Consumer Directed Care in Maine

What Consumer Directed Care Means in Maine

Consumer Directed Attendant Services — Section 12 in the MaineCare Benefits Manual — is the program that lets eligible seniors hire, train, schedule, and manage their own personal care assistants. That includes qualified family members. Instead of an agency sending an aide on their schedule, your parent chooses who provides the care and controls when and how it's delivered.

For families where an adult child or spouse has been providing unpaid care and absorbing the financial hit — reduced work hours, career disruption, physical and emotional exhaustion — CDAS converts that unpaid labor into compensated employment through MaineCare.

Who Qualifies

CDAS eligibility has two requirements that both must be met.

Financial eligibility: The senior must qualify for MaineCare long-term care benefits. That means countable assets below $10,000 for a single applicant and gross monthly income under $2,982. Married couples with one spouse applying benefit from the Community Spouse Resource Allowance, which protects up to $162,660 in assets for the community spouse.

Cognitive capacity to self-direct: This is the requirement that eliminates many potential participants. The senior must demonstrate the cognitive ability to hire, train, supervise, and if necessary fire their own care worker. They need to understand and communicate their care needs, manage the employment relationship, and handle or delegate the associated paperwork.

That second requirement creates a hard boundary. A parent with moderate to advanced Alzheimer's or another form of dementia that impairs decision-making will not qualify for CDAS — even if they clearly need personal care services. The program is designed for seniors who are physically dependent but cognitively capable of directing their own care.

If your parent doesn't meet the cognitive self-direction standard, they can still access personal care services through agency-managed programs: Section 19 (Elderly and Adults with Disabilities Waiver), Section 96, or Section 63 (Home Based Care, though the waitlist currently exceeds 1,200 people).

How Family Caregiver Employment Works

Once approved for CDAS, your parent becomes the employer. The family member becomes the employee — a Personal Support Specialist. The practical mechanics:

Who can be hired: An adult child, sibling, grandchild, niece, nephew, or other family member can serve as the PSS, provided they aren't the senior's legal guardian or representative payee. A spouse generally cannot be hired as a PSS under CDAS, though they may be eligible for compensation through other MaineCare programs.

Compensation: The hourly rate is set by MaineCare — it's lower than what a private-pay agency charges, but it's steady income for a family member who would otherwise be providing unpaid care. The rate varies and is subject to periodic adjustments.

Training requirements: The family caregiver must complete a PSS certification process, which includes a state-approved training program (typically 50 hours) covering personal care techniques, infection control, emergency response, and documentation. Some training programs are available online, others in person through local providers.

Administrative support: A fiscal intermediary — an organization contracted by MaineCare — handles payroll, tax withholding, workers' compensation insurance, and unemployment insurance for the caregiver. The senior doesn't need to run their own payroll operation.

CDAS vs. Section 19 Waiver

Both programs serve MaineCare-eligible seniors who need help with activities of daily living. The differences determine which one fits your parent's situation:

Control. CDAS gives the senior full control over who provides care and when. Section 19 uses agency-managed care — the agency assigns the aides, sets the schedule, and supervises the workers.

Cognitive requirement. CDAS requires self-direction capacity. Section 19 has no cognitive capacity requirement — it serves seniors with any level of dementia.

Service scope. Section 19 covers a broader range of services: personal care, nursing, home-delivered meals, assistive technology, home modifications, and respite care. CDAS covers personal care attendant services.

Waitlist. Neither program currently maintains a waitlist, which gives eligible seniors an advantage over the state-funded Section 63 and Section 69 programs.

Combining programs. CDAS can be used alongside Section 19 waiver services. A senior might receive agency-managed nursing visits through Section 19 while employing a family member for daily personal care through CDAS. The service plans must be coordinated to avoid duplication.

The Application Process

Applying for CDAS runs through the same pathway as other MaineCare long-term care programs:

Submit a long-term care MaineCare application to the Office for Family Independence. OFI processes the financial eligibility determination. Simultaneously, OFI issues a Form 123 to Maximus, the state's contracted clinical assessment vendor, which triggers a Medical Eligibility Determination to confirm the senior meets the functional criteria for personal care services.

Once both financial and medical eligibility are confirmed, the senior works with their case manager to develop a person-centered service plan that specifies the number of authorized care hours, the tasks covered, and the employment arrangement. The fiscal intermediary is then notified to begin processing payroll for the family caregiver.

The process typically takes several weeks from application to first paycheck. Starting the MaineCare application early — before a crisis forces a rushed decision — gives the family time to complete the PSS training requirement while the eligibility determination is in progress.

Is CDAS Right for Your Family

The program works best when three conditions align: the parent is physically dependent but cognitively capable of managing the care relationship, a family member is willing and available to provide consistent daily care, and the family needs the income that compensated caregiving provides.

If your parent's cognitive capacity is declining and may not support self-direction for much longer, the window to establish CDAS is closing. Acting now — while the cognitive assessment can be passed — lets you set up the employment relationship before the program becomes inaccessible.

For families weighing CDAS against other care options, the complete care decision framework covers how consumer-directed care fits into the broader landscape of home care, assisted living, and nursing facility placement in Maine.

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