Why Programs Differ by State

Medicaid is a joint federal-state program. The federal government sets minimum standards and provides matching funds, but each state has significant flexibility in designing its programs. This means that the availability of paid caregiver options, the family relationships allowed, pay rates, and waiting list lengths all vary from state to state.

Some states have invested heavily in home and community-based care as an alternative to nursing homes, resulting in robust paid caregiver programs. Others have more limited options or longer waiting lists.

States with the Strongest Programs

Several states are recognized for having particularly strong paid family caregiver programs:

• California (IHSS) — one of the largest programs in the country; pays family members including spouses in many cases; over 600,000 recipients
• New York (CDPAP) — allows recipients to hire almost any adult including family members; covers a wide range of services
• Washington — strong consumer-directed options through the Medicaid Personal Care program
• Oregon — robust HCBS waiver programs with consumer-directed options
• Minnesota — Personal Care Assistance (PCA) program with strong consumer-direction options
• Massachusetts — Personal Care Attendant (PCA) program with broad family caregiver eligibility

What to Look for in Your State

When researching paid caregiver programs in your state, look for these key features:

• Consumer-directed or self-directed care options within HCBS waiver programs
• Whether spouses are allowed as paid caregivers
• Whether parents of minor children are allowed as paid caregivers
• Current waiting list status and estimated wait times
• Pay rates for personal care workers in your area
• Whether there are multiple waiver programs targeting different populations

States with Waiting Lists

Many states have waiting lists for HCBS waiver programs because the number of available slots is capped. States like Texas, Florida, and Georgia have historically had long waiting lists for some waiver programs — sometimes years.

If your state has a waiting list, it's important to apply as soon as possible, even if you don't need services immediately. Your position on the list is typically based on your application date.

How to Find Your State's Programs

The best way to find paid caregiver programs in your state is to contact your state's Medicaid office directly. You can also use the following resources:

• Your state's Medicaid website (search "[your state] Medicaid home and community-based services")
• Your local Area Agency on Aging (AAA) — find yours at eldercare.acl.gov
• Your state's Department of Developmental Services (for disability-related programs)
• A Medicaid planning specialist or elder law attorney
• Our free eligibility check below

Pay Rates by Region

Pay rates for family caregivers generally mirror the rates paid to agency home care aides in each state. Rates tend to be higher in states with higher costs of living. As a general range, most states pay between $12 and $22 per hour for personal care services, with some high-cost states like California, New York, and Massachusetts paying at the higher end of that range or above.