Adult children can budget for private caregiving after Medicaid cuts by capping paid aide hours each week and comparing that cost with residential care. They can also track qualifying out-of-pocket medical costs for taxes and contact local caregiver programs for respite, training and planning help.
Private caregiving here means paying directly for a home aide for a parent with dementia. According to KFF in the 2025 issue brief, the 2025 budget reconciliation law reduces federal Medicaid spending by about $911 billion over 2025-2034, roughly 14%. States facing that gap may limit optional home-care spending.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Check eligibility on Irs’s official study page — Use this page to check the study’s participation requirements.
- Check eligibility on Irs’s official study page — Use this page to check the study’s participation requirements.
Table of Contents
- Why home care faces cuts first
- What private care costs now
- How do you set a weekly-hour budget?
- What help can taxes and caregiver programs offer?
Why home care faces cuts first
Federal Medicaid law requires states to cover nursing-facility care. KFF explains that states may choose whether to cover most home and community-based services beyond limited home-health benefits.
Home and community-based services are Medicaid supports that help people live at home rather than in nursing facilities. That choice makes home care vulnerable when budgets tighten. Families should not assume current waiver hours, waitlist movement or service levels will hold.
What private care costs now
The industry-benchmark CareScout survey reports a national median of about $33-$34 per hour for a home-health aide in the 2024 cost survey. The same survey reports about $77,792 per year for 44 hours weekly, and $5,900 monthly for assisted living, or $70,800 yearly.
These are medians, not quotes. Local rates, minimum-hour rules, nights, weekends and dementia-care premiums change the bill.
How do you set a weekly-hour budget?
Start from capped hours, not open-ended coverage. Full-time home-aide costs rival assisted living, while 24/7 care costs several times more. Families often compare 20-44 hours of home care against residential care.
- List tasks that need a paid aide, such as bathing, transfers, meals and supervision.
- Assign remaining tasks to family, adult day programs or volunteers.
- Price two caps, such as 20 hours and 44 hours, then compare each with residential care.
- Revisit the cap when needs, sleep disruption or safety risks rise.
What help can taxes and caregiver programs offer?
The IRS allows itemizers on Schedule A to deduct unreimbursed medical costs only above 7.5% of adjusted gross income, described in Topic No. 502. Qualifying spending can include medically necessary home care, nursing, therapy and long-term-care services detailed in IRS Publication 502, but only amounts not reimbursed by insurance may count.
The federal National Family Caregiver Support Program funds local supports described by the Administration for Community Living in the program description, including information, counseling, training, respite care and supplemental services. IRS rules and program materials warn of limits: standard-deduction filers and spending below 7.5% of income receive no deduction benefit, and respite varies by funding and is not a cash entitlement. Keep receipts, care logs and provider statements before assuming tax or program relief.
