The first thing Monique Washington said when I arrived at her row house in northeast Baltimore was that she didn’t want anyone feeling sorry for her. She had just finished a nine-hour shift and was heating up soup on the stove, one ear tuned to the hallway where her brother, Darnell, was watching television in his room. She set two bowls on the table, sat down across from me, and said: “I’m not a charity case. I just want people to understand what this actually costs.”
I had reached out to Monique after a reader tip came through our inbox in January 2026. She had written a short note — only four sentences — describing her situation. It was the restraint of those four sentences that made me want to call her. She wasn’t angry. She was just precise.
A Caregiver Who Never Signed Up for the Role
Monique is 43, a Teamsters-represented UPS driver with eighteen years on the job. She earns approximately $42 an hour, which sounds comfortable until she walks me through the math. Darnell, now 31, was involved in a severe car accident at 25 that left him with a traumatic brain injury and limited mobility. He receives Social Security Disability Insurance — SSDI — and is enrolled in Maryland Medicaid.
Their parents passed away within three years of each other, their mother in 2019 and their father in 2022. There was no estate. There was no plan. There was Monique.
According to the Social Security Administration, SSDI benefits are calculated based on a recipient’s own work history. Darnell’s benefit — he worked briefly before the accident — comes to roughly $890 per month. Maryland Medicaid covers his physician visits, hospitalizations, and a limited range of home health aide hours. What it does not cover is the supplemental gap that Monique fills every single month.
The Numbers She Has Memorized
When I asked Monique to walk me through her monthly out-of-pocket costs for Darnell’s care, she didn’t hesitate. She had clearly done this math so many times that the figures came out in a practiced rhythm, almost like a grocery list.
Accessible transportation is the single largest line item. Medicaid’s non-emergency medical transportation benefit, which Maryland administers through a broker system, covers rides to approved medical appointments — but not to the pharmacy, not to the community day program Darnell attends twice a week, and not to family events or recreational outings. Monique pays for a modified van service out of pocket, running her between $280 and $340 per month depending on the schedule.
Medical supplies are next. Darnell requires specific wound care materials and adaptive equipment that fall outside Medicaid’s durable medical equipment coverage thresholds. Monique estimates she spends roughly $200 to $250 monthly on supplies alone. The remaining balance goes to the supplemental hours of a private home health aide — roughly 12 hours per week — that Medicaid does not authorize because Darnell technically meets only partial eligibility criteria for expanded home care under Maryland’s waiver program.
What the Programs Offer — and Where They Stop
Monique told me she spent the better part of 2023 trying to find programs that could ease the financial load. She called 211, Baltimore’s social services hotline. She sat in a waiting room at the Social Security field office on Reisterstown Road for two and a half hours. She filled out applications for Maryland’s Community First Choice waiver program, which provides expanded Medicaid home and community-based services for people with disabilities.
Darnell was eventually placed on the waitlist. As of March 2026, he remains on it.
Monique also looked into the federal tax code for relief. She does claim Darnell as a qualifying relative dependent on her federal return, which provides some benefit. According to the IRS, taxpayers who pay more than half the support costs for a qualifying relative may claim them as a dependent, which can affect taxable income and eligibility for certain credits. But Monique told me the actual dollar difference on her refund felt like a rounding error against what she spends annually.
The Retirement She Stopped Building
This was the part of our conversation that Monique seemed most reluctant to get into. She refilled my coffee without asking and sat back down, and I waited. She stared at the table for a moment before answering.
Before 2021, Monique had been contributing 6 percent of her wages to her Teamsters pension and an additional amount to a supplemental 401(k). She suspended the 401(k) contributions when the private aide costs escalated after their father died and she assumed full caregiving responsibility. The pension continues through her union, which offers her some long-term protection — but the voluntary savings she had been building stopped cold.
She is 43. She knows what compound interest is. She told me she read an article about retirement savings gaps among caregivers and then closed the browser because she couldn’t do anything about it that day, and there was no point in reading what she already felt.
The One Thing That Actually Helped
When I asked Monique if anything had moved the needle — even partially — she mentioned the ABLE account. Maryland ABLE, which operates under the federal Achieving a Better Life Experience Act, allows individuals with qualifying disabilities to open tax-advantaged savings accounts. The funds can be used for a broad range of disability-related expenses, including transportation, housing, health, and education, without affecting Darnell’s eligibility for Medicaid or SSI.
According to the ABLE National Resource Center, contributions to an ABLE account in 2025 were capped at $18,000 annually from all sources combined. Monique contributes what she can — usually between $100 and $150 per month — and uses the account specifically for transportation costs, which keeps those expenses organized and, to some extent, tax-advantaged.
She also told me that her union, through the Teamsters, had a member assistance program she hadn’t known about until a coworker mentioned it. She called the number and was connected with a benefits navigator who helped her identify that she may qualify for Maryland’s Caregiver Support Program, a state-funded grant that provides modest direct payments to unpaid family caregivers. As of our conversation in late January 2026, her application was pending review.
She was cautiously, almost suspiciously, hopeful about it. “I’ve been disappointed enough times that I don’t let myself get too far ahead,” she said.
What Monique’s Story Reveals About the System’s Blind Spots
Monique’s situation is not unusual — it is just usually invisible. She earns enough that she doesn’t register on most means-tested program radars, but her real disposable income, after caregiving costs, is substantially lower than her gross wages suggest. She cannot relocate for a better cost of living because Darnell’s care network — his doctors, his day program, his aide — is here in Baltimore. She cannot take a different shift because his schedule is built around hers.
The American workforce contains millions of people making the same quiet calculation. According to the Department of Labor, the Family and Medical Leave Act provides up to 12 weeks of unpaid, job-protected leave for qualifying caregiving situations — but unpaid leave is not a financial solution for someone already stretched thin. Paid family and medical leave remains a federal policy gap in 2026, with no universal program enacted.
Before I left, I asked Monique what she would want someone reading her story to know — not about her, but about the system. She thought about it for a long moment. Then she said: “Tell them the gap is real. It’s not something you complain about at Thanksgiving and then move on. It’s every month. It’s every year. And nobody’s coming to fill it.”
I drove back through Baltimore thinking about that sentence. She wasn’t bitter when she said it. She was just reporting the facts. In that way, I thought, she and I had more in common than either of us expected.
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