What is MaineCare consumer-directed personal care?
Maine runs its Medicaid program under the name MaineCare, and it offers a "consumer-directed" (also called participant-directed or self-directed) way to receive personal care at home. Instead of an agency assigning you an aide, the member chooses their own personal care attendant, trains that person on exactly the help they need, sets the schedule, and can let the attendant go if it is not working out. For many families this is how a daughter, son, or other relative who is already providing care finally gets paid for it.
The main entitlement version is Consumer Directed Attendant Services, known as Section 12 of the MaineCare Benefits Manual. It is designed for adults who can direct their own care and need help with at least two activities of daily living, such as bathing, dressing, transferring, toileting, or eating. Because Section 12 is a MaineCare entitlement, there is generally no waiting list: if you qualify, you are enrolled. It covers up to about 28 hours per week of personal care, plus a modest amount of skills training and care coordination each year.
A second path is the Section 19 waiver, formally the Home and Community Benefits for the Elderly and Adults with Disabilities program. It serves people who need a nursing facility level of care and are at risk of ending up in a nursing home. Section 19 also offers a participant-directed option, and it is the one Maine program that lets a spouse be paid as a caregiver, but only for "extraordinary care" that goes beyond what a spouse would ordinarily do. Unlike Section 12, the Section 19 waiver has a limited number of slots and can carry a waiting list.
In both programs the member is the employer of record. A financial management services agency (the fiscal intermediary) sits behind the scenes to run payroll, withhold taxes, issue W-2s, and handle the employment paperwork. It does not choose your attendant, set the schedule, or supervise care. Maine's Department of Health and Human Services, through the Office of Aging and Disability Services, oversees both programs.
MaineCare consumer-directed eligibility requirements
Eligibility rules apply to the member who needs care, not to the attendant. The attendant does not have to meet any income or asset test. The figures below reflect 2026 MaineCare limits, which change each year; Section 12 (CDAS) and Section 19 (the waiver) use different income and level-of-care thresholds.
Who can - and cannot - be paid
The member picks their own attendant. Section 12 CDAS excludes spouses and other legally responsible relatives from being paid. The Section 19 waiver is stricter about level of care but is the one program that lets a spouse be paid, and only for documented extraordinary care.
- Adult children (18 and older) of the member
- Siblings, grandchildren, nieces, nephews, aunts, uncles, and in-laws
- Close friends, neighbors, and other trusted community members
- A spouse - but only under the Section 19 waiver, and only for authorized "extraordinary care"
- Attendants with no CNA, HHA, or nursing certification (no license required for CDAS)
- A spouse, under Section 12 CDAS (spouses are excluded from that program)
- Any other legally responsible relative, under Section 12 CDAS
- A parent being paid to care for their own minor child (the member must be an adult)
- A person serving as the member's paid guardian or conservator for the same hours
MaineCare consumer-directed pay, hours, and overtime
Pay is funded by MaineCare and runs through the financial management services agency, which withholds taxes and issues a W-2. Maine consistently sits at the lower end of national caregiver wages, but the state has raised rates through annual cost-of-living adjustments, including increases effective July 2025 and January 2026.
Hourly pay
In 2026, most family and personal care attendants in Maine earn roughly $16 to $20 per hour, with published caregiver wage surveys clustering around $18 per hour and a broader range of about $15 to $21. The total MaineCare reimbursement (the code S5125 personal care unit) after recent cost-of-living adjustments works out to roughly $22 to $23 per hour, but part of that pays the financial management agency and program overhead, so the attendant's take-home wage is lower than the full reimbursement. Attendants are W-2 employees, so federal and state income tax, Social Security, and Medicare are withheld from each check.
Hours and scheduling
Section 12 CDAS authorizes up to about 28 hours per week of personal care, based on the member's assessed needs, plus up to roughly 14 hours of skills training and 18 hours of care coordination per year. The Section 19 waiver can authorize more extensive hours for members who need a nursing facility level of care. The exact number of hours is set by the Assessing Services Agency after a functional assessment.
Overtime rules
Because the attendant is a W-2 employee, federal overtime rules generally apply: more than 40 hours in a single workweek for one member is typically paid at 1.5 times the hourly rate. The financial management services agency handles overtime tracking and payroll. Since CDAS caps weekly personal care hours well below 40, most single-member arrangements never reach the overtime threshold.
How to apply for MaineCare consumer-directed care in Maine
- Apply for MaineCare (or confirm existing coverage). You can apply online through My Maine Connection or by phone with the Office for Family Independence at 1-855-797-4357. Financial eligibility is decided here.
- Contact the Office of Aging and Disability Services to request long-term services and supports. Call OADS at 1-877-353-3771 and ask about Consumer Directed Attendant Services (Section 12) or the Section 19 waiver.
- Explain that you want a consumer-directed / participant-directed option
- Ask which program fits the member's level of care
- Ask about current wait times if the Section 19 waiver is being considered
- Complete the functional assessment. The state's Assessing Services Agency (Maximus) conducts a medical eligibility determination to confirm the ADL need and set your authorized hours. You can reach Maximus at 1-833-525-5784.
- Be ready to describe help needed with bathing, dressing, transfers, toileting, and eating
- A nurse or assessor reviews the member's needs
- Choose your attendant and confirm the rules for your program. For Section 12 CDAS this can be an adult child, other relative, or friend but not a spouse. For a spouse to be paid, ask specifically about the Section 19 waiver and its extraordinary-care requirement. When in doubt, confirm eligibility with MaineCare Member Services at 1-800-977-6740.
- Enroll with the financial management services agency (fiscal intermediary). Your attendant completes onboarding paperwork so they can be paid.
