You can get paid to take care of your disabled loved one. Here’s how.
NOTE: This information is accurate as of November 2024, however, changes expected in July 2025 will impact these options. Check back with us for an update!
Many family members have given up their jobs or high-paying careers in order to stay home and take care of a disabled loved one. This increased during the Covid health emergency. Because there is a workforce shortage in home health caregivers, it makes sense that family members should be compensated for some of their caregiving contributions.
The best way to become eligible to get paid for caregiving is to get your disabled loved one enrolled in a Colorado Medicaid HCBS waiver. With a waiver, the caregiver income that eligible family members can earn from Medicaid sources may be exempt from federal IRS taxes. Please consult with your tax professional for details.
Although a waiver is your best long-term path to getting paid as a caregiver, there are other options too. If you are applying for a waiver, the application process can take months, so the other options can ‘fill in the gaps’ while you’re waiting for your waiver to be approved. Here are the steps you can take to become a paid caregiver for your disabled loved one in Colorado:
FIRST: the disabled family member should apply for Colorado Medicaid with the Application for Public Assistance at the county Human Services office.
This allows joint application for food assistance, cash assistance, medical assistance, and for long-term care (state disability determination using the LTC form). Also submit a completed medical information form (PMIP) at the physician medical information page to document diagnoses confirmed by a prescribing medical professional (MD, DO, CNP). And if you are documenting an intellectual and or developmental disability (IDD), make sure to include any additional documentation such as adaptive functional test scores under 70, and put all of those diagnoses on the PMIP form.
Once on Medicaid, there are multiple options: A disabled person who is low income can get on the Medicaid medical state program Health First Colorado (MAGI Medicaid). Another option for those with higher incomes is the premium-based buy in program for disabled children or disabled working adult waiver.
Again, the best long-term option is to enroll the disabled family member in a HCBS Colorado Medicaid Waiver, which is what we help people do in our program, Roadmap for the Waiver Journey. Get state info here: https://hcpf.colorado.gov/hcbs-waivers.
On a Medicaid waiver, family caregivers who qualify to earn income for difficulty of care can have their Medicaid income exempted or deducted from their IRS adjustable gross income (AGI). This means some family caregivers can then qualify for Medicaid medical coverage themselves via MAGI low income criteria since their Medicaid income is not included in their adjustable gross income on their tax return, and nor is child support income. See details here.
SECOND: Once your disabled family member is an active Medicaid member and has a long-term care determination (state disability determination), then he or she can explore qualifying for Health First Colorado services for medically necessary therapies.
These can include speech, occupational, physical therapy and more. The 100.2 level of care assessment (LOC) is required for all Long Term Services Supports (LTSS); this assessment is given by your case management agency, and it is important to ensure that your assessment accurately reflects all of your disabled loved one’s support needs.
Family members can be trained, certified and paid to provide Certified Nursing Aide (CNA) and Private Duty Nursing (PDN) services via an approved Medicaid home health agency. Skilled medical services such as CNA and PDN are all paid through the state ‘Long Term Home Health’ medical Medicaid benefits. Your disabled loved one does not have to be on a Medicaid waiver to receive CNA or PDN services, but he or she does have to financially be on Medicaid another way for eligibility. A disabled loved one on a Medicaid HCBS waiver may qualify for LTSS in addition to HCBS service, depending on their level of support needs.
THIRD: After your disabled loved one has completed state disability determination, has an active Medicaid status, and has completed a 100.2 assessment, then this person is eligible for Colorado Long Term Supports and Services.
For disabled loved ones who need nursing level of care and for whom it is no longer feasible to live within the community, there are long-term care facilities such as Skilled Nursing Facilities (SNF), which after 90 days Medicare will no longer cover, and Intermediate Care Facilities (ICF).
For disabled family members living in the home and community, their best option is to apply for one of Colorado’s ten HCPF Medicaid Waivers for Home and Community Based Support (HCBS). The waiver programs only look at the assets and income of the Medicaid member, not the household income like many other programs. Here’s a rundown on the child and adult waivers:
CHILD WAIVERS
The waivers pay for service and support in the community and some of those services enable family caregivers to be paid for providing care on the four children’s waivers.
