Hire a Family Member as a Caregiver in Connecticut Through Medicaid

Yes, Connecticut Lets You Get Paid to Care for Your Parent

Connecticut's Community First Choice (CFC) program allows a Medicaid-enrolled parent to hire their own personal care assistants — including adult children, grandchildren, siblings, and friends — and pay them with Medicaid funds. The parent (or their legal representative) acts as the employer of record, choosing who to hire, setting schedules, and directing the care.

This is not a stipend or a nominal payment. CFC pays hourly wages processed through a fiscal intermediary, with taxes withheld and proper employment documentation. For adult children who have reduced their work hours or left jobs to care for a parent, CFC can replace some of that lost income while ensuring the parent receives care from someone they trust.

Who Can Be Hired (and Who Cannot)

CFC gives families wide latitude in hiring, but Connecticut law enforces three absolute exclusions. The parent cannot hire:

1. Their legal spouse
2. Their designated Health Care Representative — the person authorized to make medical decisions cannot simultaneously be the paid caregiver
3. Their court-appointed Conservator or Guardian — same conflict-of-interest principle

Adult children, grandchildren, and friends are among the people who may be hired. The hired personal care assistant must be at least 16 years old, physically capable of performing the required care tasks, and must pass a criminal background check and registry check.

The Health Care Representative exclusion catches families off guard. If you signed your parent's advance directive as their health care agent and you also want to be their paid caregiver, you will need to have a different family member designated as the health care representative. Plan this before starting the CFC enrollment process.

The Clinical Bar: Three ADLs

CFC is not available to every elder receiving Medicaid. The program requires an institutional level of care, which Connecticut defines as needing hands-on assistance with at least three Activities of Daily Living — bathing, dressing, toileting, transferring, or eating.

For parents with severe cognitive impairment (advanced Alzheimer's or dementia), the threshold can be met with two ADLs plus a documented need for 24-hour safety monitoring.

This clinical bar is higher than the general CHCPE threshold. Your parent may qualify for homemaker-companion services through the CHCPE but not meet the CFC criteria if their needs are below the three-ADL mark.

How GT Independence Handles the Employer Side

Connecticut consolidated all self-directed care programs under a single fiscal intermediary: GT Independence (effective March 24, 2024). GT Independence handles the employer paperwork that would otherwise fall entirely on the family:

• Onboarding: Credentialing packets for new personal care assistants, reviewed within ten business days
• Payroll processing: Tax withholding, direct deposit, W-2 issuance
• Timesheet management: Electronic visit verification through a mobile app
• Provider enrollment: Coordinating with Gainwell Technologies to issue an active Provider ID

The family's role as employer is real: you set the schedule, direct the care tasks, and manage the relationship. GT Independence handles the financial administration. Credentialing packets are reviewed within ten business days of receipt, followed by Gainwell enrollment before funds can be disbursed — plan for the required steps between CFC authorization and payment.

CFC vs. the Adult Family Living Stipend

Families sometimes ask whether CFC or the Adult Family Living (AFL) program is the better option. They serve different caregiving arrangements:

CFC pays hourly wages for a PCA who visits the parent's home to provide care. The PCA does not need to live with the parent. Taxes are withheld. Best for: a family member providing scheduled hours of care while maintaining their own household.

AFL pays a tax-free stipend to a live-in caregiver. The caregiver and parent share a household. Best for: a family member who has moved in with the parent (or the parent has moved in with them) and provides ongoing daily care.

If you live with your parent and provide care around the clock, AFL may be simpler. If you drive over for four hours each morning to help with bathing, meals, and medication management, CFC's hourly structure fits better.

How to Start the CFC Process

1. Confirm Medicaid enrollment. Your parent must be an active HUSKY C member. If they are not yet enrolled, the CHCPE Category 3 Medicaid application and CFC enrollment can be pursued simultaneously.
2. Request a CFC assessment. The Access Agency care manager evaluates whether your parent meets the three-ADL institutional level of care.
3. Designate yourself as the PCA. Tell the care manager you want to self-direct care and hire a family member.
4. Complete GT Independence onboarding. Both you (as employer representative) and the hired PCA submit credentialing paperwork.
5. Begin services once the Provider ID is active.

The Aging in Place in Connecticut guide includes a Family Caregiver Agreement template designed to document the employment relationship in a format that withstands Medicaid auditor scrutiny — critical if your parent's financial records are ever reviewed during a lookback.

See more Connecticut guides →