Most people assume that if you hold a steady union job, you are financially stable. That assumption, I have learned through years of covering economic relief, can be dangerously wrong. The caregiving economy quietly drains workers who earn too much to qualify for many forms of assistance and too little to absorb the costs on their own.
When I first reached out to Monique Washington, 43, a UPS package car driver based out of Baltimore, Maryland, she almost didn’t agree to talk. “I don’t really think of myself as someone who has a story worth telling,” she said over the phone. “I’m just doing what family does.” What family does, in her case, costs somewhere in the neighborhood of $1,900 a month above and beyond what her brother’s Medicaid and SSI cover — every single month, for nearly eighteen years.
The Accident That Redrew Her Entire Life
Monique’s younger brother, Darnell, was 25 when a driver ran a red light on a Baltimore side street and struck the car he was in. He survived. The version of him that existed before that night did not. When I sat down with Monique at a diner near her home in Northeast Baltimore, she described the aftermath without sentimentality — the way people do when they’ve rehearsed their grief into something functional.
“He has a traumatic brain injury and limited mobility on his left side,” she told me, wrapping both hands around her coffee cup. “He can communicate, he knows who I am, he has opinions about everything. But he can’t live alone, and he needs help every single day.” Their parents died within four years of each other — their father from a stroke in 2014, their mother from cancer in 2018. After that, Monique became the plan.
Darnell receives Supplemental Security Income (SSI) and is enrolled in Maryland’s Medicaid program. In 2025, the federal SSI benefit rate sat at $967 per month for an individual, a figure that has risen incrementally with Cost-of-Living Adjustments but has never kept pace with actual disability-related expenses. Medicaid covers his primary care visits and some in-home assistance hours — but not all of them.
What Medicaid Doesn’t Say Out Loud
The gap between what Medicaid covers and what full-time disability care actually costs is something Monique described with quiet precision. She keeps a spreadsheet. She showed it to me on her phone — line items for the supplemental care aide hours Medicaid doesn’t fund, the adaptive equipment replacements, the accessible transportation on days the paratransit system falls through.
“The van alone,” she said, “was $44,000 after the modifications. I financed most of it. I’m still paying it off.” She bought the wheelchair-accessible vehicle in 2021 after Medicaid’s non-emergency transport vendor repeatedly left Darnell waiting. The monthly payment on that van now runs her roughly $620.
She also buys medical supplies — incontinence products, wound care materials, specialized nutritional supplements — that Maryland Medicaid either does not cover or caps at amounts well below what Darnell actually uses. According to Medicaid.gov, covered benefits vary significantly by state, and many optional services remain subject to annual legislative appropriations. In plain language: states can and do cut things.
The Programs She Found — and Almost Didn’t
The turning point in Monique’s story came in early 2024, when a coworker mentioned something called an ABLE account during a break room conversation. Monique had never heard of it. She went home and researched it that night.
ABLE accounts — Achieving a Better Life Experience accounts — are tax-advantaged savings accounts established under federal law for individuals with qualifying disabilities that began before age 26. The key feature that most families miss: funds in an ABLE account generally do not count against the $2,000 asset limit that would otherwise disqualify a Medicaid or SSI recipient. In 2025, annual contributions to an ABLE account can reach up to $18,000 from all sources combined, per IRS guidance on ABLE accounts.
Monique also learned, through a nonprofit tax preparation service she visited in early 2024, that she may qualify for the Credit for Other Dependents — a nonrefundable federal tax credit of up to $500 for qualifying relatives who don’t meet the Child Tax Credit threshold. Her tax preparer walked her through the eligibility criteria. She had been filing as single with no dependents for years, leaving that credit unclaimed.
The relief was real, but Monique was careful not to oversell it to me. “Five hundred dollars is five hundred dollars,” she said. “It’s not nothing. But it’s also not a month of care costs.”
The Outcome: Real Relief, Real Limits
I asked Monique to walk me through what her finances look like now versus two years ago. She paused before answering, and when she did, the math was sobering. The combination of expanded waiver services, the ABLE account, the caregiver support stipend, and the tax credit added up to roughly $400–$500 per month in direct and indirect relief. That is meaningful. It is not transformative.
She still has not restarted contributions to her Teamsters pension supplement or any personal retirement vehicle. She told me she thinks about this late at night. “I know I’m burning time I can’t get back,” she said. “Every year I don’t save is a year I’ll have to work later. I understand that. But what am I supposed to do — put money in a 401(k) while he doesn’t have enough aide hours?”
The vacation question — she hasn’t taken one in six years — produced the most unguarded moment of our conversation. The Maryland Family Caregiver Support Program offered her access to respite care services, which would theoretically allow her a few days away. She used it once, for three days, in October 2024. “I spent two of those days worrying,” she said. “I’m working on it.”
What Her Story Reveals About the Caregiving Economy
Monique Washington is not an outlier. She is, in many ways, the median profile of an American family caregiver — employed, above the poverty line, and falling steadily behind. The programs that exist to help families like hers are real and, in some cases, substantive. But they are buried under layers of application processes, waitlists, and institutional silence that filter out exactly the people who need them most.
She found most of her relief not through a government website or a caseworker, but through a coworker and a volunteer tax preparer. That is not a system working as intended. That is luck dressed up as policy.
When I left the diner, Monique had already checked her phone twice for messages from Darnell’s afternoon aide. She had a split shift starting at 3:00 p.m. She did not complain about either thing. She just noted them, the way you note weather — as conditions you move through, not obstacles you resent. That composure, I thought walking back to my car, had probably cost her more than she would ever add up.
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