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Home care programs by state

Every way each state pays for care at home: skilled home health, agency personal care, consumer-directed care where the person hires their own aide, and structured family caregiving. Which states have each one, and where a family member can be the paid caregiver.

Sources: state Medicaid agencies and CMS51 states compiled

Home care Medicaid rates

Programs: 395
Consumer-directed: 50 states
Family can be paid: 51 states
Structured family caregiving: 11 states

On this page

The basics

Home health vs home care vs consumer-directed vs family caregiving

The four lanes almost every state has, and what separates them. The state pages show which programs fill each lane.

Skilled home health

Nursing, therapy and home health aide visits under a doctor's plan of care, billed by a licensed (usually Medicare-certified) home health agency.

Who delivers it: Agency nurses, therapists and aides
Employer: The home health agency
Can family be paid: Rarely: visits come from agency staff
How hours are set: Doctor's order and plan of care

Personal care (agency)

Non-medical help with bathing, dressing, eating, toileting and household tasks, delivered by aides a licensed home care agency employs.

Who delivers it: Agency-employed personal care aides
Employer: The home care agency
Can family be paid: Only where the state lets the agency hire a relative
How hours are set: Functional assessment of daily activities

Consumer-directed care

The person receiving care (or their representative) hires, schedules and supervises their own aide, often a relative or friend; a fiscal intermediary handles payroll and taxes.

Who delivers it: A worker the participant chooses, often family
Employer: The participant, with a fiscal intermediary
Can family be paid: Usually yes, within the state's rules on spouses and parents
How hours are set: Functional assessment; the participant directs the care

Structured family caregiving

A family member who lives with the person is paid a daily stipend for ongoing care, with coaching and oversight from an agency that holds the Medicaid contract.

Who delivers it: A live-in family caregiver
Employer: The sponsoring agency
Can family be paid: Yes: that is the point of the program
How hours are set: Waiver eligibility and a live-in caregiver

The split that matters most is who employs the caregiver. In home health and agency personal care the agency hires the aide. In consumer-directed care the person receiving care is the employer and a fiscal intermediary pays the worker, which is why it is the route most families use to get paid. In structured family caregiving a live-in relative is paid a daily stipend while an agency holds the Medicaid contract.

By state

Every state at a glance

Yes or no for the questions families and providers ask first. Open a state for its programs.

State	Consumer-directed care	Family can be paid	Structured family caregiving	Programs
Alabama	Yes	Yes	No	7
Alaska	Yes	Yes	No	6
Arizona	Yes	Yes	No	5
Arkansas	Yes	Yes	No	6
California	Yes	Yes	No	9
Colorado	Yes	Yes	No	13
Connecticut	Yes	Yes	Yes	8
Delaware	Yes	Yes	No	6
District of Columbia	Yes	Yes	No	4
Florida	Yes	Yes	No	10
Georgia	Yes	Yes	Yes	10
Hawaii	Yes	Yes	No	6
Idaho	Yes	Yes	No	9
Illinois	Yes	Yes	No	6
Indiana	Yes	Yes	Yes	7
Iowa	Yes	Yes	No	7
Kansas	Yes	Yes	No	10
Kentucky	Yes	Yes	No	9
Louisiana	Yes	Yes	Yes	8
Maine	Yes	Yes	No	7
Maryland	Yes	Yes	No	8
Massachusetts	Yes	Yes	No	6
Michigan	Yes	Yes	No	6
Minnesota	Yes	Yes	No	7
Mississippi	Yes	Yes	No	6
Missouri	Yes	Yes	Yes	8
Montana	Yes	Yes	No	6
Nebraska	Yes	Yes	No	9
Nevada	Yes	Yes	Yes	7
New Hampshire	Yes	Yes	No	5
New Jersey	Yes	Yes	No	8
New Mexico	Yes	Yes	No	7
New York	Yes	Yes	No	10
North Carolina	Yes	Yes	Yes	11
North Dakota	No	Yes	Yes	10
Ohio	Yes	Yes	Yes	8
Oklahoma	Yes	Yes	No	7
Oregon	Yes	Yes	No	10
Pennsylvania	Yes	Yes	No	8
Rhode Island	Yes	Yes	Yes	6
South Carolina	Yes	Yes	No	10
South Dakota	Yes	Yes	Yes	6
Tennessee	Yes	Yes	No	8
Texas	Yes	Yes	No	11
Utah	Yes	Yes	No	11
Vermont	Yes	Yes	No	7
Virginia	Yes	Yes	No	6
Washington	Yes	Yes	No	9
West Virginia	Yes	Yes	No	8
Wisconsin	Yes	Yes	No	7
Wyoming	Yes	Yes	No	6

In the workspace

Family caregiver rules, employers and pay, by state

Which relatives can be paid, who the employer of record is, the fiscal intermediary, caregiver training, how to become a provider and published pay, for every program.

State	Family rules	Employer of record	Fiscal intermediary	Pay

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Eligibility, family caregiver rules, employer of record, fiscal intermediary, caregiver requirements and how to become a provider, for every state, side by side.

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FAQ

Frequently asked questions

What is the difference between home health and home care?

Home health is a medical benefit: nursing, therapy and aide visits ordered by a doctor under a plan of care and delivered by a licensed home health agency. Home care (personal care) is non-medical help with bathing, dressing, meals and daily tasks, based on functional need rather than a skilled need.

What is consumer-directed care?

A Medicaid option in which the person receiving care hires, schedules and supervises their own aide, often a relative, while a fiscal intermediary runs payroll and taxes. New York's CDPAP is the best-known example; most states have a version under another name.

What is structured family caregiving?

A program that pays a family member who lives with the person a daily stipend for ongoing care, with coaching and oversight from an agency that holds the Medicaid contract. The agency, not the family, is the Medicaid provider.

Which states pay family members to be caregivers?

51 of the 51 states compiled so far have at least one Medicaid or state program that pays a family member as the caregiver; 50 have a consumer-directed program and 11 have structured family caregiving. The table above shows each state.