If you're researching how to get paid as a family caregiver in Michigan, you'll run into two very different models: a Fiscal Intermediary and a provider agency. They sound similar and both involve MDHHS's Home Help Program, but the difference changes who's legally your employer, who oversees your work, and ultimately how much you're paid.
Fiscal Intermediary: the recipient is the employer
Under Michigan's self-direction option, the Medicaid recipient — your loved one — is technically the employer of record for their chosen caregiver. A Fiscal Intermediary (FI) simply processes payroll and tax paperwork on the recipient's behalf. The FI does not supervise the caregiver, evaluate the care being provided, or take on liability for how care is delivered. Pay under this arrangement follows Michigan's fixed statewide individual caregiver rate: $17.13 per hour as of January 1, 2026.
Provider agency: the agency is the employer
Under a provider agency arrangement, MDHHS approves the agency itself — not the Medicaid recipient — as the care provider. The agency employs its caregivers directly, including a client's chosen family member, bills Medicaid directly for approved care, and carries responsibility for background checks, training, and compliance. Because the agency is billing at Michigan's 2026 agency provider rate of $27.00 per hour, it can pass a larger share of that rate to the caregiver it employs than the fixed self-directed rate allows.
Side-by-side comparison
| Fiscal Intermediary | Provider Agency | |
|---|---|---|
| Legal employer | The Medicaid recipient | The agency |
| 2026 hourly rate | $17.13/hr, fixed statewide | Up to $23.00/hr (agency's own pay practice) |
| Background check | Not required by the FI | Required before care begins |
| Skilled-nurse evaluation | Not included | Included as part of onboarding |
| CHAMPS enrollment | Caregiver enrolls individually | Handled by the agency |
| Day-to-day oversight | Managed by the family | Managed by the agency's care team |
Which one is right for your family?
Both are legitimate paths, and the right choice depends on how much administrative support your family wants. If you're comfortable managing scheduling and paperwork directly and simply need payroll processed, self-direction with an FI can work well. If you'd rather have an agency handle enrollment, compliance, and ongoing support — and you want your caregiver paid at the higher agency rate — a provider agency is generally the better fit.
Want the full pay math, including a calculator you can adjust to your own hours? See our complete pay breakdown.
Check current rules before you act. Home Help requirements, forms, and payment procedures can change. Use MDHHS Home Help guidance and MDHHS CHAMPS enrollment guidance as the final source for current program details.