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:
If a spouse is the primary person providing care, it's worth asking about Michigan's MI Choice Waiver, which has different rules and does allow spouses to be paid under its own self-direction option — though MI Choice is capped and can carry a regional waitlist.
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
EVV applies unless an exemption is approved. Live-in and certain other arrangements may be exempt. Individual caregivers must also continue ESV or PSV service verification. Check current MDHHS EVV instructions.
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.
Wondering if you personally could be the paid caregiver?
Tell us a bit about your situation and we'll help you understand your options.
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