How to get paid for taking care of a family member

Some states pay a family member to provide care, and VA has two programs for family caregivers of Veterans. The route depends on who needs care, which state they live in and what other coverage they have. There is no single federal program that pays every family caregiver.

This page covers the federal picture. State details are on the state program pages. Carevo does not assess eligibility, so confirm each program with the agency that runs it.

Medicaid self-directed care

Medicaid.gov says self-directed services let participants, or their representatives, make decisions about certain services and manage them with help from supports. With "employer authority," participants recruit, hire, train and supervise the people who provide their services. With "budget authority," they can also decide how the funds in an individual budget are spent. Financial management services help with tasks like payroll.

States offer this model under several federal authorities, including 1915(c) waivers and the 1915(i), 1915(j) and 1915(k) options. That is why the same idea has different names in different states.

To use it, the person needing care generally has to qualify for Medicaid and for the program. For a 1915(c) waiver, CMS lists the requirements: an institutional level of care, an assessed need for services, membership in the group the waiver serves, financial eligibility, and choosing to be served through the waiver. See Medicaid and long-term care.

Can a relative be the paid caregiver?

CMS training material says states may allow relatives and legal guardians to provide any waiver service, including personal care, if they meet the state's provider qualifications and the state monitors them like other providers. In a 1915(c) waiver, each state chooses among four positions: pay no relatives, pay them in specific circumstances, pay them with no special circumstances, or another policy.

The rules differ for spouses and parents of minor children, whom CMS calls legally responsible individuals. At the state's option, and if qualified, one may provide personal care in a 1915(c) waiver, and CMS describes this as for "extraordinary" care. Under 1915(j), hiring legally liable relatives is a state option. Federal rules do not define who counts as a legally responsible individual, so states do.

Other limits to expect: the family member must meet the state's qualifications, and Medicaid generally does not pay for the person's room and board. A narrow exception allows a share of rent and food for an unrelated live-in caregiver where the waiver allows it, but not where the person lives in the caregiver's home.

Because these choices are made state by state, the same family situation can be paid in one state and not in another. Check your state on the programs page.

VA programs for family caregivers

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

PCAFC supports family caregivers of eligible Veterans. VA.gov says the Veteran must have a VA disability rating of 70% or higher, need at least 6 months of continuous in-person personal care, and be enrolled in VA health care. The caregiver must be at least 18 and be the Veteran's spouse, child, parent, stepfamily or extended family member, or live with the Veteran full time (or be willing to).

One Primary Family Caregiver and up to two Secondary Family Caregivers can be appointed. Only the primary caregiver receives a monthly stipend. Primary caregivers can also get CHAMPVA health coverage if they have no other plan, at least 30 days of respite care a year, and other supports. The Veteran and caregiver apply together, using VA Form 10-10CG.

Veteran-Directed Care

VA Caribbean Healthcare System describes Veteran-Directed Care as a program where the Veteran gets a flexible monthly budget and chooses their own workers, including family, friends and neighbors. The Veteran must be enrolled in VA health care and need home care. To start, talk to your VA primary care provider or social worker, who creates a consult. Availability may differ by location, so ask your VA team.

For other VA help with care costs, see VA benefits for paying for care and VA Aid and Attendance.

Long-term care insurance

Whether a long-term care insurance policy pays a family member depends on the policy. The state insurance guides we read do not say policies generally do. Some policies count each calendar day toward the elimination period even when no paid care is received, which lets a person use care from family or friends while waiting. Ask the insurer in writing before you plan around it. See long-term care insurance.

What Medicare does not do

Medicare.gov says Medicare does not pay for custodial care or for personal care when that is the only care needed. Home health aide help is covered only alongside skilled care. See what Medicare pays for.

Questions to ask the state or program

1. Does this program let the person receiving care hire a relative? Which relatives?
2. Does the relative need training, a background check or enrollment as a provider?
3. What is the pay rate, and is there a cap on weekly hours?
4. Who handles payroll and taxes?
5. Is there a waiting list for the program?
6. Can a spouse be paid, and under what conditions?
7. If I live with the person, what is and is not paid?

If you are weighing the caregiving load, take the caregiver burnout quiz. If you also want a break from care, see respite care. To find a provider, tell us what you need.