Services My Way DC: Hiring Family as a Paid Medicaid Caregiver

What Services My Way Is

Services My Way is the participant-directed option within DC's Elderly and Persons with Physical Disabilities (EPD) Waiver. Instead of receiving care from an agency-assigned personal care aide, the participant acts as their own employer — selecting, hiring, training, scheduling, and paying their own caregivers using Medicaid-funded hours.

For dementia families, the most significant feature is this: Services My Way allows participants to hire qualified family members, including adult children, as paid personal care aides. A daughter who has been providing unpaid care for years can become a compensated caregiver through the program.

Who Can Be Hired — and Who Cannot

Qualified family members, including adult children, can serve as paid caregivers under Services My Way. The program explicitly permits family member employment, which is not the case in all states' Medicaid waiver programs.

The one restriction: spouses are excluded. A husband or wife cannot be hired as a paid caregiver for their spouse through Services My Way.

The hired family member must meet the program's qualifications and any training or screening requirements tied to the authorized services. Ask the case manager for the current requirements before hiring.

How to Enroll

Services My Way requires the participant to already be enrolled in the EPD Waiver. The eligibility requirements are the same: individual countable assets at or below $4,000, monthly income at or below $2,982, and a nursing facility level of care determination.

Once on the waiver, the participant (or their authorized representative, which is typically the adult child managing care) requests the participant-directed option through their case manager. The transition from agency-directed to participant-directed services involves:

1. Completing a participant-directed services enrollment packet
2. Receiving training on employer responsibilities (timekeeping, payroll documentation, supervision)
3. Setting up the program's payroll and Medicaid billing process
4. Identifying and hiring the caregiver(s)

The participant remains the employer and should confirm the current payroll, tax, and billing process with the case manager or program administrator.

What It Pays

Compensation for personal care aides hired through Services My Way is based on the Medicaid reimbursement rate for PCA services in DC. The rate is set by DHCF and is not negotiable by the participant — it is a fixed hourly amount that the fiscal intermediary pays from the participant's authorized Medicaid hours.

This rate is typically well below what private home care agencies charge (private rates in DC run $32–$38/hour), but for a family member who was previously providing unpaid care, it represents real income for work they were already doing.

The 16-Hour Daily Cap

One structural limitation affects Services My Way participants with advanced dementia: the EPD Waiver caps Personal Care Aide services at 16 hours per day, with no medical necessity exception for 24-hour care. This leaves an 8-hour daily gap that the family must cover through other arrangements or personal time.

For families using Services My Way to pay one adult child as a primary caregiver, this cap defines the maximum paid hours. Care beyond 16 hours per day — including overnight supervision, which is critical for parents who wander — must be covered by unpaid family support, other funded programs (like respite hours), or private resources.

When Participant-Directed Care Makes Sense

Services My Way is strongest when:

• A family member is already the primary caregiver and the only barrier to sustainability is that the caregiving is unpaid
• The parent with dementia has established trust and comfort with a specific family member, and introducing an unfamiliar agency aide would cause distress or resistance
• The family can manage the employer responsibilities (or delegate them effectively to the fiscal intermediary)
• The care needs can be met within the 16-hour daily cap

It is less ideal when the parent's care needs exceed what one family member can safely provide, when the family member lacks training in dementia-specific care techniques, or when the relationship between caregiver and care recipient is strained by the demands of the disease.

The District of Columbia Dementia & Memory Care Guide covers the full EPD Waiver enrollment process including the participant-directed pathway, with specific documentation requirements and the steps to transition from agency-directed to self-directed care.

See more District of Columbia guides →