Florida Medicaid caregiver pay guide
Last checked: May 18, 2026
Florida has a Medicaid self-directed care route called the Participant Direction Option, often shortened to PDO. It is part of Florida’s Statewide Medicaid Managed Care Long-Term Care program.
PDO may let an enrolled person hire a family member, friend, or neighbor as a direct service worker for certain approved home care tasks. The person must be in the right Medicaid long-term care program, the service must be on the care plan, and the worker must finish the plan’s hiring steps before pay can start.
Quick answer
Yes, Florida Medicaid can allow self-directed home care through the Participant Direction Option, or PDO, for people enrolled in a Statewide Medicaid Managed Care Long-Term Care plan. The person getting care may be able to hire a family member, friend, or neighbor as a direct service worker for approved services.
This is not automatic caregiver pay. The care must be in the approved care plan, the worker must pass the plan’s hiring steps, and the payroll agent must approve the paperwork before the worker starts.
Main Florida programs and routes
| Route | Who it helps | Where to start |
|---|---|---|
| Statewide Medicaid Managed Care Long-Term Care with PDO | Adults who need long-term services and supports and are enrolled in a Long-Term Care plan. PDO may let the person hire, train, and supervise a direct service worker for approved services. | Not enrolled: call the Elder Helpline at 1-800-963-5337 for ADRC screening. Enrolled: call the Long-Term Care plan case manager and ask for PDO. |
| Statewide Medicaid Managed Care Long-Term Care without PDO | People who need approved home and community services but do not want, or cannot manage, the employer role. | Call the case manager and ask what services are already on the care plan, such as personal care, respite care, homemaker, or adult day health care. |
| DCF Medicaid financial eligibility | People who need Medicaid coverage or must prove financial eligibility for long-term care Medicaid. | Use MyACCESS, a DCF Family Resource Center, or a DCF community partner. DCF says applying for benefits is free. |
| VA benefits for caregivers | Caregivers of eligible Veterans. VA help is separate from Florida Medicaid and has its own rules. | Start with VA Aid and Attendance and VA caregiver support if the person served in the military. |
| Respite and caregiver support outside Medicaid | Family caregivers who need short breaks, training, or local help while waiting for Medicaid or plan approval. | Call the local ADRC. Also see respite care for caregivers. |
What self-directed care means
Self-directed care means the person getting care has more say in who helps them and when the help happens. In Florida Medicaid Long-Term Care, the person may act as the employer for a direct service worker.
That does not mean the person gets a blank check. The Long-Term Care plan still approves the care plan. The care plan says which services are covered, how many hours are allowed, and what tasks the worker may do.
Under PDO, the person getting care, or a representative if one is needed, takes on employer tasks. These tasks can include hiring, training, scheduling, supervising, signing timesheets, and telling the case manager when there is a problem.
The federal Medicaid idea is similar: self-directed services give the person or their representative decision-making authority over certain services, with support systems in place. Florida uses its own program names and plan process.
Program name in Florida
The Florida name to ask for is Participant Direction Option, or PDO.
PDO is offered through Florida Medicaid Statewide Medicaid Managed Care Long-Term Care plans. The state agency over Medicaid policy is the Florida Agency for Health Care Administration, or AHCA. The Department of Elder Affairs and local Aging and Disability Resource Centers, called ADRCs, handle screening and wait list steps for the Long-Term Care program. The Department of Children and Families, or DCF, handles many Medicaid financial eligibility steps.
To use PDO, the person must have at least one PDO service on the approved care plan. AHCA’s public PDO materials list these services:
- adult companion care
- attendant care
- homemaker services
- intermittent and skilled nursing
- personal care
For a plain-English overview of Medicaid home and community-based services, see Medicaid HCBS waivers explained.
Florida warning: confirm the rule before you count on pay
Rules can change. Counties, managed care plans, waiver contractors, and agencies may use different names for the same step. Always confirm with the Florida Long-Term Care plan, the case manager, or an official Florida source before a family member starts work.
If the first person says, “We do not do that,” ask for the PDO-trained case manager or the plan’s PDO contact. Use the term “Participant Direction Option.” Do not only ask, “Can I get paid?”
Who can be hired
Florida AHCA PDO materials say the participant may hire a direct service worker of their choosing, including a neighbor, family member, or friend. The worker does not have to be in the plan’s provider network.
The worker still has to meet the rules. A family relationship does not skip the paperwork.
A direct service worker usually must:
- be at least 18 years old
- prove identity and legal work status
- complete the hiring packet
- complete tax and payroll forms
- submit references if the participant asks for them
- pass the required background screening
- wait for the plan or Fiscal/Employer Agent to approve the start date
- work only the services, duties, and hours listed in the agreement
For attendant care or intermittent and skilled nursing, AHCA materials say the direct service worker must be a Florida licensed registered nurse or licensed practical nurse. For adult companion, homemaker, and personal care services, AHCA’s PDO guide says a certification or license is not required, but the worker still must meet the plan’s hiring rules.
Who cannot be paid through PDO?
- A person who is only acting as the PDO representative cannot be paid as the representative.
