GuideHome health vs home care vs consumer-directed care in Maryland
What each kind of program is, who employs the caregiver and when a family member can be paid.
Home health: the medical benefit
In Maryland, skilled home health is Home Health Services. It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.
Only a licensed home health agency enrolled with Maryland Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits. Family members are not paid under this benefit.
Home care: non-medical personal care through an agency
Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Maryland the agency route is Community First Choice Program (CFC) and Community Personal Assistance Services Program (CPAS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.
The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.
Consumer-directed care: the person hires their own aide
Maryland's consumer-directed option is Self-Directed Services Delivery Model (DDA). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.
This is the route most families use to be paid: Self-Directed Services Delivery Model (DDA) allows a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.
Structured family caregiving: a paid live-in family caregiver
Maryland has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Self-Directed Services Delivery Model (DDA)), by the hour, as the participant's chosen aide.
Other ways Maryland pays for care at home
Waiver in-home services: Community Pathways Waiver, Home and Community-Based Options Waiver, and Increased Community Services Program (ICS). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.
State-funded: Attendant Care Program (ACP). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.
Which one fits
- Needs nursing, wound care, injections or therapy at home: home health (Home Health Services).
- Needs daily help and wants an agency to supply and manage the aide: Community First Choice Program (CFC) and Community Personal Assistance Services Program (CPAS).
- Wants to choose the aide, including a relative where allowed: Self-Directed Services Delivery Model (DDA).
- Meets nursing-home level of care and needs more than personal care: Community Pathways Waiver, Home and Community-Based Options Waiver, and Increased Community Services Program (ICS).