Latest / Home Care Powered By AUAF / Paid Caregiving for Spouses: Medicaid, VA Benefits, and Insurance Options

Transcript

Paid Caregiving for Spouses: Medicaid, VA Benefits, and Insurance Options · Home Care Powered By AUAF

• 0:00
  SPEAKER_00: Welcome to the Home Care Powered by AUAF podcast.
• 0:03
  SPEAKER_00: You know, when we take marriage vows, we uh we promise to stay together in sickness and in health.
• 0:09
  SPEAKER_01: Right.
• 0:09
  SPEAKER_01: The classic vows.
• 0:10
  SPEAKER_00: Yeah.
• 0:11
  SPEAKER_00: But what literally nobody tells you at the altar is that if your spouse actually gets sick, taking full-time care of them could, I mean, it could legally and financially bankrupt you.
• 0:22
  SPEAKER_01: Oh, absolutely.
• 0:22
  SPEAKER_00: Unless, of course, you somehow know how to navigate this completely hidden labyrinth of state and federal loopholes.
• 0:29
  SPEAKER_01: Trevor Burrus, Jr.: Yeah.
• 0:29
  SPEAKER_01: The reality of those vows is that the you know the romanticized emotional duty of caregiving, it slams very quickly into this harsh brick wall of lost wages and uh depleted savings and just systemic bureaucracy.
• 0:44
  SPEAKER_00: Aaron Powell Which brings us to the core mission of today's deep dive.
• 0:46
  SPEAKER_00: We are unpacking a question that completely upends the lives of millions of married couples, which is can I get paid to care for my spouse?
• 0:54
  SPEAKER_01: Aaron Powell It's the million-dollar question.
• 0:56
  SPEAKER_00: Literally.
• 0:56
  SPEAKER_00: So to decode this, we are relying on a stack of resources from home care powered by EUAF.
• 1:02
  SPEAKER_00: Aaron Ross Powell, Jr.
• 1:02
  SPEAKER_01: Right.
• 1:02
  SPEAKER_01: They're an agency with over 30 years of on-the-ground experience in the Chicagoland area.
• 1:06
  SPEAKER_00: Aaron Powell Exactly.
• 1:07
  SPEAKER_00: And we're looking heavily at a really detailed July 2026 article by Rana Batani on spousal caregiving options.
• 1:15
  SPEAKER_00: So whether you are trying to map out your own family's future, or you're helping aging parents, or you're just fascinated by this massive societal shift.
• 1:23
  SPEAKER_00: Trevor Burrus, Jr.
• 1:23
  SPEAKER_01: Because it is a massive shift.
• 1:24
  SPEAKER_01: Yeah.
• 1:25
  SPEAKER_00: Oh, totally.
• 1:25
  SPEAKER_01: Yeah.
• 1:26
  SPEAKER_00: This deep dive is going to be your roadmap through the confusing maze of caregiving compensation.
• 1:31
  SPEAKER_01: Aaron Ross Powell Well, the short answer to that central question is thankfully, yes, eligible spouses can get paid.
• 1:36
  SPEAKER_00: Okay, good.
• 1:37
  SPEAKER_01: But the real answer is heavily dependent on geography, your veteran status, and uh the fine print of your insurance.
• 1:44
  SPEAKER_00: Aaron Powell Right.
• 1:45
  SPEAKER_00: Okay, let's unpack this, starting with the state-by-state maze.
• 1:48
  SPEAKER_00: Because the text begins with the most common path people attempt to navigate first, right?
• 1:52
  SPEAKER_01: Aaron Ross Powell Yeah.
• 1:53
  SPEAKER_01: The state funded care programs and Medicaid waivers.
• 1:56
  SPEAKER_00: Trevor Burrus, Jr.
• 1:56
  SPEAKER_00: Right.
• 1:56
  SPEAKER_00: Medicaid waivers.
• 1:57
  SPEAKER_00: Which I mean that sounds like legal jargon.
• 1:59
  SPEAKER_00: What is a waiver exactly?
• 2:00
  SPEAKER_01: Aaron Ross Powell Well, historically, Medicaid primarily paid for institutional care, like nursing homes, but those are astronomically expensive for the state.