- Children's Home and Community-Based Services Waiver (CHCBS): in home support services (IHSS) is a possible way for family members to receive payment from a home health agency with nurse supervision.
- Children's Extensive Support Waiver (CES): a family caregiver parent can be paid for 10 hours a week of Homemaker parental provision and 10 hours a week of Community Connector parental provision. Also, any non-parent family member over 18 who completes requirements can also be paid to provide care.
- Children's Habilitation Residential Program Waiver (CHRP): a parent can provide up to 20 hours a week of Community Connector parental provision. This waiver is for those who qualify under age 21. Also, non-parent family members over 18 who complete requirements can also be paid to provide care.
- Children With Life Limiting Illness wavier (CLLI): it does not offer payment options for family caregivers under HCBS services, but they may qualify for skilled CNA or PDN care, and family members with proper certifications could possibly be paid.
The waivers pay for service and support in the community services. These HCBS Waiver services are either paid via a private Program Approved Service Agency (PASA) or using Consumer Directed Attendant Services and Supports (CDASS) fiscal management service.
CDASS is an option for some services in five of the six adult waivers. The DD waiver does not have the CDASS option; one must use a PASA. Consumer-Directed Attendant Support Services (CDASS) lets you direct and manage the attendants who provide your personal care, homemaker, and health maintenance services, rather than working through an agency.
ADULT WAIVERS
ADULT WAIVERS Parents or family caregivers may be able to be paid to provide caregiving on all six of the adult waivers. There are fewer restrictions for family payment on adult waivers as family members are not expected to give uncompensated support to legal adults.
- Supported Living Services waiver (SLS): there are many services that can be provided by family members if they qualify and are paid via approved medicaid vendors. These are more time and distance-based payments.
- Developmental Disability waiver (DD or Comp): this is a 24/7 waiver and there is the option to use the Family Caregiver Act to receive the IRSS daily residential rate. And there are other services such as transportation, supported Community Connector and more that offer the possibility of payment to family members. The person billing the per diem rate cannot bill other services during their shift, but others can.
- Elderly, Blind and Disabled waiver (EBD): this offers in home support services (IHSS) as a possible way for family members to receive payment from a home health agency with nurse supervision. There is also transportation and other HCBS services which family members may qualify to provide and get paid for via a PASA.
- Colorado Mental Health Services waiver (CMHS): personal care, health maintenance and homemaker are common services that family members can get paid to provide.
- Complementary and Integrative Health Waiver (CIH): (formerly the Spinal Cord Injury waiver): personal care, health maintenance and homemaker are common services that family members can get paid to provide.
- Brain Injury waiver (BI): personal care, health maintenance and homemaker are common services that family members can get paid to provide. This waiver is available to those who qualify, ages 16 and up.
There are projected changes coming in July 2025 when a new roll-out of delivery of services is scheduled to happen. These could affect in-home support services, CNA, PDN, homemaker, personal care and health maintenance activities. We will give you our expert analysis of these changes when they happen!
Outside of the Colorado Medicaid system, you may also qualify for additional SSI or SSDI Federal financial benefits from the Social Security Administration.
- SSI versus SSDI is confusing, here is a link to explain more.
- Some disabled minors (under 18) in very low-income households may qualify for social security benefits to assist with cost of living. Adults with disabilities may qualify for SSI or SSDI.
- All applications are made at Social Security Administration offices. The ability to work in order to support oneself is the crucial lens they use; they are less about medical diagnoses and more about the ability to work significantly.
- At 18 or older, an approved recipient of SSI has a portion of their monthly distributions dedicated to room and board, typically about $750 per month, which can go to their family household budget or toward their agency for residential placement. This can be a great income supplement, especially in addition to any state Medicaid income you are eligible to earn as a caregiver!
If your family has taken a financial hit due to taking care of a disabled loved one, we can help your loved one successfully apply for a Medicaid waiver, which is the best pathway for you to earn future income for the care you’re already providing.
To learn more, sign up for an upcoming Live Info Session, which I personally host about once a month in the evening. We’ll help you chart a course that can improve your finances and help you save more for retirement! Or, if you want to see if waivers might be a good fit, you can complete our online assessment HERE .
