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Many individuals in America struggle with balancing their work and family life while saving up for their retirement. All this doesn’t get easy if they are unable to provide live in care services to their senior/minor and are left with no option but doing the job themselves. 

The pressure these caregivers have to deal with gets a lot harder if public policies don’t evolve to respond to their needs. The hustle for time and money puts them in a position where they find themselves overextended in one way or another.

For such people, public policies play an important part in steadying their income. Improved Medicaid policies allow caregivers to stabilize and earn more income, and the Family and Medical Leave Act allow caregivers to loosen work pressure and take temporary leave for care giving. However, currently, the policies are limited in scope and are unable to address the negative impact on the caregiver’s Social Security work credits.

Current Policies Affecting Caregivers

Multiple Medicaid mechanisms authorize fund­ing for professional home care services, but often, family caregivers are excluded. According to Medicaid regulations, “personal care services” are clear to exclude services provided by a “legally respon­sible relative,” such as a parent or the spouse of a minor (Code of Federal Regulations, Title 42, Section 440.167). This regulatory limitation a lot of times has prevented natural caregivers (spouses or parents) from getting the authorized payment.

Moreover, Medicaid Home and Com­munity-Based Services (HCBS) programs have the legal authority to fund personal care services pro­vided by responsible relatives. The policy was written based on what is best for both the caregiver and the Medicaid ben­eficiary. In such cases, the responsible relative might as well need to work to maintain a sufficient income, and the program sees no reason to drive the rela­tive to seek external employment while paying a third person to be the caregivers. The Medicaid beneficiary always prefers that the relative is the service provider. Medicaid personal care programs, however, usually pay at a low rate. In Los Angeles County, the In-Home caregiving service program pays $11.18 per hour for personal care services, while the minimum wage there is $12 to $13.25.

One route to Medicaid payment of caregiving relatives is based on a state’s choice: in Med­icaid HCBS waivers, each state can choose to seek contract of the rule that would otherwise prohibit payment to responsible relatives (Code of Federal Regulations, Title 42, Section 440.167). Another route that arises from Medicaid’s move towards consumer-directed services. In this rule, the Medicaid beneficiary has the principal say on how services are provided and by whom. According to the agreement, the authorizing statute (enacted in 2006) conditions that the beneficiary may “choose to use any individual capable of providing the assigned tasks, including legally liable relatives as paid providers of the services” (United States Code, Title 42, Section 1396n[j]).

Final word

Public policy’s effect on the income of a caregiver, regardless of their relationship with the elderly/minor, is significant. Effective changes time-to-time can further facilitate caregivers on various grounds. Legislatures and relevant government agencies must address the issues and needs of the citizens who cannot afford caregiving services and other facilities like light housekeeping in Maryland.


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