- The representative cannot also be the direct service worker.
- A person who fails the required background check cannot start paid work.
- A person who does not meet the service’s license or training rule cannot provide that service.
- A worker cannot be paid for care that is not on the approved care plan or direct worker agreement.
- A worker cannot be paid for hours before the hiring process is approved.
Spouse and adult child rules
AHCA’s public PDO materials reviewed for this guide say a participant may hire a family member, friend, or neighbor. They do not spell out a separate public rule for spouses, adult children, or live-in relatives on the pages and PDO forms reviewed.
That means you should not assume the answer from a general web page. Ask the Long-Term Care plan directly before you plan around spouse or adult child pay.
Ask these exact questions
- Can my spouse be hired as my PDO direct service worker for the services on my care plan?
- Can my adult child be hired if they live with me?
- Can a live-in family member be paid for personal care, homemaker, or adult companion services?
- Can the same person be my representative and my paid worker? If not, who can be my representative?
- What plan policy or AHCA rule are you using for this answer?
If the plan says a spouse or adult child cannot be paid, ask for the reason in writing. The answer may depend on the service, the plan’s PDO process, the worker’s role, or whether the worker is also serving as representative.
Payroll and timesheets
PDO uses a Fiscal/Employer Agent, often shortened to F/EA. This is the payroll and tax support agency tied to the Long-Term Care plan.
The participant is the employer. The Fiscal/Employer Agent helps with payroll, tax forms, tax deposits, worker forms, and pay records. The direct service worker is not paid by cash from the family. The worker is paid through the plan’s payroll process, usually by direct deposit or prepaid card.
Before the worker starts
The plan and Fiscal/Employer Agent usually send two sets of papers. The participant gets an enrollment packet. The worker gets a hiring packet.
The packet can include tax forms, direct deposit forms, identity and work papers, the worker agreement, the pay schedule, background screening information, and timesheet instructions.
Timesheet rules
- The timesheet must show the worker’s name, participant’s name, days worked, hours worked, and service provided.
- The participant and worker must sign the timesheet.
- The hours must match the approved care plan and the worker agreement.
- The family should keep copies of signed timesheets.
- Late or incomplete timesheets can delay pay.
- False or wrong timesheets can lead to fraud review and can end PDO participation.
The plan must tell the participant the set pay rate for the PDO service. Do not guess the rate. Ask the plan for the current rate by service before the worker agrees to the job.
For tax questions, see caregiver tax deductions and ask a tax professional. Medicaid payroll can affect income reporting, tax filing, and other benefits.
What to say on the phone
Use this script if the person is already enrolled in a Florida Long-Term Care plan:
Hello. I am calling about the Participant Direction Option, or PDO. I want to know if the services on the care plan can be self-directed. We are interested in hiring a family member as the direct service worker. Please connect me with the PDO-trained case manager or the plan’s PDO contact.
Then ask:
- Which services on the care plan can be PDO?
- How many hours are approved?
- Can the family member I name be hired for those tasks?
- What background check is required?
- Who is the Fiscal/Employer Agent?
- When can the worker start?
- What should I do if agency care stops before PDO is ready?
If making calls is hard, use the templates in caregiver phone scripts.
Documents to gather
Ask the plan for its exact list. These are common items to have ready:
- Florida Medicaid number or Gold Card number
- date of birth for the person getting care
- Medicaid Long-Term Care plan name
- case manager name and phone number
- current care plan and approved services
- recent denial, approval, or service change letters
- doctor notes or care needs notes, if a reassessment is needed
- caregiver name, address, phone, and Social Security number for payroll forms
- caregiver photo ID and work papers
- bank information for direct deposit, if the worker wants direct deposit
- background screening instructions from the plan
- a backup care plan in case the worker is sick or quits
For a printable list, see caregiver checklists.
How to switch from agency care to self-directed care
If the person already gets agency home care through a Florida Long-Term Care plan, do not stop that care first. Start by asking the case manager for PDO.
Step 1: Ask which current services can be self-directed.
PDO only works for certain services. Ask if personal care, homemaker, adult companion care, attendant care, or nursing services are on the care plan.
Step 2: Ask for PDO screening and training.
The plan should use a PDO pre-screening tool and explain the employer duties. If the person cannot manage the duties alone, ask if a representative can help.
Step 3: Name the worker you want to hire.
Ask the case manager if the worker can be hired for the exact service. If the worker is a spouse, adult child, or live-in relative, ask for a clear answer before the hiring packet starts.
Step 4: Complete the employer and worker packets.
Do every form. Missing tax forms, background checks, signatures, or direct deposit forms can delay the first paycheck.
Step 5: Build the emergency backup plan.
Florida PDO requires an emergency backup plan. The backup plan says what happens if the direct service worker does not show up or cannot work.
Step 6: Wait for the approved start date.
Do not submit timesheets for work before the plan says the worker is approved to start. Ask for the start date in writing.
Who to call first in Florida
- Not on Medicaid Long-Term Care yet: Call the Elder Helpline at 1-800-963-5337 and ask for ADRC screening for Florida Medicaid Long-Term Care.
