Why are spouses excluded in the Cash and Counseling Program?

Spouses are not paid as caregivers under Medicaid Law. If your Spouse needs 24-7 care and you cannot afford to stay home from work, when he is enrolled in Medicaid programs you can work and he can either go to Day Care or have a provider come in to care for him while you are gone.
Explore every option.
Is your Spouse a Veteran? Did he serve during War Time? There are Veterans benefits for people who served for in home care.

LONG POST AHEAD.
Blue Eyes, You asked why a spouse can't get paid to be a caregiver. I made a point recently of looking up the Federal law that governs Medicaid. Federal Medicaid does not pay spouses to be caregivers and this is governed by federal law. I've copied and pasted the applicable statute below.

Code of Federal Regulations
Title 42 - Public HealthVolume: 4Date: 2008-10-01Original Date: 2008-10-01Title: Section 440.167 - Personal care services.Context: Title 42 - Public Health. CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED). SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS. PART 440 - SERVICES: GENERAL PROVISIONS. Subpart A - Definitions.
§ 440.167
Personal care services.
Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter—
(a) Personal care services means services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for the mentally retarded, or institution for mental disease that are—
(1) Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State;
(2) Provided by an individual who is qualified to provide such services and who is not a member of the individual's family; and
(3) Furnished in a home, and at the State's option, in another location.
(b) For purposes of this section, family member means a legally responsible relative.
[42 FR 47902, Sept. 11, 1997]
Explanation: The federal government does not pay caregivers that have a legal responsibility to provide care for spouses, minor children, or people you have guardianship over. Many states have a STATE-funded Medicaid waiver program or request a WAIVER from the federal government for the federally paid Medicaid in their state in order to pay family members (i.e. spouses). The programs are referred to as Cash and Counseling, Service My Way, etc. The idea being that an individual is not supposed to be paid to provide a service to someone that is a legal requirement due to their relationship (like child support agreements for minor children are transfers for the child's living expense needs like food and housing from one parent to the other, not payment to a parent for providing those services). The payment of family members/household members is a mine field since under the waiver program usually the person receiving the services becomes an employer of the family member and subject to all the tax reporting, withholding, etc for employment purposes including workers compensation and other liability. Some states also require family members take courses in first aid or get licensed to provide care. Your meeting should help lay that out for you. A waiver program is frequently on a waiting list depending on the volume of users in a county or state and is NOT a guarantee that you will qualify. You may also find that being paid as a caregiver will change eligibility for Medicaid, Meals on Wheels, or other INCOME based programs because when you are paid to be a caregiver, your income changes. It can cause part of Social Security or pension payments to be taxable depending on how much you receive. So if you enter a program for a state waiver program, get ready for lots of paperwork on top of caregiving, find a good elder lawyer and tax preparer, and make sure that you keep good records to navigate Medicaid Estate Recovery programs once your loved one passes on – if they go first *sigh*.

Thanks for your reply--We have an appointment on the 20th--I will learn than if our state has this program but I am told, it does.

If your state doesn't pay it, find a state that does and move there. But, there's waiting lists and they don't pay much, and, hubby has to qualify for Medicaid. Does he have more than $2000 in assets? He won't get Medicaid if he has assets.

Many states DO allow spouses yo be paid under this program. I guess it's a question for your state lawmakers.