Get Paid to Care for a Family Member in Maine

You're already doing the work — helping your mother shower, preparing meals, managing medications, driving to every appointment. The question isn't whether you're a caregiver. The question is whether Maine will pay you for it.

In most cases, yes — but through specific MaineCare programs with specific rules about who can be hired and who cannot. Getting this wrong means working for free when you could be earning a wage, or worse, getting hired and then having the payments clawed back because you didn't follow the enrollment process correctly.

The Main Programs

MaineCare offers several pathways for paid family caregiving:

Section 19 Participant-Directed Option (PDO)

Under the Section 19 waiver, your parent can choose the Participant-Directed Option instead of agency-managed care. In PDO mode, your parent (or their authorized representative) becomes the employer. They hire, train, schedule, and supervise their own personal support specialist — and that person can be a family member.

Who can be hired: Adult children, siblings, nieces, nephews, grandchildren, in-laws, and close friends.

Who cannot be hired: Spouses, parents or stepparents of a minor child, and legally responsible relatives. These exclusions are statutory and non-negotiable under both Section 19 and Section 12.

Eligibility for the care recipient: Must meet nursing facility level of care (determined by Maximus assessment), have countable assets under $10,000 (single) or $15,000 (married, both applying), and monthly income at or below $2,982 or qualify through Maine's medically needy deductible/spend-down pathway.

Pay rate: The hourly wage is paid by MaineCare. Your parent exercises "budget authority" to set your wage within the program's overall clinical allocation cap. Rates vary but typically align with the state's personal care worker wage scale.

Section 12 — Consumer Directed Attendant Services (CDAS)

CDAS is specifically designed for self-directed care. It's available to chronically disabled adults who have the cognitive capacity to direct their own personal care. The clinical eligibility threshold is lower than Section 19 — your parent needs help with ADLs but doesn't need to meet nursing home level of care.

Financial eligibility is tighter: Income capped at $1,330/month for a single applicant ($1,804 for couples). Asset limit is $10,000 (single) or $15,000 (married).

Same family hiring rules apply: Adult children can be paid. Spouses and legal guardians cannot.

CDAS is particularly useful when your parent doesn't qualify for Section 19 because their care needs aren't intensive enough for nursing home level of care — but they still need daily help with bathing, dressing, or meals.

Section 96 — Family Provider Service Option (FPSO)

Section 96 also includes a Family Provider Service Option for self-directed personal care when the care recipient has a documented medical need but does not necessarily meet nursing facility level of care. Ask the regional Area Agency on Aging or ADRC about FPSO eligibility and enrollment.

The Fiscal Intermediary: How You Actually Get Paid

In these programs, you don't get paid directly by MaineCare. All payroll flows through a state-contracted Fiscal Intermediary (FI) — such as Alpha One.

The FI handles:

• Employment verification — confirming your citizenship, identity, and work eligibility
• Background checks — criminal background screening, the federal Office of Inspector General exclusion list, and the CNA and Direct Care Worker registries
• Payroll processing — withholding state and federal taxes, processing your timesheets, and issuing biweekly W-2 paychecks

This is a real employment arrangement. You'll receive a W-2 at year's end. Income taxes are withheld. You're building Social Security credits. It's not under-the-table money — it's a documented wage that counts toward retirement benefits.

The Enrollment Process

Getting set up as a paid family caregiver follows a specific sequence:

1. Your parent applies for MaineCare long-term care through the Office of Family Independence (financial eligibility)
2. Your parent requests a Maximus assessment at 1-833-525-5784 (functional eligibility, for Section 19) or contacts their Service Coordination Agency (for CDAS)
3. Your parent chooses the self-directed option — PDO under Section 19, or CDAS enrollment
4. You enroll with the Fiscal Intermediary — the FI, such as Alpha One, runs the background check, verifies your identity, and sets up the payroll account
5. Your parent's care plan specifies your hours and duties — you can't bill for hours that aren't in the authorized plan
6. You submit timesheets — biweekly, through the FI's system

The most common mistake is skipping step 4 and starting to provide paid care before the FI enrollment is complete. Any hours worked before formal enrollment are not reimbursable.

What About the Caregiver Agreement?

If your parent is applying for MaineCare and you've been providing care without a formal agreement, there's a financial risk. The 60-month lookback audit reviews all transfers made during the five years before the MaineCare application. Payments to a family member for care without a pre-existing, written personal support agreement can be classified as uncompensated transfers and trigger a penalty.

The penalty is calculated by dividing the total payments by Maine's transfer penalty divisor of $12,294 per month. If your parent paid you $60,000 over two years without a formal agreement, that's a 4.9-month penalty period during which MaineCare won't pay for care — even after your parent is financially and medically eligible.

A properly drafted caregiver agreement should predate the care, specify the duties and hourly rate, and reflect fair market value for the services provided.

The Maine Home Care, Waivers & Support Guide includes a self-directed hiring checklist and a caregiver agreement framework — the documentation you need to get paid legitimately while protecting your parent's MaineCare eligibility.

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