• 2:07
  SPEAKER_00: I can imagine.
• 2:08
  SPEAKER_01: So a waiver is essentially the state government saying, hey, we are going to waive our normal rules.
• 2:13
  SPEAKER_01: Instead of paying for a facility bed, we'll let this person direct their own care at home.
• 2:17
  SPEAKER_00: Aaron Powell Got it.
• 2:18
  SPEAKER_00: And that triggers when they need help with ADLs, right?
• 2:20
  SPEAKER_01: Aaron Powell Yes.
• 2:21
  SPEAKER_01: Activities of daily living, like bathing, dressing, meal prep.
• 2:25
  SPEAKER_01: If they need physical assistance with those, many of these waivers are uh consumer directed.
• 2:30
  SPEAKER_00: Aaron Powell Meaning the patient gets to pick who helps them.
• 2:33
  SPEAKER_01: Exactly.
• 2:34
  SPEAKER_01: Which can include hiring their spouse.
• 2:36
  SPEAKER_00: Okay.
• 2:36
  SPEAKER_00: So let's focus on Illinois since our sources are based in Chicagoland.
• 2:40
  SPEAKER_00: The text highlights a massive recent change here.
• 2:42
  SPEAKER_01: Aaron Powell Oh, the 2026 update.
• 2:44
  SPEAKER_00: Yeah.
• 2:44
  SPEAKER_00: This 2026 policy update in Illinois that expanded who can qualify for the community care program.
• 2:50
  SPEAKER_01: Aaron Powell or the CCP, which is run by the Illinois Department on Aging.
• 2:53
  SPEAKER_01: That update is huge because it finally expands eligibility.
• 2:57
  SPEAKER_00: Aaron Powell But I got a pushback here because it's not a universal safety net, right?
• 3:01
  SPEAKER_00: Like why do the rules differ so wildly if Medicaid is federal?
• 3:05
  SPEAKER_01: Aaron Powell Because the waivers are administered by individual states.
• 3:08
  SPEAKER_01: So what works in Illinois under the CCP might be explicitly banned in another state.
• 3:15
  SPEAKER_01: Like, really?
• 3:16
  SPEAKER_01: Oh yeah.
• 3:16
  SPEAKER_01: Some states completely exclude spouses from certain waiver programs.
• 3:20
  SPEAKER_01: You won't get a dime.
• 3:21
  SPEAKER_00: That is wild.
• 3:22
  SPEAKER_00: It's basically like trying to use a generic gift card, only to realize every single state has completely different fine print on what you're actually allowed to buy with it.
• 3:32
  SPEAKER_01: It's a perfect analogy.
• 3:33
  SPEAKER_00: And the text points out another massive hurdle.
• 3:36
  SPEAKER_00: The eligibility for the care recipient and the caregiver are assessed separately.
• 3:41
  SPEAKER_01: Right.
• 3:41
  SPEAKER_01: It's a double hurdle.
• 3:42
  SPEAKER_00: So just because, say, my husband is sick, that doesn't mean I'm automatically approved to be his paid caregiver.
• 3:49
  SPEAKER_01: Absolutely not.
• 3:50
  SPEAKER_01: The state assesses him to see if he needs care, and then they assess you to see if you are physically and legally qualified to provide it.
• 3:57
  SPEAKER_00: Wow.
• 3:57
  SPEAKER_00: Okay.
• 3:58
  SPEAKER_00: So state programs are incredibly slow and confusing.
• 4:01
  SPEAKER_00: Let's pivot to the federal fast track, or I guess VA benefits.
• 4:04
  SPEAKER_01: Yeah, because this path often has clearer rules if you qualify.
• 4:08
  SPEAKER_01: There are three specific VA programs we need to look at.
• 4:11
  SPEAKER_00: Okay.
• 4:11
  SPEAKER_00: Lay them out for me.
• 4:12
  SPEAKER_01: First is aid in attendance.
• 4:14
  SPEAKER_01: This is a VA pension benefit that basically adds extra monthly funds for veterans or surviving spouses who need daily help.