- Federal I-9 employment verification and W-4 tax forms
- Any required background check and health screening
- Direct deposit setup
- Submit timesheets and reassess. The member (or their representative) approves hours each pay period, the agency runs payroll, and MaineCare reassesses eligibility and hours periodically to keep the authorization current.
MaineCare consumer-directed frequently asked questions
Can my spouse be paid to care for me through MaineCare in Maine?
It depends on the program. Under Consumer Directed Attendant Services (Section 12), the answer is no: spouses and other legally responsible relatives are specifically excluded from being paid. However, Maine's Section 19 waiver, the Home and Community Benefits for the Elderly and Adults with Disabilities program, does allow a spouse to be paid as a Personal Support Specialist, but only for "extraordinary care." Extraordinary care means help that goes beyond what a spouse would ordinarily provide for a partner of the same age without a disability, and it must be documented and authorized through the person-centered planning process by the Service Coordination Agency. The spouse also has to meet the qualifications of a Personal Support Specialist and work through a personal care agency. So if you need a spouse paid, the Section 19 waiver is the route, and you should ask OADS about it directly.
How much does MaineCare pay a family caregiver in 2026?
In 2026, most personal care attendants and family caregivers in Maine earn roughly $16 to $20 per hour, with wage surveys clustering around $18 and a broader range of about $15 to $21 depending on the region and the fiscal agency. The full MaineCare reimbursement for personal care (billing code S5125), after cost-of-living adjustments that took effect in July 2025 and January 2026, is higher, around $22 to $23 per hour, but part of that covers the financial management services agency and program overhead, so the attendant's take-home wage is lower than the total reimbursement. Attendants are W-2 employees, meaning federal and state income tax, Social Security, and Medicare are withheld from each paycheck. Maine tends to sit toward the lower end of national caregiver pay, though the state has been raising rates through annual adjustments.
How long does it take to get approved?
Plan on roughly one to three months from application to approval. If the member is not yet on MaineCare, the financial eligibility review through the Office for Family Independence is usually the longest step, and gathering documents in advance speeds it up. After that, the functional assessment through the Assessing Services Agency (Maximus) confirms the level of care and sets your authorized hours, and enrollment with the financial management services agency and attendant onboarding typically takes another couple of weeks. Section 12 CDAS is a MaineCare entitlement with no waiting list, so once you qualify you can enroll. The Section 19 waiver has a limited number of slots and can carry a waiting list, which may add time if all slots are full when you apply.
What training or certification does the attendant need?
For Consumer Directed Attendant Services (Section 12), no formal training, certification, or license is required. The attendant does not need to be a Certified Nursing Assistant or Home Health Aide. The member trains the attendant on the specific tasks they need help with, which is a major reason CDAS works well for relatives who have been caregiving informally. There are basic onboarding steps handled through the financial management services agency, such as employment paperwork (I-9 and W-4), a background check, and any required health screening. The Section 19 waiver can be different: when a spouse is paid for extraordinary care, that spouse has to meet the qualifications of a Personal Support Specialist and work through a personal care agency, which involves more formal requirements than CDAS.
What is the difference between Section 12 CDAS and the Section 19 waiver?
Section 12 Consumer Directed Attendant Services is a MaineCare entitlement for adults who can direct their own care and need help with at least two activities of daily living. It has generally no waiting list, lower income limits, and it covers up to about 28 hours per week of personal care, but it excludes spouses from being paid. The Section 19 waiver, Home and Community Benefits for the Elderly and Adults with Disabilities, is for people who need a nursing facility level of care and are at risk of institutionalization. It allows higher income, can authorize more hours, offers a participant-directed option, and uniquely permits a spouse to be paid for extraordinary care. The tradeoff is that Section 19 is not an entitlement, so slots are limited and a waiting list can form. Many families start by asking OADS which program fits their situation.
Can I be paid to care for more than one MaineCare member?
Yes. An attendant can work for more than one MaineCare member, and each member is a separate employment relationship through the financial management services agency. Overtime is generally calculated per employer, so working part-time hours for two different members will not automatically trigger overtime the way exceeding 40 hours for a single member would. This is common among family caregivers who help their own parent and also pick up hours with another relative or a neighbor. Keep in mind that federal labor rules include joint-employer provisions that can apply in some situations, so if you plan to work for multiple members it is worth confirming the details with the fiscal agency that runs your payroll.
Does the member have to be able to direct their own care?
For Section 12 Consumer Directed Attendant Services, yes. The program is designed for members who are cognitively able to direct their own care, meaning they can choose, train, schedule, and supervise their attendant. That is the core idea of a consumer-directed model. If the member cannot fully self-direct, Section 12 CDAS may not be the right fit, and a different MaineCare personal care option may apply instead. Under the Section 19 waiver's participant-directed option, a member who cannot manage everything alone may still direct their care with help from a designated representative or surrogate who assists with hiring and supervising the attendant. When you contact OADS, describe the member's ability to make care decisions so they can steer you to the program that matches.
Will consumer-directed care affect the member's other MaineCare benefits?
No. Enrolling in a consumer-directed personal care program does not change the member's other MaineCare coverage. They keep their doctor visits, hospital coverage, prescription drugs, durable medical equipment, and other covered services. Consumer Directed Attendant Services and the Section 19 waiver are specific long-term-care benefits that sit alongside the rest of the MaineCare package. If the member is dually eligible for Medicare and MaineCare, Medicare continues to cover acute care such as hospital stays, doctor visits, and short-term skilled home health, while MaineCare covers the ongoing personal care through the consumer-directed program. The two programs coordinate and do not cancel each other out, so choosing self-directed care simply adds a paid caregiver option to the coverage the member already has.
See also: Maine caregiver guide
For all the ways to get paid to care for a family member in Maine — including MaineCare Consumer-Directed, VA programs, long-term care insurance, and more — read the full Maine guide.