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Can Medicare Pay a Family Member to Be a Caregiver in Illinois? · Home Care Powered By AUAF

• 0:13
  SPEAKER_00: Today, we're answering a question we hear all the time.
• 0:16
  SPEAKER_00: Can Medicare pay a family member to be a caregiver in Illinois?
• 0:20
  SPEAKER_00: I'm Elena.
• 0:21
  SPEAKER_01: And I'm Brooks.
• 0:22
  SPEAKER_01: Let's start with the short answer, because a lot of families are hoping for a yes.
• 0:27
  SPEAKER_00: The short answer is no.
• 0:29
  SPEAKER_00: No program rule lets Medicare pay a family caregiver for daily help at home.
• 0:34
  SPEAKER_00: Medicare covers short-term skilled home health care, not ongoing personal care.
• 0:39
  SPEAKER_01: Even if the family member is giving care full-time?
• 0:42
  SPEAKER_00: Even then.
• 0:43
  SPEAKER_00: Medicare.gov's long-term care page says Medicare does not pay for long-term care.
• 0:50
  SPEAKER_00: So families pay those costs themselves.
• 0:53
  SPEAKER_01: And most long-term care isn't really medical, right?
• 0:56
  SPEAKER_00: Right.
• 0:57
  SPEAKER_00: It's help with everyday tasks, which Medicare calls custodial care.
• 1:02
  SPEAKER_00: Think bathing, dressing, and using the bathroom.
• 1:05
  SPEAKER_00: If your parent mainly needs a hand with daily routines, Medicare won't cover that help, and it won't pay you, a sibling, or a spouse for giving it.
• 1:14
  SPEAKER_01: That surprises people, because Medicare does pay for some care at home.
• 1:19
  SPEAKER_00: It does.
• 1:19
  SPEAKER_00: And that's the confusing part.
• 1:22
  SPEAKER_00: Knowing the limit early helps you plan before a hospital stay ends.
• 1:26
  SPEAKER_01: So is there any way Medicare helps the relative who gives care?
• 1:30
  SPEAKER_00: Not with money, but a relative still gains when a certified agency treats their loved one.
• 1:36
  SPEAKER_00: Medicare's home health benefit lists caregiver education as a covered nursing service, so the visiting nurse can teach you too.
• 1:43
  SPEAKER_01: Let's talk about that home health benefit.
• 1:46
  SPEAKER_01: Who actually qualifies?
• 1:48
  SPEAKER_00: It's a narrow group.
• 1:50
  SPEAKER_00: First, a doctor or another provider, like a nurse practitioner, has to see the patient in person and order the care.
• 1:57
  SPEAKER_00: Then, a Medicare certified home health agency has to provide it.
• 2:01
  SPEAKER_01: And the patient has conditions to meet as well.
• 2:04
  SPEAKER_00: Four of them, according to Medicare's Home Health Services page.
• 2:08
  SPEAKER_00: They need part-time or intermittent skilled nursing or therapy.
• 2:12
  SPEAKER_00: They're homebound, meaning leaving home takes major effort or help.
• 2:16
  SPEAKER_00: They don't need more than part-time skilled care.
• 2:19
  SPEAKER_00: And they get care from a Medicare certified agency.
• 2:23
  SPEAKER_01: What's covered once someone qualifies?
• 2:25
  SPEAKER_00: Part-time skilled nursing when a doctor orders it, and physical, occupational, or speech therapy.
• 2:32
  SPEAKER_00: A home health aid can help with bathing, but only alongside skilled nursing or therapy.
• 2:37
  SPEAKER_01: And what's left out?
• 2:38
  SPEAKER_00: 24-hour care at home, shopping or cleaning that isn't part of the care plan, meal delivery, and personal care when that's the only need.
• 2:48
  SPEAKER_01: What about cost for the services that are covered?
• 2:51
  SPEAKER_00: Covered home health services cost the patient nothing per Medicare.gov as of October 2026.
• 2:57
  SPEAKER_00: Medical equipment is different.
• 2:59
  SPEAKER_00: It usually costs 20% of the approved amount after the Part B deductible.
• 3:04
  SPEAKER_01: Still, the uncovered list is the help a lot of families need most.
• 3:09
  SPEAKER_00: Exactly.
• 3:10
  SPEAKER_00: But a few Medicare services can ease the load on the relative who helps every day.
• 3:15
  SPEAKER_01: Like that nurse training we mentioned.
• 3:17
  SPEAKER_00: Yes.
• 3:18
  SPEAKER_00: Ask the agency to show you the routines you handle between visits so you feel more confident at home.
• 3:24
  SPEAKER_00: The second one is for people living with dementia.
• 3:27
  SPEAKER_00: It's called the CMS Guide Model.