• 4:20
  SPEAKER_00: So it's just extra cash added to the pension.
• 4:23
  SPEAKER_01: Essentially, yes.
• 4:25
  SPEAKER_01: Then there's veterans directed care.
• 4:27
  SPEAKER_00: And how is that different?
• 4:28
  SPEAKER_01: This one lets eligible veterans manage a home care budget themselves.
• 4:33
  SPEAKER_01: So they actually get a budget and they can use it to hire a spouse.
• 4:36
  SPEAKER_00: Oh, nice.
• 4:37
  SPEAKER_01: And the third one The comprehensive assistance for family caregivers.
• 4:41
  SPEAKER_01: That provides a direct monthly stipend for a spouse caring for a veteran with a qualifying service connected disability.
• 4:49
  SPEAKER_00: Here's where it gets really interesting, though.
• 4:51
  SPEAKER_01: How so?
• 4:51
  SPEAKER_00: Well, put yourself in the listener's shoes.
• 4:54
  SPEAKER_00: If my spouse is sick and I am already drowning in medication management and I'm doing all the household chores.
• 5:01
  SPEAKER_01: You're exhausted.
• 5:01
  SPEAKER_00: Exactly.
• 5:02
  SPEAKER_00: I'm completely burnt out.
• 5:03
  SPEAKER_00: Yeah.
• 5:03
  SPEAKER_00: Navigating overlapping federal VA bureaucracy sounds literally impossible.
• 5:09
  SPEAKER_00: It might deter me from even trying.
• 5:11
  SPEAKER_01: And that is a completely valid concern.
• 5:13
  SPEAKER_01: The bureaucracy is incredibly daunting.
• 5:16
  SPEAKER_01: Right.
• 5:16
  SPEAKER_01: Which is why the source heavily recommends using a local veteran service officer or VSO.
• 5:21
  SPEAKER_00: Okay, dude.
• 5:22
  SPEAKER_01: They navigate all the paperwork for you and it's at no cost.
• 5:25
  SPEAKER_01: But the key here is timing.
• 5:27
  SPEAKER_00: Because it's the government, so it takes forever.
• 5:29
  SPEAKER_01: Exactly.
• 5:30
  SPEAKER_01: Processing takes weeks to months, so you must apply before the caregiving need becomes a full-blown emergency.
• 5:37
  SPEAKER_00: You can't wait until you're completely underwater.
• 5:39
  SPEAKER_01: No, by then it's too late to wait for the VA to process your forms.
• 5:43
  SPEAKER_00: Okay, so we have state Medicaid, we have federal VA benefits, but what if you don't qualify for Medicaid and you're not a veteran?
• 5:50
  SPEAKER_01: Then you're usually looking at private long-term care insurance.
• 5:53
  SPEAKER_00: Which brings us to the private insurance track.
• 5:56
  SPEAKER_01: Yes.
• 5:56
  SPEAKER_01: This is a tough one.
• 5:58
  SPEAKER_00: I was shocked reading this part.
• 5:59
  SPEAKER_00: So you're telling me a couple could pay premiums for decades to protect themselves, and then the policy explicitly prevents the healthy spouse from being paid.
• 6:09
  SPEAKER_01: In many cases, yes.
• 6:10
  SPEAKER_01: There is a massive difference between older and newer insurance policies.
• 6:14
  SPEAKER_01: Right.
• 6:15
  SPEAKER_01: Older policies often strictly restrict payment to licensed home care agencies.
• 6:20
  SPEAKER_01: They just will not pay an informal family caregiver like a spouse.
• 6:24
  SPEAKER_00: That is so frustrating.
• 6:25
  SPEAKER_00: To pay all that money and then be told, sorry, your healthy wife doing all the grueling daily work gets nothing.
• 6:32
  SPEAKER_01: It is.
• 6:32
  SPEAKER_01: But newer policies are starting to change that and might explicitly allow family caregivers to be compensated.
• 6:38
  SPEAKER_00: Aaron Powell But even if the policy won't pay the spouse directly, there's another angle here.
• 6:42
  SPEAKER_01: Right.
