participant's representative to provide services to that participant,' and the same goes for a guardian. Here is the trap most families walk into: MDH's own plan-of-service manual says anyone who SIGNS the plan of service is automatically recorded as the representative -- and a representative can never be the paid caregiver. Sign Mom's plan and you have just disqualified yourself from the job. Sort this out before the planning meeting: one adult child signs as representative, a different one gets hired and paid. One more rule people miss -- if you are the paid caregiver, you cannot also be the named back-up caregiver, so the plan needs a second person's name on it.

The spouse question

For a spouse, assume NO until Maryland tells you otherwise -- and know that this is the shakiest fact on this page. CMS's published summary of Maryland's Community First Choice state plan says family members may provide CFC services 'if not legally responsible,' and under Medicaid rules a husband or wife IS a legally responsible relative -- that reads as a spouse exclusion. Paid.care says it outright: CFC lets you choose almost any adult family member 'other than a spouse.' One specialist site, Medicaid Planning Assistance, says the opposite -- that a spouse can be paid so long as they aren't the guardian or program representative. Maryland's actual regulations (COMAR 10.09.84 for CFC, 10.09.20 for CPAS) bar only the participant's 'representative' and say nothing about spouses either way, and MDH does not publish a spouse rule anywhere public. So it is genuinely unresolved, and the safe assumption is no. Do not build a household budget around a spouse getting paid -- call MDH Long Term Services and Supports at 410-767-1739 and get an answer in writing first. None of this touches adult children: an adult child caring for a parent is clearly allowed.

Waitlist reality

CFC and CPAS: no waitlist, ever — they are state-plan entitlements; qualify and you're in (application processing still takes ~2-3+ months). The catch is financial: they require full community Medicaid, which has strict limits. The higher-income pathway — the Community Options Waiver (income up to $2,982/mo, 300% of SSI, 2026) — has a real waitlist: about 20,600 people on the registry, with roughly 700 invited to apply per month, i.e., a multi-year wait. Big exception: someone who has been in a nursing home on Medicaid for 30+ days bypasses the registry entirely and can apply directly (410-767-1739).

Worth knowing: What disqualifies people: (1) Money -- CFC and CPAS require full community Medicaid, and Maryland's 2026 community (aged, blind, disabled) income standard is only about $350/month for one person and $392 for a couple, with countable assets under $2,500 single / $3,000 for a couple. That is low enough to stop almost anyone with a normal Social Security check. Maryland does have a medically-needy spend-down against that same $350 standard, figured over a 6-month period, for people with heavy medical bills -- ask MAP about it. The higher-income route, the Community Options Waiver at up to $2,982/month, means a years-long registry unless your parent has been in a nursing home on Medicaid for 30+ days. (2) Role conflict -- the parent's guardian, or anyone recorded as their representative, cannot be the paid caregiver, and MDH treats whoever SIGNS the plan of service as the representative automatically. Decide deliberately which sibling signs and which one gets hired, and name a third person as the back-up caregiver, because the paid caregiver can't also be the back-up. (3) Living situation -- the parent must live at home or in the community, not in assisted living, to get personal assistance. (4) You never contract with the state directly; you have to be hired by a licensed Residential Service Agency, which keeps a slice of the Medicaid rate, so shop several RSAs on wage. (5) Hours are capped twice: by what the assessment approves, and by rule -- personal assistance may not exceed 12 hours a day or 84 hours a week, no matter how much care your parent needs. Time is clocked by phone through ISAS, and unlogged time is unpaid. Could not confirm from an official source: the caregiver's actual take-home wage (MDH publishes the agency billing rate, not wages) and the spouse rule (sources conflict and the evidence leans toward spouses being excluded) -- verify both by phone at 410-767-1739 before making financial decisions. The newest CFC/CPAS billing rate we could find is dated January 1, 2024 with a 3% bump effective July 1, 2024; rates are supposed to rise 3% each July 1.

Other doors in Maryland

ProgramWhat to know
Community Personal Assistance Services (CPAS)Same self-directed setup as CFC but for parents who need ADL help without nursing-home level of care. No waitlist. Same Medicaid financial rules and same family-hire path through an RSA.
Community Options Waiver (Home and Community-Based Options Waiver)The door for parents whose income is too high for regular Medicaid (up to $2,982/mo, 2026). Enrollees also get CFC personal assistance, so family can be paid — but the registry is ~20,600 deep (years). Nursing home residents on Medicaid 30+ days skip the line.
Attendant Care Program (Maryland Department of Disabilities)Non-Medicaid state program that reimburses attendant costs — but only for adults 18-64 with severe physical disabilities who work, study, or are at risk of nursing home placement. Not for a parent 65+. Has its own registry/waitlist. 410-767-6025 / 1-800-637-4113.
Veteran-Directed Care (VA)If your parent is a veteran enrolled in VA health care, VDC gives a flexible monthly budget to hire caregivers — family, including spouses, allowed. Availability depends on the VA medical center (VA Maryland Health Care System, Baltimore; Washington DC VAMC for the DC suburbs); ask the VA social worker. Also ask about Aid & Attendance (cash pension add-on).
National Family Caregiver Support Program (local Area Agency on Aging)Not wages — but respite money, supplies, and counseling for unpaid caregivers. Reach it through the same MAP number.
Structured family caregivingMaryland does NOT have a structured family caregiving (daily-stipend) benefit like Georgia or Indiana. Anyone promising one in Maryland is wrong.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Call Maryland Access Point (MAP) at 1-844-627-5465 (1-844-MAP-LINK) — the statewide front door. Say you want to apply for Community First Choice / long-term services and supports for your parent.
  2. 2. If your parent doesn't have Medicaid yet, apply (myMDTHINK portal at mymdthink.maryland.gov or with MAP's help). Assets must generally be under $2,500 (single); income limits for community Medicaid are strict. If income is too high, ask MAP to put your parent on the Community Options Waiver registry the same day — and remember the 30-day nursing home bypass.
  3. 3. Your parent gets a medical assessment (interRAI) from the local health department to confirm they need nursing-facility level of care (for CFC) or hands-on ADL help (for CPAS).
  4. 4. Pick a supports planning agency (e.g., The Coordinating Center and others) — they build the plan of service and approved weekly hours.
  5. 5. Choose a licensed Residential Service Agency (RSA) that hires family caregivers; you get hired, pass a background check, and clock in/out by phone via ISAS.
  6. 6. Questions or stalls: MDH Office of Long Term Services and Supports, 410-767-1739.

Where to start: Maryland Access Point (MAP): 1-844-627-5465 (1-844-MAP-LINK), aging.maryland.gov; MDH Office of Long Term Services and Supports: 410-767-1739

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.