Have you ever looked at your bank account at the end of the month and wondered where the money went not because of impulse spending or poor planning, but because someone you love needed it more than your future self did?
When I sat down with Monique Washington at a diner near her home in Baltimore’s Belair-Edison neighborhood on a Tuesday morning in late March, she had just finished a 10-hour overnight shift. She ordered black coffee, declined the menu, and told me she had about 90 minutes before she needed to relieve her neighbor, who watches her brother Marcus while she works. She was precise about the time. She is always precise about the time.
Monique is 43 years old. She has worked as a UPS package car driver for 14 years, earning what she describes as “good money” — somewhere north of $42 per hour under the Teamsters contract. By most measures, she is financially stable. By the measure that matters most to her future, she is running on empty.
A Car Accident That Changed Two Lives
The story starts in 2007, when Monique’s younger brother Marcus was 25. He was driving home from a night shift at a warehouse when another driver ran a red light and hit him at an intersection in East Baltimore. Marcus survived, but the traumatic brain injury he sustained left him with significant cognitive and physical impairments. He requires daily assistance with bathing, meals, medication management, and mobility.
For the first few years, their parents managed Marcus’s care. When their mother died of a stroke in 2016 and their father followed two years later from heart failure, the responsibility passed entirely to Monique. There were no other siblings. There was no estate to speak of. There was just her.
Marcus receives Social Security Disability Insurance (SSDI) and is enrolled in Maryland Medicaid. According to the Social Security Administration, the average SSDI monthly benefit in 2025 was approximately $1,537. Marcus’s benefit, Monique told me, is close to that figure. It covers his rent — he lives in a small accessible apartment two blocks from Monique’s house — and his basic utilities.
What it does not cover is everything else.
The Gap Between What Medicaid Covers and What Marcus Actually Needs
Maryland Medicaid covers a substantial portion of Marcus’s medical care, but Monique has spent years navigating what she calls “the edges” — the services and supplies that fall just outside what the program will authorize.
She walked me through a rough monthly accounting from memory, the way someone does when they’ve run the same numbers so many times they no longer need to write them down:
- Supplemental personal care aide hours (beyond what Medicaid authorizes): approximately $620/month
- Accessible transportation for Marcus’s medical appointments when paratransit is unavailable or delayed: roughly $180/month
- Medical supplies — incontinence products, wound care items, adaptive equipment — not fully reimbursed: approximately $210/month
- Co-pays and out-of-pocket pharmacy costs for medications with coverage gaps: $90–$130/month
That totals somewhere between $1,100 and $1,160 per month coming directly out of Monique’s paycheck. Over a year, that is roughly $13,400. Over the 18 years since Marcus’s accident — accounting for inflation and the years their parents absorbed the cost — Monique estimates she has personally spent well over $80,000 on his supplemental care.
The retirement piece is what haunts her most. Monique had been contributing to her Teamsters pension and a supplemental 401(k) through UPS for years. Around 2021, when care costs spiked after a Medicaid authorization for additional aide hours was denied following a reassessment, she stopped contributing to the 401(k) entirely. The pension continues because it is employer-funded and automatic. But the voluntary contributions — the ones that would have compounded quietly in the background — stopped.
The Shift She Can’t Change and the Vacation She Can’t Take
Monique works the pre-load shift, starting before dawn. It is not her preference. It is the shift that works around Marcus’s care schedule — his aide arrives at 7 a.m., and Monique is typically home by 6:30 p.m. Changing shifts would mean finding coverage for an overlap window that doesn’t exist in her current arrangement. She has been on the same shift for seven years.
She told me she has watched colleagues with more seniority transfer to better routes, take lateral moves into feeder driving — which pays even more — or relocate to hubs in other cities for advancement opportunities. She has stayed put.
The vacation question came up almost as an aside, but it landed heavily. Monique told me she took a long weekend in 2019 — three days in Atlantic City with friends from her route. Since then, nothing. Not because she can’t arrange coverage for Marcus in theory, but because the cost of arranging full-time substitute care for even a week runs between $800 and $1,200, and she has never been able to justify the expense against everything else pulling at her budget.
She is 43. She has not had a week off in six years.
What the System Offers — and Where It Falls Short
I asked Monique whether she had explored any programs that might offset some of her costs. She had. She described a years-long process of applications, appeals, and reassessments that reads less like a safety net and more like an obstacle course.
The $500 payment from the state caregiver program stood out to me — not because it was meaningless, but because of the contrast. Monique spends that amount on Marcus’s supplemental care in less than two weeks.
According to Medicaid.gov, home and community-based services waivers are designed to help people like Marcus remain in community settings rather than institutional care. But the gap between what waivers authorize and what individuals actually need is a well-documented problem, and Monique’s experience is far from unique.
The Resentment She Admits, Quietly
Toward the end of our conversation, I asked Monique a direct question: does she ever resent Marcus, or the situation? She was quiet for a moment. She wrapped both hands around her coffee cup.
She said it without self-pity, more like she was reading from a list she had compiled privately and was finally allowed to read aloud. Then she straightened up and said Marcus had a good week — his physical therapy had gone well, and he’d been in better spirits. She said it the way you report good news when you’ve learned not to expect it too often.
Monique told me she has started looking into whether Marcus might qualify for additional benefits under a Supplemental Security Income review, and whether there are any changes in Maryland’s Medicaid waiver program that might expand his authorized hours. She is not optimistic, but she is methodical. She does her research the same way she runs her route — efficiently, without wasted motion.
She has not yet restarted her 401(k) contributions. She knows she needs to. She also knows that knowing and doing are two different things when every dollar is already spoken for.
When I left the diner, Monique was already on her phone — checking in with the neighbor watching Marcus, confirming the aide’s schedule for the next morning. She waved without looking up. She had 20 minutes to get home.
There is no tidy resolution to Monique’s story. She is not in crisis. She is not a cautionary tale about reckless spending. She is a person doing exactly what she is supposed to do — working hard, showing up, taking care of her family — and finding that the system surrounding her was not designed with someone like her in mind. The gap she lives in, between earning enough to be ineligible for help and earning enough to actually be okay, is one of the quietest and most common financial traps in America.
She will go home, she will check on Marcus, and tomorrow she will get up before dawn and do it again.
Related: She’s Been Her Brother’s Caregiver for 18 Years — and Her Own Retirement Is Paying the Price
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