Federal policies present roadblocks to caregivers, especially to their financial security. Federal Medicaid law limits payments for spousal caregiving and the Family and Medical Leave Act only provides for unpaid leave. The Social Security Administration gives no work credits for persons providing free caregiving. Federal Medicaid law requires all caregiving be provided voluntarily, but many state Medicaid programs are not in compliance. And, federal law requires that state Medicaid programs provide protections against spousal impoverishment for persons receiving Medicaid HCBS, but the federal requirement expires at the end of 2018.