Florida SMMC: How to Get Paid as a Family Caregiver — A Step-by-Step Guide
Florida is home to one of the largest senior populations in the country. If you’re caring for an aging parent, a spouse, or a relative with a disability here, you are part of a vast, mostly invisible workforce that keeps the state’s long-term care system from collapsing.
And yes — in Florida, some family caregivers can get paid for this work.
But the path is narrow. The rules are strict. And the waitlist can be long. This guide walks you through exactly what’s available, who can qualify, and how to get started — so that if there’s a way for you to be paid, you don’t miss it.
(Remember: I’m not a Medicaid caseworker or attorney. Rules change. Use this as your map, and always confirm details with the Florida Department of Elder Affairs or a benefits counselor.)
The Florida Landscape: An Overview
Florida runs most of its long-term care Medicaid through a managed care system called the Statewide Medicaid Managed Care (SMMC) program. Within SMMC, there are two main paths:
- The Long-Term Care (LTC) Waiver — for people who need nursing-home-level care but want to stay at home. This is the program that can pay family members in some situations.
- The Managed Medical Assistance (MMA) program — for general Medicaid health coverage. This does NOT pay for long-term care services like a personal attendant at home.
You want the LTC Waiver. That’s where the possibility of getting paid lives.
Within the LTC Waiver, there is a specific option called the Participant Directed Option (PDO) . This is what lets the care recipient hire and manage their own personal care attendants — including, potentially, you.
Who Can Get Paid, and Who Can’t
Florida has clear rules about which family members can be paid as personal care attendants through the PDO.
Can be paid:
- Adult children caring for a parent
- Siblings
- Grandchildren
- Nieces, nephews, and other relatives
- A trusted friend or neighbor
Cannot be paid (in most cases):
- A spouse. Florida, like Texas, generally excludes spouses from being paid attendants. The state considers a spouse legally responsible for providing care.
- A legal guardian or the designated patient advocate, unless certain narrow exceptions apply.
- A parent of a minor child with a disability, in most cases.
One Florida-specific rule to know: The person you are caring for must be able to direct their own care — or have a designated representative who can. The representative cannot be the same person who is being paid as the attendant. If your parent has dementia and cannot direct care, you will need someone else to serve as the representative if you want to be the paid attendant.
The LTC Waiver and Participant Directed Option (PDO)
The LTC Waiver provides a package of services designed to keep people at home instead of in a nursing home. These services include:
- Personal care (bathing, dressing, grooming, toileting)
- Homemaker services (light housekeeping, meal prep, laundry)
- Respite care (temporary relief for the primary caregiver)
- Adult day care
- Home modifications and medical equipment
- And more
Through the Participant Directed Option (PDO) , the care recipient can choose to manage some of these services themselves — specifically personal care and homemaker services. Instead of an agency sending a stranger to the house, the recipient can hire someone they trust.
That someone can be you.
How the PDO Works
- The care recipient is assessed and approved for the LTC Waiver.
- They select a managed care plan that offers the PDO.
- They (or their designated representative) complete PDO training on how to be an employer.
- They hire you as their personal care attendant.
- A Fiscal/Employer Agent (F/EA) handles payroll, tax withholding, and W-2s. You are an employee of the care recipient, not the state.
Who Qualifies for the LTC Waiver
The care recipient must pass three tests.
A) Financial Eligibility (Medicaid)
The care recipient must qualify for Medicaid. For seniors and people with disabilities in Florida, this means:
- Income under approximately $2,829 per month (2024 figure).
- Countable assets under $2,000 for an individual or $3,000 for a couple.
- The primary home (up to an equity limit), one vehicle, and certain prepaid burial arrangements are exempt.
B) Functional Eligibility (Level of Care)
The care recipient must need nursing-home-level care. This is determined by a comprehensive assessment called the 701B assessment, conducted by the Florida Department of Elder Affairs. The assessor evaluates the person’s ability to perform activities of daily living — bathing, dressing, eating, toileting, transferring, and continence — as well as any cognitive or behavioral issues.
C) Living Situation
The care recipient must live at home, in a family member’s home, or in certain community-based settings. They cannot live in a nursing home, an assisted living facility, or an adult family care home.
The Waitlist: What You Need to Know
Florida’s LTC Waiver has a waitlist. It’s officially called the “wait list,” and it is prioritized by need — those at highest risk are moved up more quickly.
The wait can be long. For some priority levels, it can stretch for years. This is the hard truth, and I’m not going to soften it.
But here’s what matters:
- Get on the list now. Don’t wait until the situation is desperate. Call the Florida Department of Elder Affairs at 1-800-963-5337 and ask to begin the screening process for the LTC Waiver.
- While you’re waiting, explore other resources. Your local Area Agency on Aging can connect you to non-Medicaid services — like in-home support, meal delivery, and caregiver respite — that don’t require a waiver. Call the Elder Helpline at 1-800-963-5337.
- If your loved one’s condition worsens, update your screening. A change in condition can affect priority status. Don’t suffer in silence — let them know.
How to Apply: A Step-by-Step Path
Step 1: Screen for the LTC Waiver.
Call the Florida Department of Elder Affairs at 1-800-963-5337. Say: “I am caring for [name], and I want to request a screening for the Long-Term Care Waiver.” You can also contact your local Aging and Disability Resource Center (ADRC) to start the process.
Step 2: Complete the 701B assessment.
