Updated September 3, 2026. Quick answer: yes, through Community First Choice (CFC), self-directed Personal Assistance Services. Most adult family members can be hired and paid to provide the care. Whether a spouse specifically qualifies is not clearly stated in the materials reviewed this session.
How Maryland pays a family caregiver
| Program | Community First Choice (CFC), self-directed Personal Assistance Services |
|---|---|
| Can a family member be paid? | Yes. “Supports planning services shall: … Support the participant to self-direct services and exercise as much control as desired to select, train, supervise, schedule, determine duties, and dismiss the personal assistance worker.” |
| Can a spouse be paid? | Not clearly addressed in the materials reviewed this session. “”Representative” means: (a) The person authorized by the individual to serve as a representative… (d) A legal guardian of the individual for the participant; or (e) The parent or foster parent of a dependent minor child. … A personal assistance provider agency may not assign the participant’s representative to provide services to that participant.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
A person applies through Maryland Medicaid’s Long Term Care and Waiver Services / a local Supports Planning agency; CFC is a State Plan personal-care benefit built around participant self-direction, where the participant selects, trains, schedules, and can dismiss their own worker.
What this doesn’t answer
Maryland’s own regulation (COMAR 10.09.84) never uses the word “spouse” or “family member”. It only bars the participant’s plan-of-service “representative” (decision-maker/guardian/parent-of-a-minor) from also being the paid worker, a narrower and different rule than a spousal exception, so spousal eligibility is left Unclear rather than asserted. No published hourly rate was found.
Sources
- Library of Maryland Regulations: COMAR 10.09.84, Community First Choice
- Maryland Dept. of Health: Plan of Service (POS) Reviewer Training Manual
- Maryland Dept. of Health: Community First Choice Fact Sheet
Read September 3, 2026.
Same question, other states: Massachusetts · Michigan.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.