How to get paid to take care of a family member in Florida: SMMC LTC and the PDO

Ways a paid family caregiver is funded in Florida

The Long-Term Care program is not an entitlement like regular Medicaid, and it does not cover doctor visits or hospital stays. It pays for home and community-based services delivered through managed care plans.

Who qualifies for SMMC Long-Term Care in Florida

AHCA lists three conditions. The person must be:

• 65 or older and eligible for Medicaid, or 18 or older and eligible for Medicaid because of a disability; and
• found by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) program at the Department of Elder Affairs (DOEA) to need nursing home level of care (or hospital level of care for people with cystic fibrosis).

Two agencies decide: DOEA rules on the medical side, while the Department of Children and Families (DCF) handles Medicaid financial eligibility. DCF mails a letter with its decision.

Screening and the waitlist

1. Call your local Aging and Disability Resource Center (ADRC). The ADRC asks screening questions about health and daily needs over the phone. AHCA says space for in-home services is limited, which is why this screening comes first.
2. Your score sets your place. Screening scores give a priority rank; people with a high rank go on the waitlist, and people with a low rank are not placed on it.
3. Release and assessment. When enrollment opens up, DOEA releases people from the waitlist and CARES staff, a registered nurse or assessor, usually visit at home at no cost. A doctor or registered nurse reviews each file to set the level of care.

The participant directed option in Florida: how PDO works

AHCA's contract with the Long-Term Care plans (Exhibit II-B, updated October 1, 2025) sets the rules for the Participant Direction Option. Plans must offer PDO to any enrollee living at home, whether their own or a relative's, whose plan of care has one or more of these services:

• adult companion care
• attendant nursing care
• homemaker services
• intermittent and skilled nursing
• personal care

What the plan has to do once you ask for PDO:

• Offer PDO when you first enroll and again at each annual reassessment.
• Assign a case manager trained extensively in PDO within two business days of the enrollee choosing it.
• Train the enrollee on employer duties: writing job descriptions, interviewing, hiring, training, supervising, evaluating and ending employment.
• Have the enrollee sign a Participant Agreement, explain how to submit timesheets, and help build a backup plan with network providers for times the worker cannot come.

The plan is the fiscal/employer agent, meaning it handles payroll for PDO workers, or it may subcontract that job after giving enrollees at least 30 days' notice.

Which family members can be paid caregivers in Florida

The contract says enrollees "may hire any individual who satisfies the minimum qualifications," naming neighbors, family members and friends, and that the plan may not limit that choice or require a worker from its own network.

• Representative. The enrollee may hand employer authority to a representative, but that person receives no pay as representative and may not double as the direct service worker. A relative has to choose one job or the other.
• Background screening. Each contract year, the plan covers the cost of Level II screening for a minimum of one representative and one direct service worker per service for each enrollee, then makes the clearance decision under Chapters 435 and 408.809, F.S.
• Spouses, legal guardians and parents of minors. The AHCA pages and contract exhibit we reviewed do not address whether these relatives can be paid as PDO workers. Ask the plan's PDO case manager before anyone starts, and get the answer in writing.
• Hours. Paid hours follow the approved plan of care; the plan monitors payroll against it.

What a family caregiver is paid under Florida PDO

AHCA does not publish a single statewide PDO wage on the pages reviewed. The contract requires the plan to tell the enrollee the rate of payment when PDO is chosen, to give enrollees and workers written notice at least 30 days before any rate change, and to record the hourly rate, schedule, duties and the worker's relationship to the enrollee in the Participant/Direct Service Worker Agreement.

Reference points only, not program rates:

The contract also allows plans, with AHCA approval, to offer Structured Family Caregiving in place of other services for members leaving a nursing facility who can live safely in the community with more intensive help at home. Ask the plan whether it offers it.

VA caregiver programs and taxes on Medicaid waiver pay

VA

• PCAFC stipend. When a veteran holds a VA disability rating (combined or individual) of at least 70 percent who is in VA health care and will need someone physically present for personal care for no less than six straight months, VA can approve a caregiver aged 18 or older for a monthly payment. The caregiver must be family (VA lists spouse, son, daughter, parent, stepfamily and extended family) or live with the veteran full time. File the joint VA Form 10-10CG online, by mail or at a VA medical center; VA's Caregiver Support Line takes calls at 855-260-3274.
• Veteran Directed Care: enrolled veterans who meet clinical criteria, in places where it runs, manage a budget with a counselor and may hire a relative or neighbor with it.

Taxes

The AHCA contract describes the Long-Term Care program as authorized by a 1915(c) waiver. Under IRS Notice 2014-7, the IRS treats such waiver payments as difficulty of care payments that a provider can exclude from gross income, as long as the care happens in a home the provider and the recipient both live in. In the IRS Q&A, an adult child who moved into a parent's house and has no other residence qualifies; a worker who sleeps over on weekdays but returns to a separate family home does not. If you paid tax on qualifying payments in an earlier year, Form 1040-X lets you claim a refund within the usual time limits.

Who to call in Florida: ADRC, Elder Helpline and the abuse hotline

• Elder Helpline, toll-free at 1-800-963-5337 (spelled 1-800-96-ELDER). DOEA works through 11 Area Agencies on Aging that double as ADRCs; call yours, or the helpline, to start the Long-Term Care screening.
• Medicaid Helpline: 1-877-254-1055, for problems getting Long-Term Care services from your health plan.
• Medicaid financial eligibility: the Department of Children and Families.
• Florida Abuse Hotline: 1-800-962-2873, answered around the clock, with an online report form too. DCF takes reports when a vulnerable adult may be abused, neglected or exploited. Dial 911 first if the danger is immediate.

Hiring privately while you wait for Long-Term Care

The waitlist, the income rules or a plan of care with too few hours can leave a gap. On CaregiverConnect, a family can list what care they need without paying and then employ the caregiver they choose, which puts the family in the household employer role described in IRS Topic 756. That topic sets a $3,000 cash-wage line for 2026, above which Social Security and Medicare tax is due, and excludes pay to your spouse, a child of yours under 21 and, unless an exception is met, your parent. Caregivers make a profile free of charge and reply to listings. The site does not act as a Medicaid provider, fiscal/employer agent or agency, and enrolling in SMMC LTC or PDO happens only through the state and the health plans. See how CaregiverConnect works and optional paid features.

Florida pages: caregiver jobs in Mulberry and find caregivers in Wellington. Related guides: hiring a caregiver yourself, how to write a caregiver profile, the Medicaid family caregiver overview and STAR+PLUS and consumer directed services in Texas.

Frequently asked questions

Sources

1. AHCA, Who can receive Long-Term Care services
2. AHCA, SMMC Long-Term Care recipient FAQs (screening, waitlist, CARES, helplines)
3. AHCA, Find out about Long-Term Care services
4. AHCA, Attachment II Exhibit II-B, Long-Term Care (LTC) Program contract, update October 1, 2025 (PDO, PDO provider qualifications, fiscal/employer agent)
5. Florida DOEA, ADRC directory by planning and service area
6. Florida Senate, state constitution text (Art. X, s. 24, minimum wage)
7. O*NET OnLine, Florida wage percentiles for SOC 31-1120 from 2025 BLS data
8. Florida Department of Children and Families, Abuse Hotline
9. VA.gov, family caregiver stipend (PCAFC) requirements and application
10. VA geriatrics pages, Veteran Directed Care
11. IRS questions and answers on Notice 2014-7 waiver payments
12. IRS Topic 756, household employer taxes