Family caregivers
How a family member becomes a direct service worker in Florida
"Direct service worker" is the term Florida Medicaid uses for the person who actually gives the care. A relative can hold that role, as long as the person receiving care is in a program that allows it.
The short answer
First your loved one must be enrolled in the right program. Then the requirements depend on it. Under Medicaid Long-Term Care's Participant Direction Option, the enrollee hires you, you pass a Level 2 background screening, train in universal precautions, HIPAA, CPR and first aid, and the health plan pays you at a set rate. Licensure is only required for nursing services.
Step 1: confirm your loved one's program
Check which path fits. If your loved one is not yet in a program, start with the Medicaid guide. You cannot become a paid worker for someone who has not been approved.
Step 2: meet the requirements
| Program | What you need | Who pays |
|---|---|---|
| Participant Direction Option | Level 2 background screening, signed Participant/Direct Service Worker Agreement, training in universal precautions and HIPAA, CPR and first aid. No license for companion, homemaker or personal care. RN or LPN license for nursing. | The health plan, at a set rate, from timesheets |
| CDC+ | Level 2 background screening. Hired directly by the participant. Personal care assistants must be at least 16. | Fiscal/Employer Agent from the participant's budget |
| iBudget relative provider | Not legally responsible for the person. Same qualifications as other providers of that service. Personal supports, respite or transportation only. | Through the waiver |
| Family Home Health Aide | Age 18+, Level 2 screening, 76 hours of approved training, CPR and HIV training, RN competency check, 12 hours of yearly in-service. | Your employer, a licensed home health agency |
Step 3: make it official
- Tell the case manager or support coordinator you want to do this. Under Long-Term Care, plans must offer PDO when someone enrolls and every year at reassessment.
- Get screened. Under PDO the plan pays for the screening of at least one worker per service each contract year.
- Complete the training. Save your certificates.
- Agree your schedule and duties in writing. The PDO agreement lists services, hourly rate, schedule, your relationship and job duties, and is signed by the case manager, enrollee and worker.
- Plan for backup. Plans must help set up an emergency backup, because you will get sick too.
Rules that catch people out
- Under PDO, an enrollee's representative cannot also be their paid worker. If you manage your parent's care as their representative, someone else must do the paid work, or someone else must be representative.
- Under regular iBudget, parents of minors, spouses, guardians and legal representatives cannot be paid unless the person is in CDC+.
- Under CDC+, a parent or primary caregiver cannot be paid for respite, and a parent can only be an unpaid backup for nursing.
Working with Aster Care
Talk to us about what your situation allows. For the Family Home Health Aide program, the law requires the relative to be employed by a licensed home health agency that provides the training. Ask us on your call whether we can train and employ you for your child's care.
About this page. Aster Care LLC is a private home care agency, not a government agency. Eligibility decisions are made by the state offices named here. This is general information, not legal or benefits advice, and program rules change, so please confirm details with those offices.
Questions families ask
Do I need to be a CNA?
Not for PDO companion, homemaker or personal care work. AHCA lists no certification or license for those, only the general training. Nursing services require an RN or LPN license.
Can I do this and keep my other job?
Program rules do not generally require it to be your only job, but hours are limited to what your loved one's plan authorizes. Ask the case manager.
Are my earnings taxable?
Ask a tax professional. We cannot give tax advice.
Sources
- AHCA: SMMC Long-Term Care contract, Exhibit II-B (July 1, 2026)
- AHCA: SMMC Long-Term Care Program presentation (February 2023)
- AHCA: iBudget Waiver Services Coverage and Limitations Handbook (May 2023)
- CDC+ Program Coverage, Limitations and Reimbursement Handbook (October 2015)
- Florida Statutes s. 409.221: Consumer-directed care
- Florida Statutes s. 400.4765: Home health aide for medically fragile children
- AHCA: Family Home Health Aide Program