Association of Health Care Journalists: Some states flout HCBS Medicaid rules by requiring unpaid family caregiving (7/5/2016) Justice in Aging’s recent report, Voluntary Means Voluntary: Coordinating Medicaid HCBS with Family Assistance, reveals several cases in Florida where Medicaid programs required family caregivers to provide unpaid assistance to elders. The hours of unpaid assistance provided by family caregivers were then used to refuse or reduce Medicaid-funded personal care services to their loved ones.