- Already enrolled in a Long-Term Care plan: Call the plan case manager and ask for the Participant Direction Option.
- Need to choose or change a plan: Call Florida Medicaid Choice Counselors at 1-877-711-3662.
- Need Medicaid financial eligibility help: Use MyACCESS or call the DCF Office of Economic Self Sufficiency Customer Call Center at (850) 300-4323.
- Problem with an SMMC plan: Call the Medicaid Help Line at 1-877-254-1055 or file a Medicaid complaint.
Common problems
Problem: “The person is on Medicaid, so we thought family pay could start.”
Regular Medicaid coverage is not the same as Long-Term Care enrollment. The person usually needs the SMMC Long-Term Care route, an approved care plan, and PDO setup.
Problem: “The plan says the service is not on the care plan.”
Ask for a care plan review. Explain what help is needed with bathing, dressing, toileting, meals, safety, or other daily tasks. If costs are a concern, use the care cost calculator to write down the private cost of the missing help.
Problem: “The caregiver lives in the home.”
Official PDO materials reviewed for this guide do not give a simple public live-in rule. Ask the plan whether a live-in family member can be paid for the approved service and whether any tax or documentation rule applies.
Problem: “The worker passed the family interview but has not been paid.”
Check the start date, hiring packet, background check status, direct deposit form, timesheet signatures, and pay schedule. Ask the Fiscal/Employer Agent what is missing.
Problem: “The hours are not enough.”
Ask the case manager for a reassessment or care plan review. Keep notes about what happens when care is missed. Include falls, unsafe transfers, missed meals, toileting problems, wandering, or hospital visits.
Problem: “The person was denied Long-Term Care or lost eligibility.”
Read the notice. Screening, medical eligibility, financial eligibility, service denials, and service cuts may have different appeal steps. AHCA says a person may ask for a hearing about certain screening or eligibility issues within 90 days of the notice. For services denied, reduced, or stopped after plan enrollment, the person usually must go through the plan appeal process before a Medicaid fair hearing.
If income or assets are the issue, read Medicaid spend-down and Medicaid look-back period, then talk with a qualified elder law attorney before moving money or property.
FAQ
Can I get paid to care for my parent in Florida?
Maybe. If your parent is enrolled in Florida Medicaid Long-Term Care and has approved PDO services on the care plan, the plan may allow a family member to be hired as a direct service worker. The plan must approve the worker and payroll setup first.
Can a spouse be paid through Florida Medicaid PDO?
AHCA’s public PDO materials reviewed for this guide say family members may be hired, but they do not give a clear separate public spouse rule. Ask the Long-Term Care plan case manager or PDO contact for a written answer before counting on spouse pay.
Can an adult child be paid?
Often, adult children are the family members asking about PDO. Florida’s public PDO materials say family members may be hired if they meet the rules, but the plan should confirm the answer for the exact service, living setup, and worker role.
Does the worker have to be licensed?
It depends on the service. AHCA PDO materials say workers providing attendant care or intermittent and skilled nursing must be a Florida licensed registered nurse or licensed practical nurse. Adult companion, homemaker, and personal care workers do not need a license under AHCA’s PDO guide, but they still must meet plan rules.
Can the same person be the representative and paid caregiver?
No. AHCA’s PDO manual says a representative cannot be paid for representative duties and cannot be the direct service worker.
What if the plan will not explain PDO?
Ask for a PDO-trained case manager or the plan’s PDO contact. If the issue is not fixed, call the Medicaid Help Line at 1-877-254-1055 or file a Medicaid complaint. If a service is denied, reduced, or stopped, read the notice and ask about the plan appeal process.
Resumen breve en español
En Florida, la opción principal se llama Participant Direction Option, o PDO. Es parte del programa Medicaid Long-Term Care.
La persona que recibe cuidado puede escoger a un trabajador directo, que puede ser un familiar, amigo o vecino, si el plan lo aprueba. Pregunte al administrador del caso si un esposo, esposa, hijo adulto o familiar que vive en la casa puede ser pagado antes de empezar.
About this guide
This guide was written for family caregivers who need a practical first step. It focuses on Florida Medicaid self-directed care, family caregiver pay, payroll steps, and where to ask for help.
Rules may change. Managed care plans may also use plan-specific forms and contact names. Use this guide to ask better questions, not as proof of approval.
Official sources used
- Florida AHCA: Long-Term Care Plans Participant Direction Option (PDO)
- Florida AHCA: Participant Direction Option Manual
- Florida AHCA: Participant Direction Option Guidelines
- Florida AHCA: Statewide Medicaid Managed Care Long-Term Care Program
- Florida AHCA: Long-Term Care Recipient FAQs
- Florida Department of Elder Affairs: Aging and Disability Resource Centers
- Florida Department of Elder Affairs: Caregiving
- Florida State Medicaid Managed Care: Enrolling in a Health Plan
- Florida DCF: Medicaid
- Florida DCF: Applying for Assistance
- Florida AHCA: Make a Complaint or Ask for a Fair Hearing About Long-Term Care Services
- Medicaid.gov: Self-Directed Services
Disclaimer
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state.
