Medicaid
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Why Spouses Can't Be Paid Under Structured Family Caregiving Program

Spouses can’t be paid caregivers under Medicaid’s Structured Family Caregiving program—explore why and discover alternative caregiving support options here.
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One of the most frequently asked questions we receive is, "Can a spouse care for their spouse under the Structured Family Caregiving program?"

Unfortunately, the answer is no. Medicaid, which oversees the program, has specific rules prohibiting spouses from being paid caregivers under this initiative. Let's look at why this restriction exists and explore alternative options for families in this situation.

Key Takeaways

  • Spouses cannot be paid caregivers under the Structured Family Caregiving program due to Medicaid rules prohibiting payment to legally responsible relatives, like spouses, to maintain program integrity and avoid conflicts of interest.
  • Alternatives include hiring another family member, exploring other Medicaid waiver programs, or seeking support through local Area Agencies on Aging (AAA).
  • Why are spouses not allowed to be paid caregivers?

    The Structured Family Caregiving program—like similar programs across the United States—follows federal Medicaid regulations that prohibit payment for caregiving services provided by legally responsible relatives, including spouses.

    A "legally responsible relative" is a family member, such as a parent of a minor child or a spouse, who has is legally obligated to provide reasonable care to another family member due to their relationship.

    But why is this the case?

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    Who are you caring for?

    There are a few key reasons:

    1. Legal responsibility: Spouses are generally considered to have a legal duty to care for one another under the principles of marital law. This means that many of the tasks performed by a spouse, such as helping with daily living activities, are already expected within the framework of marriage. Paying a spouse for these tasks would blur the line between familial and professional caregiving roles.
    2. Program integrity: The rules aim to maintain the integrity of Medicaid-funded programs. Allowing payment to spouses could create opportunities for fraud or misuse of funds, as it might be challenging to verify whether services are being provided in addition to what would naturally occur within a marriage.
    The concept that spouses have a "duty of care" to one another is not explicitly written into most laws directly relating to caregiving. However, it stems from the broader marital obligations recognized under common law and statutes in many jurisdictions, which establish that spouses are inherently expected to provide mutual support, including financial, emotional, and basic caregiving responsibilities.

    Understanding the frustration

    We understand how frustrating this restriction can feel for families. In many households, the spouse is already the primary caregiver, providing round-the-clock assistance to their loved one. Excluding spouses from compensation can seem like an unfair burden, especially when caregiving responsibilities often limit the spouse's ability to work outside the home. It can also feel like a missed opportunity for Medicaid to support families already saving the system money by avoiding institutional care.

    While these frustrations are valid, remember that the Structured Family Caregiving program is only one of several Medicaid programs available. Each has its own rules and limitations based on the broader goals of Medicaid policy.

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    Alternatives to explore

    If you are a spouse currently caring for your partner, there may be other ways to find support:

    1. Contact Your Local Area Agency on Aging (AAA): Your local AAA is an excellent resource for exploring other caregiving options. They can help connect you with programs and services for your situation, such as respite care, home modifications, or financial assistance.
    2. Consider hiring another family member: While spouses are excluded, other family members—such as adult children, siblings, or in-laws—may qualify as paid caregivers under the Structured Family Caregiving program.
    3. Explore additional Medicaid waiver programs: Beyond Structured Family Caregiving (only available in some states), Medicaid offers other waiver programs which may offer different forms of support.
    4. Look into private pay options: If you have the means, you might consider hiring a professional caregiver privately. While this can be costly, it may provide much-needed respite and help make sure your loved one receives the highest standard of care.

    A note from Givers

    If you're unsure about your options or need guidance, please reach out to contact@joingivers.com. While the journey can be challenging, you don't have to go it alone.

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