Family caregivers
The Participant Direction Option: hiring a relative under Medicaid Long-Term Care
PDO lets a person on Florida Medicaid Long-Term Care hire, train, supervise and let go of their own workers, including neighbors, friends and family.
The short answer
If you are enrolled in Medicaid Long-Term Care, live in your own or a family home, and have adult companion care, attendant nursing care, homemaker services, intermittent and skilled nursing, or personal care on your plan of care, your plan must make PDO available. You choose who to hire, and the plan cannot require you to use its network.
How it works
- You are the employer. The enrollee, or a representative they name, hires and supervises the worker.
- The plan pays. The plan tells you the payment rate and gives 30 days' written notice of a change.
- A trained case manager helps. The plan must assign a case manager trained in PDO within two business days after you choose it, and help with job descriptions, hiring, disputes and backup plans.
- It is growing. The July 2026 state contract requires plans to raise PDO participation each year, reaching 27 percent by contract year six.
The five PDO services
| Service | License needed? |
|---|---|
| Adult companion care | No |
| Homemaker | No |
| Personal care | No |
| Attendant nursing care | RN or LPN |
| Intermittent and skilled nursing | RN or LPN |
All workers train in universal precautions and HIPAA privacy standards and hold CPR and first aid certification, per AHCA's program summary.
The one rule that trips families
A representative cannot be paid for being a representative and cannot be a direct service worker. So one person manages and another gives paid care.
How to start
- Enroll in Long-Term Care. See the steps.
- Tell your case manager you want PDO. Plans must offer it at enrollment and each year.
- Complete the pre-screening tool and sign the Participant Agreement.
- Choose your worker. They pass Level 2 screening and sign the Participant/Direct Service Worker Agreement.
- Submit timesheets as your plan instructs.
PDO and agency care can work together
Some people self-direct some services and use an agency for others, and PDO and non-PDO services cannot duplicate each other. An agency can also serve as your backup plan. Ask your case manager how it would work with your plan.
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
Can my daughter be my paid worker?
The contract says enrollees may hire any qualified individual, including family members. She cannot also be your representative.
What if my worker gets sick?
Your plan must help you develop an emergency backup plan that includes network providers.