Medicaid covers in-home care through baseline benefits, HCBS waivers, and Community First Choice programs. Family members can get paid through "self-directed," "consumer-directed," or "participant-directed care" where recipients act as employers hiring family members within state rules. The 2024 80/20 rule requires 80% of HCBS funds go directly to caregivers. The One Big Beautiful Bill (2025) cuts Medicaid spending $1 trillion over 10 years, threatening HCBS programs.

Read more