Getting Paid by the VA as a Family Caregiver

Family members provide most of the care older veterans receive at home. Several VA programs, and the VA pension, can help pay for that care, and in some cases pay the family caregiver directly. The programs have very different eligibility rules: one depends on a service-connected disability, one on the veteran’s need for care and the local VA’s resources, and one on financial need. This guide explains each, with how they interact with Medicaid’s own paid family caregiver programs.

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

The main ways the VA can help pay family caregivers

Program	Pays the caregiver?	Key requirement
Program of Comprehensive Assistance for Family Caregivers (PCAFC)	Yes, a monthly stipend	Veteran has a service-connected disability rating of 70 percent or more and needs personal care for at least six continuous months
Program of General Caregiver Support Services (PGCSS)	No stipend; training and support	Caregiver of any enrolled veteran
Veteran Directed Care (VDC)	Yes, the veteran can hire family members	Veteran enrolled in VA health care, needs care and is accepted into the program at their VA medical center
VA pension with Aid and Attendance or Housebound	Indirectly; the veteran can pay a caregiver	Wartime service, financial need and need for care
Homemaker and home health aide services	Pays an agency, not family	Clinical need

1. Program of Comprehensive Assistance for Family Caregivers (PCAFC)

PCAFC is the VA’s most generous caregiver program. It provides:

a monthly stipend paid directly to the primary family caregiver;
access to health care coverage for the caregiver through the VA’s CHAMPVA program, if they have no other coverage;
caregiver training, mental health counseling and respite care;
in some cases, travel and lodging for the caregiver during the veteran’s medical care.

Who qualifies

In general, the veteran must:

have a single or combined service-connected disability rating of 70 percent or more;
need in-person personal care services for at least six continuous months because of an inability to perform an activity of daily living, or a need for supervision, protection or instruction;
be enrolled in VA health care, or apply to enroll.

The caregiver must be at least 18 and be a family member or someone who lives with the veteran full time (or will). Originally limited to post-9/11 veterans, the program expanded in stages and, since October 1, 2022, has been open to eligible veterans of all service eras.

How much the stipend is

The stipend is based on the federal government’s General Schedule pay rate for a GS-4, step 1 employee in the caregiver’s area, and on the level of care the veteran needs (two levels). Because it is tied to local pay rates, the amount differs by location.

2. Veteran Directed Care (VDC)

Veteran Directed Care gives an eligible veteran a flexible budget to hire their own personal care aides, which can include family members (rules on paying spouses vary). The veteran, or a representative, decides who to hire, sets schedules and approves time sheets, with help from a local agency. VDC is available at many but not all VA medical centers, and enrollment may be limited. A service-connected rating is not required; eligibility depends on enrollment in VA health care and clinical need for nursing-home-level care or help with daily activities.

3. The VA pension with Aid and Attendance

The VA pension does not pay caregivers directly, but it can give the veteran or surviving spouse money to pay one. Payments to a family caregiver may also count as an unreimbursed medical expense that reduces countable income for the pension, if the veteran needs the care and the payments are for care actually provided. A written caregiver agreement, a care log and regular payments make this easier to document. See VA pensions.

4. General caregiver support

Through the Program of General Caregiver Support Services, caregivers of any enrolled veteran can receive training, peer support, coaching and respite care. Each VA medical center has caregiver support staff. There is no stipend, but these services can make caregiving sustainable.

How VA caregiver payments affect Medicaid

Families often combine VA programs with Medicaid. Key points:

For the veteran. A PCAFC stipend is paid to the caregiver, not the veteran, so it is generally not the veteran’s income. VDC budgets pay for services and are not cash income to the veteran. VA pension payments are treated as described in How VA benefits count for Medicaid.
For the caregiver. If the caregiver is on Medicaid or another means-tested program, a stipend may count as their income. Rules vary.
Caregiver agreements and the look-back. Payments from the veteran to a family caregiver at a fair rate under a written agreement are generally not gifts. Payments without an agreement, or for care that was not needed or provided, can be treated as transfers under both the VA and Medicaid look-backs. See Caregiver agreements.
Medicaid paid caregiver programs. Many state Medicaid programs also pay family caregivers through consumer-directed options or structured family caregiving. A veteran may qualify for both VA and Medicaid programs, but the same hours generally cannot be paid twice. See Paid family caregivers.

How to apply

PCAFC: apply with the VA’s application for the comprehensive caregiver program, signed by both the veteran and the caregiver. The VA assesses the veteran and the caregiver, and the caregiver completes training.
VDC: ask the veteran’s VA primary care team or social worker for a referral.
VA pension: file the pension claim with medical evidence for Aid and Attendance; accredited veterans service officers help at no cost.
General caregiver support: contact the caregiver support staff at the nearest VA medical center.

Example

Paul is a 74-year-old Vietnam veteran with a 100 percent service-connected rating. After a stroke, his daughter, Lisa, moves in and helps him bathe, dress and manage medications. She applies with Paul for PCAFC. The VA approves her as his primary family caregiver and pays a monthly stipend based on local pay rates. Lisa also gets respite care and caregiver training. Because the stipend is paid to Lisa, it does not count as Paul’s income. If Paul later needs Medicaid home care services for more hours, the family must make sure the same hours are not paid by both programs.

Documenting family care

Whichever program is used, good records protect the veteran and the caregiver:

a written caregiver agreement (for private payment) describing services, hours and pay;
a daily or weekly care log;
payment records, such as checks or bank transfers, rather than cash;
a physician’s statement that the care is needed;
records of any VA or Medicaid program hours, so the same care is not billed twice.

These records help with the VA’s medical expense deduction for the pension, with Medicaid’s look-back review if a nursing home is needed later, and with taxes.

Questions to ask the VA caregiver support staff

Which caregiver programs is the veteran likely to qualify for?
How long does a PCAFC application and assessment take?
Is Veteran Directed Care available at our VA medical center, and is there a waiting list?
What respite options are available for the caregiver?
What training and support groups are offered?

Getting experienced help

VA caregiver programs, the VA pension and Medicaid’s own caregiver programs can work together, but the rules on income, transfers and double payment are easy to trip over. Accredited veterans service officers can help with VA applications at no cost. A Certified Medicaid Planner can explain the Medicaid side, including caregiver agreements. As a rough guide, hourly help ranges from about $150 to $600, and full planning from about $2,500 to $15,000 or more.

When the caregiver is also working

Many family caregivers juggle a job. Respite care, adult day health care and homemaker services from the VA can cover hours when the caregiver is at work. Some caregivers also qualify for unpaid job-protected leave under federal family leave law, depending on their employer. Planning a realistic weekly schedule with the VA social worker helps avoid burnout and gaps in care.

Key terms

Primary family caregiver: the person approved under PCAFC to receive the stipend.
Stipend: the monthly payment to an approved PCAFC caregiver, based on local federal pay rates and the level of care.
CHAMPVA: a VA health care program available to some PCAFC caregivers who have no other coverage.
Respite care: short-term care that gives a family caregiver a break.
Consumer direction: programs that let the person needing care hire and supervise their own caregivers.

Frequently asked questions

Can a spouse be paid? A spouse can be a PCAFC caregiver. Whether a spouse can be paid through VDC or Medicaid programs varies.

Is the stipend taxable? Tax treatment of caregiver payments can be complicated and depends on the program and the caregiver’s situation. A tax professional can explain how it applies.

Can I be paid by the VA and Medicaid? Possibly, for different hours or services, but not twice for the same care.

Does the veteran need a service-connected disability? For PCAFC, yes (70 percent or more). For VDC and the VA pension, no.

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