• 3:30
  SPEAKER_01: When did that start?
• 3:31
  SPEAKER_00: July 1st, 2024, and it runs for eight years.
• 3:35
  SPEAKER_00: As of October 2026, it reimburses up to$2,500 per patient each year for respite.
• 3:43
  SPEAKER_00: That can include in-home care or adult day programs.
• 3:47
  SPEAKER_01: Anyone with dementia can use it?
• 3:49
  SPEAKER_00: It works only through participating providers.
• 3:52
  SPEAKER_00: Guide also offers caregiver training and links to community resources.
• 3:56
  SPEAKER_00: So ask your loved one's doctor whether a guide program serves your area.
• 4:01
  SPEAKER_01: Okay, so if Medicare won't pay the caregiver, where do Illinois families turn?
• 4:07
  SPEAKER_00: Usually to Medicaid-funded programs for in-home help.
• 4:11
  SPEAKER_00: Whether a family member can be the paid caregiver depends on the program and the agency.
• 4:16
  SPEAKER_00: So ask before you apply.
• 4:18
  SPEAKER_01: Walk us through the main programs.
• 4:20
  SPEAKER_00: There are three.
• 4:21
  SPEAKER_00: The community care program serves seniors 60 and older who need long-term care.
• 4:26
  SPEAKER_00: It's run by the Illinois Department on Aging.
• 4:29
  SPEAKER_00: The Home Services Program serves adults under 60 with severe disabilities through the Illinois Department of Human Services.
• 4:37
  SPEAKER_00: And the VA Family Caregiver Program serves veterans with a 70% or higher service-connected rating.
• 4:44
  SPEAKER_01: What does the community care program require?
• 4:46
  SPEAKER_00: According to the Illinois Department on Aging, applicants must show a need for long-term care on the determination of need assessment.
• 4:54
  SPEAKER_00: They also have to apply for Medicaid and enroll if they're eligible.
• 4:58
  SPEAKER_00: And as of October 2026, the asset limit is$17,500 in non-exempt assets.
• 5:06
  SPEAKER_00: The home, the car, and personal furnishings don't count.
• 5:10
  SPEAKER_01: And the home services program?
• 5:12
  SPEAKER_00: Per the Illinois Department of Human Services, its customers can hire their own personal assistants under a service plan.
• 5:19
  SPEAKER_01: Then there's the VA path.
• 5:21
  SPEAKER_00: The VA Caregiver Support Program pays a monthly stipend to a primary family caregiver.
• 5:27
  SPEAKER_00: As of October 2026, the veteran needs a service connected rating of 70% or more, among other criteria, and the need for in-person personal care has to last at least six continuous months.
• 5:40
  SPEAKER_01: Does the caregiver get anything besides the stipend?
• 5:43
  SPEAKER_00: They may get CHAMP VA health insurance if they have no other coverage, plus mental health counseling.
• 5:49
  SPEAKER_00: And the veteran receives at least 30 days of respite care each year.
• 5:53
  SPEAKER_01: So how should a family figure out which path fits?
• 5:57
  SPEAKER_00: The article lays out five steps.
• 5:59
  SPEAKER_00: 1.
• 6:00
  SPEAKER_00: Confirm Medicare coverage by asking the doctor whether your loved one qualifies for home health care right now.
• 6:06
  SPEAKER_00: 2.
• 6:07
  SPEAKER_00: Check age and disability.
• 6:09
  SPEAKER_00: 60 and older starts with the community care program.
• 6:12
  SPEAKER_00: Younger adults with disabilities look at the home services program.
• 6:16
  SPEAKER_00: 3.
• 6:17
  SPEAKER_00: Ask about veteran benefits.
• 6:19
  SPEAKER_00: And four, call for an assessment.
• 6:22
  SPEAKER_00: You'll need a determination of need assessment, so contact your local care coordination unit.
• 6:27
  SPEAKER_00: 5.
• 6:28
  SPEAKER_00: Choose a home care agency and ask whether it can hire a family member as the paid caregiver.
• 6:34
  SPEAKER_01: Is there a number people can call to get started?
• 6:36
  SPEAKER_00: The Illinois Department on Aging Senior Helpline is 1-800-252-8966.
• 6:44
  SPEAKER_00: Adults under 60 with disabilities can call the Department of Human Services helpline at 1-800-843-6154.
• 6:53
  SPEAKER_01: Last question.
• 7:17
  SPEAKER_01: And Medicare still has a role there.
• 7:20
  SPEAKER_00: It does.
• 7:20
  SPEAKER_00: It still pays for covered home health care when your loved one meets its conditions, like a need for part-time skilled nursing.
• 7:27
  SPEAKER_00: The full article on homecareaid.com has all the details and links.
• 7:32
  SPEAKER_01: One more thing.