• 6:43
  SPEAKER_01: You have to look closely at the paperwork to see if it covers supplemental professional home care.
• 6:48
  SPEAKER_00: Aaron Powell Supplemental.
• 6:49
  SPEAKER_01: Yeah.
• 6:50
  SPEAKER_00: Meaning bringing someone else in.
• 6:51
  SPEAKER_01: Yes.
• 6:52
  SPEAKER_01: Because of burnout.
• 6:53
  SPEAKER_01: The daily reality of caregiving is brutal.
• 6:56
  SPEAKER_00: Aaron Ross Powell Oh, I mean your daily life just completely expands into managing medications, doctor's appointments, household tasks.
• 7:03
  SPEAKER_01: Aaron Powell And you're often doing all of that while still working your own job.
• 7:06
  SPEAKER_00: Aaron Powell Or managing your own health issues.
• 7:08
  SPEAKER_01: Aaron Powell Exactly.
• 7:09
  SPEAKER_01: So having an agency step in for respite care, even just a few hours a week, is the only way to make staying at home sustainable.
• 7:16
  SPEAKER_00: Aaron Powell Otherwise you're looking at a nursing home which nobody wants.
• 7:18
  SPEAKER_01: Right.
• 7:19
  SPEAKER_00: So this bridges the gap to what agencies like home care, powered by AUAF, actually do to support these families in Illinois, right?
• 7:27
  SPEAKER_01: Aaron Ross Powell, Jr.
• 7:27
  SPEAKER_01: Yes.
• 7:28
  SPEAKER_01: They physically step in to provide that exact support.
• 7:30
  SPEAKER_01: And they abide by those Illinois community tear program requirements we talked about.
• 7:35
  SPEAKER_00: Aaron Powell And they've been doing this for over 30 years in the Chicagoland area.
• 7:39
  SPEAKER_01: Trevor Burrus, which means they really understand the nuances of keeping someone independent at home.
• 7:44
  SPEAKER_00: Yeah, the source lists their services and it's super comprehensive.
• 7:47
  SPEAKER_00: Personal care, meal prep, medication reminders, lighthousekeeping, laundry, errands.
• 7:53
  SPEAKER_01: Companionship too.
• 7:54
  SPEAKER_00: Oh, and private sitters.
• 7:56
  SPEAKER_01: Yeah.
• 7:56
  SPEAKER_00: With specialized care for Alzheimer's and dementia, which is huge.
• 7:59
  SPEAKER_01: It's vital.
• 8:00
  SPEAKER_01: And their service area is massive.
• 8:02
  SPEAKER_00: I know.
• 8:02
  SPEAKER_00: I was looking at the list.
• 8:03
  SPEAKER_00: It's basically everywhere.
• 8:04
  SPEAKER_00: Chicago, Arlington Heights, Barrington, Bloomingdale.
• 8:08
  SPEAKER_01: Evanston, Hoffman Estates.
• 8:09
  SPEAKER_00: Yeah.
• 8:09
  SPEAKER_00: Lincolnwood, Morton Grove, Mount Prospect, Niles, Palatine, Roselle, Schomburg, Skokie, and Streamwood.
• 8:16
  SPEAKER_01: And they partner with all the major health plans, too.
• 8:18
  SPEAKER_01: Trevor Burrus, Jr.
• 8:18
  SPEAKER_00: Right.
• 8:19
  SPEAKER_00: Medicaid, Aetna, Blue Cross, Blue Shield, County Care, Humana, Meridian, Molina.
• 8:25
  SPEAKER_00: They take practically everything.
• 8:26
  SPEAKER_01: Aaron Powell But there's one detail about AUAF that really stands out when we talk about tailored care.
• 8:31
  SPEAKER_00: The languages.
• 8:32
  SPEAKER_00: I thought that was incredible.
• 8:33
  SPEAKER_00: Their staff is fluent in a wide array of languages.
• 8:36
  SPEAKER_00: English, Assyrian, Arabic, Spanish, Polish, Russian, Ukrainian, and Persian.
• 8:41
  SPEAKER_00: Right.
• 8:42
  SPEAKER_00: So what does this all mean?
