Getting Paid as a Family Caregiver

Millions of adult children, spouses and other relatives care for a family member at home, often while giving up work hours or leaving jobs entirely. Many do not know that Medicaid may pay them. In most states, a family member can be paid to provide personal care to a relative who qualifies for Long-Term Care Medicaid, through consumer-directed programs, structured family caregiving or agency arrangements. This guide explains the main ways family caregivers get paid, who can be paid, and how to get started.

Figures change periodically. Double-check current amounts before relying on them.

The short version

The person receiving care must qualify for a Medicaid program that pays for home care, usually a waiver, a state plan personal care program or a managed care plan.
Most states let adult children and other relatives be paid; rules for spouses and legal guardians are stricter and vary by state and program.
The most common routes are consumer-directed (self-directed) programs, agency-with-choice models where an agency hires the family member, and structured family caregiving, which pays a daily stipend to a live-in caregiver.
Pay is usually an hourly wage (or a daily stipend), and caregivers often must complete training, a background check and electronic visit verification.
Veterans have separate VA programs that can pay family caregivers.
A private personal care agreement is a separate option for families who pay a relative from the older person’s own funds.

Route 1: Consumer-directed programs

In consumer-directed (self-directed) programs, the person receiving care, or a representative, hires and manages their own caregivers. Many states allow relatives to be hired. The state or a fiscal intermediary pays the caregiver for approved hours. See Consumer-directed care.

Route 2: Agency-with-choice

In some states, a home care agency hires the family member as an employee, trains and supervises them, and assigns them to their relative. The agency handles payroll and compliance. This can be a good option when the family wants the caregiver to be paid but does not want to manage employer paperwork.

Route 3: Structured family caregiving

Some states offer structured family caregiving (or similar programs, sometimes called adult foster care or caregiver homes), in which a live-in family caregiver receives a daily stipend plus coaching and support from an agency. See Structured family caregiving.

Route 4: Other state programs

Some states pay family caregivers through state-funded programs, adult family care, or caregiver homes. Some offer modest monthly stipends for caregivers of people who do not qualify for full Medicaid.

Who can be paid

Relative	Commonly allowed?
Adult children and grandchildren	Yes, in most states
Siblings, nieces, nephews, other relatives	Yes, in most states
Friends and neighbors	Yes, in most states
Spouses	Some states and programs allow it; many do not
Legal guardians or agents under a power of attorney	Often restricted, or allowed with safeguards
Parents of minor children	Restricted

Federal rules for 1915(c) waivers allow states to pay “legally responsible individuals,” such as spouses, for extraordinary care (care beyond what a spouse would ordinarily provide), with safeguards, if the state includes this in its waiver. Many states expanded spousal payment during the COVID-19 public health emergency, and some kept it.

What paid caregivers do

Paid family caregivers provide the services in the person’s care plan, such as:

bathing, dressing, grooming and toileting;
transferring and mobility help;
meal preparation and feeding;
medication reminders;
light housekeeping and laundry;
escorting to appointments, in some programs.

Paid hours are limited to what the assessment approves. Care beyond those hours is unpaid.

Requirements caregivers usually meet

be at least 18;
pass a criminal background check;
complete required training, which varies from a short orientation to certification;
complete enrollment paperwork with the fiscal intermediary or agency;
record visits through electronic visit verification (EVV), required by federal law for Medicaid-funded personal care and home health services;
keep accurate time records.

Pay and taxes

Pay rates are set by the state or program and are often modest. Caregivers are usually treated as employees and receive a W-2. In some cases, payments to a live-in caregiver under a Medicaid waiver may be excludable from federal income under IRS guidance on “difficulty of care” payments (IRS Notice 2014-7). Caregivers should talk with a tax professional about their situation.

Veterans programs

The Department of Veterans Affairs has separate programs that can pay family caregivers, including the Program of Comprehensive Assistance for Family Caregivers (for veterans with serious service-connected injuries) and Veteran-Directed Care. See Getting paid by the VA as a family caregiver.

Paying a family caregiver privately

If the person does not qualify for Medicaid yet, or the program does not allow family caregivers, the person can pay a relative from their own funds under a written personal care agreement. Done correctly, these payments are not gifts for the Medicaid look-back. See Personal care (caregiver) agreements.

How to get started

Check eligibility. The person receiving care must qualify for Medicaid, both financially and functionally.
Apply for the program that allows family caregivers, and ask for a needs assessment.
Ask about self-direction, agency-with-choice or structured family caregiving.
Complete enrollment and caregiver requirements.
Start care and record hours through EVV.

A simple example

Maria cares for her mother, Elena, 83, who has Parkinson’s disease and lives with her. Maria cut back to part-time work. Elena qualifies for her state’s waiver, which offers self-direction. Elena’s assessment approves 25 hours a week of personal care. With her mother’s agreement, Maria enrolls as Elena’s paid caregiver through the fiscal intermediary, completes training and a background check, and records her hours on a phone app. She is paid every two weeks. Elena’s son acts as her representative, approving timesheets, because Maria cannot be both caregiver and representative under the state’s rules.

Getting help

The Area Agency on Aging or the state Medicaid agency can explain which programs allow family caregivers. A Certified Medicaid Planner can help the care recipient qualify for Medicaid, which is the first step to getting a family caregiver paid.

Frequently asked questions

Can I be paid to care for my spouse? In some states and programs, yes. Many do not allow it. Check the state’s rules.

Will being paid affect my own benefits? Earnings may affect means-tested benefits you receive. Review the rules for each benefit before accepting payment.

Can I be paid for care I already gave? Not through Medicaid. Payment starts when you are enrolled and approved.

How many hours will I be paid for? It depends on the care recipient’s assessment and program limits.

Key terms

Self-direction: a model in which the person, or a representative, hires and manages caregivers.
Agency-with-choice: a model in which an agency employs a caregiver the family has chosen.
Legally responsible individual: a person with a legal duty of support, such as a spouse or the parent of a minor child.
Extraordinary care: care beyond what a legally responsible person would ordinarily provide.
Difficulty of care payments: certain Medicaid waiver payments to live-in caregivers that may be excludable from income under IRS guidance.

Common mistakes

Assuming Medicaid will pay for care already given.
Recording hours that were not worked.
Not having a backup caregiver.
Not checking whether the program allows the specific relative to be paid.
Forgetting that paid hours are limited to the assessment.

A second example: caring for a spouse

Harold cares for his wife, Jean, who has advanced multiple sclerosis. Their state’s waiver allows payment to spouses for extraordinary care with safeguards. After Jean’s assessment, the waiver approves 30 hours a week of personal care, and Harold enrolls as her paid caregiver under the state’s rules, with a care manager reviewing the plan and a second worker covering some hours. In a state that does not allow spousal payment, Harold could still receive respite and other supports, and a different relative or a hired aide could be paid.

Balancing paid care with family life

Being paid does not change the emotional side of caregiving. Paid family caregivers still need breaks, support and a plan for what happens if they get sick. Respite, adult day care and caregiver support groups can help. Families should also talk openly about how the arrangement affects siblings and how decisions will be made.

Where to start in your state

Begin with the state Medicaid agency’s home care or waiver page, the local Area Agency on Aging, or the aging and disability resource center. Ask specifically, “Which programs allow a family member to be the paid caregiver, and is the relative I have in mind allowed?” Write down program names, because the same idea goes by different names in different states.

Keep notes of every call, including the date and the name of the person you spoke with.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.