Caregiver exemptions work by excusing you from the new Medicaid work rule entirely. If you are a parent, guardian, caretaker relative, or family caregiver of a young child or a disabled person, work is not a condition of your eligibility.
The work rule is called community engagement. It requires 80 hours per month of work, school, job training, or community service for nonpregnant expansion adults ages 19-64, according to the CMS fact sheet. For dementia families, the key group is adults caring for a disabled spouse, parent, or other adult.
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 CMS’s official study page — Use this page to check the study’s participation requirements.
- Check eligibility on Specialneeds’s official study page — Use this page to check the study’s participation requirements.
Table of Contents
- Who qualifies as an exempt caregiver
- Why the disability definition helps dementia families
- Do you need 80 hours of caregiving
- What to do to keep your coverage
Who qualifies as an exempt caregiver
The rule creates a group called specified excluded individuals. It includes a parent, guardian, caretaker relative, or family caregiver of a dependent child age 13 and under or a disabled individual.
The child branch has an age cap. The disability branch does not. A daughter caring for a mother with advanced dementia can qualify in the same way as a mother caring for an adult son with cerebral palsy.
Why the disability definition helps dementia families
Disability for this exclusion uses a broad functional test. As explained by SpecialNeeds.com, citing the federal rule, the standard follows the ADA approach rather than Social Security's stricter test in its analysis of the caregiver exclusion.
That matters because dementia limits daily function, memory, safety awareness, and self-care. More care recipients count under this functional view. The person you assist does not need Social Security disability approval for you to qualify.
Do you need 80 hours of caregiving
Most relative caregivers and caregivers who live with the person face no hour test. You do not need to log 80 hours of care to stay exempt.
The limit applies to one smaller group. A caregiver who is neither related to nor living with the disabled adult must complete 80 hours of caregiving to qualify, according to the Justice in Aging guide. A neighbor who shops weekly for a person with dementia, but does not live there, would fall under that hour rule.
What to do to keep your coverage
States must first check existing records to grant the exclusion before asking you for proof. In some cases, states may accept your own statement that you provide care.
You still need to respond when the state asks. States recheck compliance at least every six months, and missing paperwork can cost coverage.
- Answer caregiving screening questions at application and renewal.
- Report that you care for a child 13 or younger or a disabled person.
- Provide proof promptly if the state requests it.
- Open every Medicaid notice right away and meet the deadline.