• 8:43
  SPEAKER_01: Aaron Ross Powell It means that if you're an elderly patient, maybe dealing with dementia, having someone speak your native language is a massive comfort.
• 8:50
  SPEAKER_00: It changes everything.
• 8:51
  SPEAKER_00: It takes it from being just medical care to actual human connection.
• 8:55
  SPEAKER_01: Exactly.
• 8:55
  SPEAKER_00: So for you listening, whether you need help navigating that 2026 Illinois policy update where you just desperately need respite care to avoid burnout, you aren't alone.
• 9:04
  SPEAKER_01: You don't have to figure this out by yourself.
• 9:06
  SPEAKER_00: No.
• 9:07
  SPEAKER_00: You can call them to figure out your specific situation.
• 9:10
  SPEAKER_00: Their number is 773-274-9262.
• 9:14
  SPEAKER_00: Again, 773-274-9262.
• 9:18
  SPEAKER_01: It's a great resource.
• 9:19
  SPEAKER_00: So just to summarize everything we've thrown at people today.
• 9:21
  SPEAKER_01: Sure.
• 9:22
  SPEAKER_01: The core takeaway is that paid spousal care giving is possible.
• 9:25
  SPEAKER_00: Okay.
• 9:26
  SPEAKER_01: But you have to investigate the three distinct paths.
• 9:28
  SPEAKER_01: The state Medicaid waivers, which remember, have that double hurdle.
• 9:31
  SPEAKER_01: Right.
• 9:32
  SPEAKER_01: VA benefits where you absolutely should use a VSO.
• 9:35
  SPEAKER_00: And apply early.
• 9:36
  SPEAKER_01: Yes, apply early.
• 9:37
  SPEAKER_01: And finally, long-term care insurance, where you really have to read the fine print.
• 9:42
  SPEAKER_00: And most importantly, acknowledging that caregiving requires a support system.
• 9:47
  SPEAKER_01: You cannot do it alone without burning out.
• 9:50
  SPEAKER_00: So we really hope this deep dive acts as a shortcut for you, whether you're having this conversation with your spouse tonight over dinner, or you're just filing the knowledge away for your aging parents.
• 10:00
  SPEAKER_01: You're now equipped to ask the right questions before a crisis hits.
• 10:04
  SPEAKER_00: Exactly.
• 10:05
  SPEAKER_00: But before we wrap up, you mentioned a really provocative thought earlier that wasn't strictly in the sources, but it builds on all this.
• 10:13
  SPEAKER_01: Yeah.
• 10:13
  SPEAKER_01: I think it's something really important for people to ponder.
• 10:16
  SPEAKER_00: Let's hear it.
• 10:17
  SPEAKER_01: Well, as medical advancements allow us to live much longer, you know, and the preference heavily shifts towards staying at home rather than going to nursing facilities.
• 10:26
  SPEAKER_00: Which is great, obviously.
• 10:27
  SPEAKER_01: It is.
• 10:28
  SPEAKER_01: But will society eventually have to redesign the entire concept of retirement?
• 10:33
  SPEAKER_00: Oh wow.
• 10:34
  SPEAKER_00: I mean, yeah.
• 10:35
  SPEAKER_01: Think about it.
• 10:36
  SPEAKER_01: If the golden years are increasingly becoming a couple's new full-time state-funded job of just caring for one another.
• 10:44
  SPEAKER_00: Right, because someone has to do it.
• 10:46
  SPEAKER_01: Exactly.
• 10:46
  SPEAKER_01: How is that going to reshape our economy?
• 10:49
  SPEAKER_01: And even more profoundly, how is that going to reshape our marriages in the decades to come?
• 10:55
  SPEAKER_00: Wow.
• 10:56
  SPEAKER_00: That is a heavy but incredibly necessary question to think about.
• 10:59
  SPEAKER_00: It really reframes those wedding vows we started the show with.
• 11:02
  SPEAKER_01: It really does.
• 11:03
  SPEAKER_00: Well, thank you all for joining us on this deep dive.
• 11:05
  SPEAKER_00: Take care, and we'll catch you next time.