A Department of Elder Affairs assessor will come to the home — or arrange a phone assessment — to evaluate functional need. Be honest about the worst days, not the best. If your parent has dementia, describe the hardest moments — wandering, incontinence, the need for constant supervision. This assessment determines priority level.
Step 3: Apply for Medicaid (if not already enrolled).
Visit the Florida Department of Children and Families (DCF) online at myflorida.com/accessflorida or call 1-866-762-2237. The application can be completed online, by phone, or in person at a local DCF office. If the care recipient has too much income, ask about the Medically Needy program — Florida has a “share of cost” pathway similar to a deductible.
Step 4: Wait for a waiver slot to open.
When a slot becomes available, the state will contact you. You’ll then select a managed care plan that offers the Participant Directed Option (PDO) . Not all plans offer it. Ask specifically when choosing.
Step 5: If offered the PDO, complete the training and enroll.
Once enrolled, the care recipient and their designated representative complete PDO training. Then they can hire you as their personal care attendant. The Fiscal/Employer Agent handles everything from there — payroll, taxes, the works.
How Much Does It Pay?
Wages for personal care attendants through Florida’s PDO typically range from $10 to $14 per hour, depending on the region and the managed care plan. This is not as high as California or New York — it’s fair to say that upfront.
But you receive a W-2, you build Social Security credits, and you are covered by workers’ compensation. For a job you’re already doing for free, that’s meaningful.
Live-in caregiver tax note: If you live with the care recipient, your wages may be exempt from federal income tax under the IRS “live-in caregiver” rule. Work with your Fiscal/Employer Agent and a tax preparer to get this set up correctly.
What About Florida’s Paid Family Leave?
Florida does not have a state-level paid family leave program. It is one of the majority of states that has not enacted paid family leave legislation. However, federal Family and Medical Leave Act (FMLA) protections still apply — this provides up to 12 weeks of unpaid, job-protected leave to eligible employees caring for a seriously ill family member. It won’t pay you, but it protects your job while you provide care.
If You Don’t Qualify: Alternative Paths
If the LTC Waiver path doesn’t work for your family, don’t give up. Consider these:
- Veteran-Directed Care: If your loved one is a veteran, the VA has programs that allow veterans to hire family members as caregivers. Florida has a large veteran population, and local VA offices are generally familiar with these programs. Call the VA Caregiver Support Line at 1-855-260-3274.
- Long-term care insurance: Check your loved one’s policy. Many cover in-home care by family members.
- Personal Care Agreement: A formal contract between you and your loved one, drafted with an elder law attorney. This creates a legal paid arrangement using their private funds and can protect assets if Medicaid is needed later.
- Community Care for the Elderly (CCE): A state-funded program administered through local agencies that provides some in-home services. It doesn’t pay family caregivers directly, but it can bring in outside help to lighten your load. Contact your local ADRC to ask about it.
- Alzheimer’s Disease Initiative (ADI): Florida has a specific program for families affected by Alzheimer’s and related dementias. It provides respite care, in-home support, and caregiver education. Again, not direct payment to family members, but it can reduce your burden.
Common Mistakes Florida Families Make
- Not getting on the waitlist because it’s long. The time will pass anyway. Get screened and get on the list.
- Assuming the MMA program covers personal care at home. It doesn’t. You need the LTC Waiver. These are two different things under the SMMC umbrella.
- Not asking specifically about the PDO when choosing a managed care plan. Not all plans offer it. If you pick a plan without PDO, you lose the chance to hire yourself as the attendant.
- Assuming a spouse can be paid. Florida generally excludes spouses. Know this early and consider whether an adult child or other relative can step into the paid role.
- Underestimating the importance of the 701B assessment. This assessment sets your priority level. Describe the worst days, not the best.
Your Florida Action Plan
- Today: Call 1-800-963-5337 to request a screening for the LTC Waiver.
- This week: Start gathering documents — identity, income, assets, medical records. Begin the Medicaid application at myflorida.com/accessflorida if not already enrolled.
- Prepare for the 701B assessment. Keep a care diary. Write down everything you do each day. Describe the hardest moments honestly.
- Research managed care plans. When a slot opens, you’ll need to choose a plan that offers the PDO. Start familiarizing yourself with the options now.
- If you’re caring for a veteran: Call 1-855-260-3274 and ask about Veteran-Directed Care.
Resources for Florida Families
- Florida Department of Elder Affairs / Elder Helpline: 1-800-963-5337
- Florida Medicaid (DCF): myflorida.com/accessflorida or 1-866-762-2237
- Florida Aging and Disability Resource Centers (ADRCs): Find your local ADRC through the Elder Helpline.
- VA Caregiver Support Line: 1-855-260-3274
- Florida Bar Elder Law Section: floridabar.org — for finding an elder law attorney.
The Bottom Line
Florida is not the easiest state in which to get paid as a family caregiver. The waitlist is real, the process is bureaucratic, and spouses face a hard exclusion. But thousands of families have walked this path before you, and many of them now receive a paycheck for work they were already doing for free.
The key is to start now. Make the call. Get on the list. And while you wait, build your knowledge, explore alternatives, and remind yourself: this work has value. Whether the state recognizes it yet or not.
Ready to explore other states? Our state-by-state paid caregiver guide covers every option across the country.
Last updated: 06/26
Disclaimer: WiseCareNest provides educational content. This is not legal or benefits advice. Consult with a qualified professional for your specific situation.