If you’ve ever found yourself quietly rearranging your work schedule to drive your mum to a doctor’s appointment or popping round every evening to make sure Dad’s eaten something, you already know what caregiving feels like — you’re just not being paid for it.
Here’s something most families in the US have absolutely no idea about: in many states, you don’t have to do it for free.
There are government-funded programs that allow family members — adult children, spouses, even siblings — to receive payment for the care they’re already providing at home. And the process for getting access to that support is more straightforward than most people think. The trouble is that nobody tells you it exists until you’ve been quietly burning out for months.
Let’s change that.
First, a quick word on why this matters right now
Unpaid family carers in the US have been steadily increasing over the years. AARP says that over 53 million Americans provide unpaid care to an adult family member, with most of them being women ages 40-60. Sound familiar?
The difficulty of this is that caring does not proclaim itself. It creeps in. Some additional phone calls turn into daily check-ins. Daily check-ins turn to overnight stays. Soon, you’re beginning to manage medicines, make appointments, deal with finances, and taking care of yourself — and your life, too.
Finances are also a real burden. A large number of family carers work reduced hours or sometimes quit their jobs in order to be able to care for the individuals they look after. That’s not an easy thing to give up. That’s why it’s important to know what you have to choose from.
So, what are these programs actually called?
Medicaid Home and Community Based Services (HCBS) Waiver programs are the primary pathway in the United States to receive paid family care services. The main concept is that while a nursing home is the last resort for an elderly or disabled person’s care, the state will pay for the home care of an older person, and in many instances that care will be given by a family member.
The Nebraska Medicaid Waiver program is a great illustration of this in practice and one of the most available models across the nation. Specifically, the state’s Aged and Disabled (AD) Waiver is for seniors 65 and over and adults with physical disabilities who would otherwise need to receive nursing home level care, but who would prefer to live in their own home.
This is especially true for Omaha families, as the number of providers offering in-home care has increased over the past few years, particularly in the context of the Medicaid Waiver system — providers such as Caretech can assist families with the practical care and the funding process at the same time.
Let’s take a step-by-step look, though, at how it works, since mechanics are important.
How the Medicaid Waiver works in plain English
Medicaid Waivers are like the State telling you, “We don’t want to pay for a nursing home bed for your loved one; we’d prefer to pay them to be cared for at home. In theory, it is very simple, though takes some time to fill out.
Here’s what the process typically looks like:
- Eligibility must be determined first on financial status. Your loved one must have income and asset requirements. The income cap for one person in 2026 is $1,330 per month in Nebraska, with assets that cannot exceed $4,000. A surprising number of people are surprised that in most cases the family home is not considered an asset in the assessment.
- A Care Needs Assessment follows – A nurse or social worker makes a visit to determine if your relative requires “nursing facility level of care. This is not a sign of poor health; it is just a sign that they need regular and meaningful assistance in daily living, such as bathing, dressing, moving around or taking medicines.
- A care plan is drawn up that is individualised by the person. Describes the support required, its frequency and who will provide it. It is at this point that family members can officially be designated as paid carers by the Legally Responsible Individual (LRI) program. As Nebraska would call it — essentially, the family member becomes an employee.
- You select a provider. Families can choose to use a home care agency that has been approved or, in some situations, to self-direct the care. In either case, the expense is not incurred by the individual but rather through the waiver.
Who qualifies — and who might be surprised
This is the part that most families fail to get right. They conclude that their parents “make too much money” or “has too many savings” and they never look into it more. However, the eligibility requirements are not as rigid as they may seem at first glance.
For example, the home is seldom included in the asset calculation. A moderate pension or Social Security benefit may be within the income limit. This is particularly the case for married individuals who are only one person filing; there are separate (and usually more favorable) provisions for married couples.
Additionally, Nebraska has a WAITLIST for the AD Waiver, like many states do. The great news is that Nebraska’s HCBS Waiver Transformation has been diligently engaged in this effort to decrease wait times and be on a path to an assessment model based on need through 2025 and into 2026. Families applying now are in a better situation than those who applied two or three years ago.
Applications may be submitted for urgent needs, which may be identified by providers and case managers.
Practical tips for families starting this process
If any of this is landing and you want to take a next step, here’s where to begin — without falling into the rabbit hole of confusing government websites:
Begin with an area (local) agency on aging (AAA). One can be found in every part of Nebraska. They can let you know right away if your relative is likely to be eligible, the current waitlist status, and who to contact DHHS.
Prepare financial papers in advance. If you have your income statements, bank statements, and information about any assets available, the application process will move along a lot more quickly. By the time you are requested, weeks have passed!
Please consult with an approved provider prior to applying. This is the opposite of what you think you need to do, but it really works. If you’re a little mystified about the eligibility requirements, you can have a conversation with a home care agency that’s familiar with Medicaid Waivers, such as those in Nebraska (including Omaha) and let them guide you through the process without any pressure. They have encountered hundreds of applications and understand where people get trapped.
No does not necessarily mean forever. Circumstances change. Income changes. Requires more care. A program that doesn’t work out this year can likely work out in six months, so it’s better to be put on a wait list than be marked down to no.If a program is failing to make the cut to make it to six months, it’s better to be on a wait list than marked down to no.
Final thought
If you’re already doing the caring — the quiet, daily, showing-up kind that nobody puts on a CV — just know that you’re not doing it unseen. There are programs built specifically because people like you exist, and because the people who designed them finally understood that supporting a family carer is supporting the whole family.
You don’t have to have it all figured out before you start. You don’t need to understand every form or know every rule. The only thing between you and finding out what you’re entitled to is one conversation — a phone call, a question, a “I wonder if this applies to us.”
And more often than not? It does.