Have you ever looked at your bank account and realized that almost nothing in it actually belongs to your future? That most of what you earn disappears into someone else’s needs before you can even name it as sacrifice?
When I sat down with Monique Washington at a diner in East Baltimore on a Tuesday afternoon in March 2026, she was still in her brown UPS uniform. She had worked a full route that morning and driven her brother Marcus to a physical therapy appointment before meeting me. She ordered coffee, no food, and said she wasn’t hungry — though I suspected that wasn’t entirely true.
A Life That Pivoted at Someone Else’s Crisis
Monique is 43. Her brother Marcus is 38. When Marcus was 25, a distracted driver ran a red light in West Baltimore and hit the passenger side of his car. The collision left him with a traumatic brain injury and permanent mobility limitations that require daily personal assistance.
For the first few years after the accident, Monique’s parents coordinated his care. Then her mother died of a stroke in 2018. Her father followed in 2021. Overnight, Monique became Marcus’s only person — his scheduler, his advocate, his financial backstop, and his emergency contact.
Marcus receives Supplemental Security Income through the Social Security Administration. According to SSA’s SSI program page, the federal benefit rate for an individual in 2026 is $967 per month. Maryland adds a small state supplement, bringing Marcus’s total to approximately $1,020 monthly. He also qualifies for Medicaid, which covers a portion of his care.
The word “portion” is doing a lot of heavy lifting in that sentence.
What Medicaid Pays For — and What It Doesn’t
Monique walked me through a breakdown of Marcus’s monthly expenses that she had written on the back of a receipt. She keeps it in her jacket pocket. She said she pulls it out sometimes when she’s trying to understand why her checking account looks the way it does.
Maryland Medicaid covers Marcus’s base personal care aide hours — but only up to a state-determined threshold. When his needs exceed those hours, Monique fills the gap herself, either with her time or her money. She estimates she pays roughly $600 per month for additional care aide hours that Medicaid won’t authorize.
Accessible transportation is another line item. Medicaid covers medical transport to approved appointments, but not the everyday trips — the pharmacy, the grocery store, the occasional outing that constitutes a life. Monique told me she spends approximately $380 per month on accessible van services and modified rideshare costs for Marcus.
Medical supplies round out the gap. Certain wound care products, specific adaptive equipment, and some nutritional supplements that Marcus’s doctors recommend fall outside Medicaid’s covered benefits. Monique estimates another $300 to $350 per month there. Add it up and she’s spending somewhere between $1,250 and $1,400 every month — money that comes directly out of her union wages as a Teamsters-represented UPS driver.
The Retirement Account She Stopped Feeding
Monique earns a livable wage. Her Teamsters contract provides solid pay and benefits that most workers in her income bracket don’t have access to. On paper, she should be building toward a stable retirement. She is not.
She told me she stopped making voluntary contributions to her supplemental retirement account four years ago, in early 2022, when Marcus had a hospitalization that generated roughly $4,200 in out-of-pocket costs not covered by Medicaid. She pulled from her retirement contributions to cover it. She never went back to contributing.
Her union pension will provide some baseline income in retirement. But the years without voluntary contributions represent tens of thousands of dollars in potential compounding that simply did not happen. Monique is 43. The window isn’t closed — but it isn’t wide open either.
She has also been unable to change shifts or accept a supervisor position she was offered in 2023, because the hours would conflict with Marcus’s care schedule. She turned down a pay increase of approximately $6,800 annually. She said she doesn’t dwell on it. I noticed she said this twice.
The Bureaucratic Maze Around Marcus’s Benefits
Monique has tried to find more formal support. She described the process to me in a tone that was somewhere between exhausted and sardonic. She has contacted Maryland’s Medicaid office to request additional authorized care hours. She was told Marcus’s current level of need doesn’t trigger a higher tier of authorization under the waiver program he’s enrolled in — despite documentation from his neurologist recommending expanded support.
She applied for a different Medicaid waiver, the Maryland Community Options Waiver, which can provide more comprehensive services. As of our conversation, Marcus had been on the waiting list for approximately 14 months.
She won the 2024 appeal, which resulted in eight additional covered aide hours per week. She told me she cried in her car afterward — not from relief, but from the realization that she had spent 14 months fighting for something that cost her more in lost time than it saved in money.
What She Carries Quietly
There’s a particular emotional register that long-term caregivers inhabit. It isn’t despair exactly. It’s something closer to a very controlled form of grief — for the choices not made, the trips not taken, the version of their own life that exists only in the abstract.
Monique told me she hasn’t taken a real vacation in six years. The last one was a four-day trip to Atlanta in 2019, before her father got sick. She described it as the last time she felt like a person with options. She said this without self-pity, which made it land harder.
She is clear-eyed about the financial reality in a way that some people only get after years of doing the math over and over. She knows what her retirement looks like if nothing changes. She knows what it would look like if Marcus’s waiver application is approved. She knows the difference between those two numbers. She carries both of them.
When I left the diner, Monique checked her phone and said she needed to call Marcus’s aide to confirm the next morning’s schedule. She thanked me for listening. It occurred to me that she probably doesn’t get thanked for much of anything herself.
There are millions of Moniques in the United States — family members holding together what public systems leave incomplete, absorbing costs that appear in no budget line, and aging toward a retirement they can’t quite afford to plan for. Their stories don’t often get told, partly because they’re too busy to tell them.
Related: She’s Been Her Brother’s Caregiver for 18 Years — and Her Own Retirement Is Paying the Price
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