You can choose who provides the care

Who can be a paid caregiver

Under self-direction, the Medicaid recipient (or their authorized representative) can choose almost anyone they trust as their caregiver:

Who generally cannot be paid

Two categories are excluded under this program's rules:

The "recipient-as-employer" model

Here's the part that surprises people: in the self-directed option, the Medicaid recipient is technically the caregiver's employer — not MDHHS, and not the caregiver themselves. That has real implications. The recipient (or their representative) is generally involved in:

• Choosing who provides care
• Setting the day-to-day schedule
• Being the point of contact if something changes about their needs

A Fiscal Intermediary can help process the payroll and tax paperwork this employer relationship creates, without the FI itself providing any hands-on care — see our FI vs. provider agency breakdown for the full picture.

What this means day to day

No CNA license, nursing degree, or prior caregiving certification is required to enroll as an individual Home Help provider. What is required: enrolling correctly in CHAMPS, passing the standard background check, and — once approved — consistently using EVV to log every visit. Missing steps in enrollment is one of the most common reasons applications sit in limbo, so getting each step right the first time matters.

Caring for more than one person

If you have more than one family member who qualifies — say, both parents — you can potentially be approved as the paid caregiver for each of them individually, as long as each person's own assessment and approval is in place. Hours and pay are tracked separately per care recipient.