Medicaid Funding Reductions Affect Family Caregivers in Maryland

The Democratic-controlled state Legislature and Gov. Wes Moore adopted the measures after hearings in which dozens of disabled program recipients and their families asked lawmakers to restore funding.

Paying family members to care for disabled and elderly relatives had broad bipartisan support until recently as a way to address a shortage of home-care workers. The approach grew out of a 1980s policy change under the Reagan administration that used Medicaid funds to support home- and community-based services as an alternative to institutionalization.

States and the federal government share the costs of the system, which has long had waiting lists numbering in the hundreds of thousands nationally. Many states expanded paid family caregiving options to provide consistent care by trusted relatives rather than rotating outside workers.

Enrollment growth later increased costs and drew scrutiny from some conservative policymakers who described the programs as prone to fraud and waste. Molly Morris, co-founder of the Self-Direction Center, said attacking paid family caregiving could overwhelm a system that is already strained with too few workers and long waiting lists.

Jason Resendez, president and CEO of the National Alliance for Caregiving, stated that the payments compensate for services required because of serious illness or disability rather than simply paying relatives to be present. Gonce said she now faces a decision on whether she can absorb the reduced payments and continue caring for her son at home or whether she will need to return him to programs she believes previously failed him.

On Wednesday, Vice President JD Vance announced the Trump administration was withholding $1.3 billion in Medicaid funds from California over fraud concerns that included home care. Republicans on the House Oversight Committee also sent a letter to Ohio’s Medicaid director questioning payments to family caregivers.