Yes, in many states Medicaid can pay a family member to give care, and some veterans' families can be paid by the VA. Spouses face stricter rules. How each route works, who decides, and where your state stands.
Yes. In many states a family member can be paid to care for a parent or other relative through Medicaid, and spouses face stricter rules than any other relative. The pay comes from a program, not from the person you care for: Medicaid pays when your parent qualifies for Medicaid and for a home care program that lets a relative do the work, and the VA pays the families of some veterans. Every route below has its own rules about who qualifies, who can be the paid caregiver and how to apply.
This guide explains each route the way it works across the country, then shows where every state we have checked stands. The rules that decide your case are set by your state, so the last step is always your state's page, where each fact carries its source and the date we checked it.
We have published the answer for 45 of the 50 states and the District of Columbia so far. The oldest check behind these answers is ; each state's page dates every fact.
Can a family member be paid?
35 statesYes.
At least one state program on record pays a family member to give care.
9 statesDepends.
A program pays a family member only under conditions, which the state's page sets out with their sources.
1 stateNo.
No state program on record pays a family member.
Spouses are another matter.
10 statesYes.
At least one program on record pays a spouse.
20 statesDepends.
A spouse can be paid only under conditions.
10 statesNo.
No program on record pays a spouse.
For 5 states, our record does not yet answer the spouse question for every program, so we give no answer there.
We publish a state's answer only once every fact behind it is confirmed at its source.
Every state and DC is on one page, with its answer where we have published one and the date behind it.
There are four main ways a family caregiver gets paid through a public program. It helps to know which one fits before you call anyone.
The first two run through your state's Medicaid program, so the person you care for must qualify for Medicaid. The last two run through the VA and do not depend on Medicaid. A few states also run programs of their own outside Medicaid; where we have one on record, the state's page lists it.
Self-direction means the person who gets care, or a representative they choose, decides who provides the care and how. The Centers for Medicare & Medicaid Services (CMS) calls the power to "recruit, hire, train and supervise the individuals who furnish their services" employer authority, and the power to decide how a Medicaid budget is spent budget authority (Medicaid.gov, Self-Directed Services, checked November 2, 2026). When your parent has employer authority, they may be able to hire you, if the program lets a relative be the paid worker.
You are paid as a worker, not as a family member. A financial management service, which CMS says "must be available" when a program gives budget authority, helps with payroll and taxes, such as withholding and filing employment taxes and processing timesheets. CMS adds that "Individuals can perform some or all of the FMS functions themselves," though most hand them to the service (Medicaid.gov, checked November 2, 2026). In practice, expect hiring paperwork and a record of the hours you work, and you are paid for the hours in the care plan. Federal waiver rules say a paid relative must meet the same provider qualifications as any other worker and sign a provider agreement (CMS 1915(c) waiver technical guide, version 3.5, Appendix C-2, checked November 2, 2026).
States give these programs their own names, which is one reason families miss them. In New Jersey it is the Personal Preference Program, where you set your worker's pay within the budget, at no less than the state minimum wage of $15.92 and no more than $25 an hour in 2026 (New Jersey Division of Medical Assistance and Health Services, PPP overview for 2026, checked November 2, 2026). In Florida it is the Participant Direction Option, and in Oregon the Independent Choices Program. Each state's page gives the program's own name, so you can ask for it by name.
One rule catches many families. In several states, the person who acts as your parent's representative, the one who makes the employer decisions, cannot also be the paid worker. Our records show that rule in New Jersey, Florida, Oregon and Kansas, each linked to the state's own text on its page. If you hold power of attorney and also want to be paid, ask the program before you sign anything which role you can take. Someone else in the family may need to be the representative.
Some states pay a relative who lives in the same home through a provider agency, at a daily rate instead of by the hour. Indiana's program is a clear example: structured family caregiving "allows a caregiver living with an individual to be paid for providing daily care and support," the caregiver "may be a nonfamily member or a family member," gets training from the agency, and has home visits from a caregiver coach or nurse (Indiana Family and Social Services Administration, Structured Family Caregiving, updated August 25, 2025, checked November 2, 2026).
The money in these programs is paid to the agency, which passes part of it to you. In Indiana, since July 1, 2025, the state pays the agency $77.54, $99.71 or $133.44 a day depending on the person's level of need, and the agency must use at least 60 percent of that rate for caregiver stipends and direct care (Indiana Health Coverage Programs bulletin BT2025105, checked November 2, 2026). So the stipend you receive is less than the daily rate, and you should ask any agency what share it keeps before you choose one.
We have a live-in caregiver program of this kind on record in 8 states:
Each state's page says who the program serves, whether a spouse can be the paid caregiver, and how to apply, with the source and checked date beside each fact.
Much paid family care runs through a Medicaid home and community-based services waiver, usually called a 1915(c) waiver after the section of the Social Security Act that allows it. A waiver lets a state pay for care at home instead of in a nursing home. To get one, a person "must demonstrate the need for a Level of Care" that would qualify them for an institution under the state's rules (Medicaid.gov, Home & Community-Based Services 1915(c), checked November 2, 2026). In plain terms, your parent needs enough help that a nursing home would otherwise be an option.
Waivers are also limited. CMS says "States choose the maximum number of people that will be served" by a waiver, and states may set extra criteria to target a waiver to particular groups. About 257 waiver programs are active nationwide (Medicaid.gov, checked November 2, 2026). That is why two families in the same state can get different answers: one parent fits a waiver that has room, and another does not. When you apply, ask whether the program has a waiting list and how long it is.
Not every program is a 1915(c) waiver. CMS notes that "Some states also use demonstration authority under section 1115(a) of the Act to test home and community-based service strategies" (CMS, Long-Term Services and Supports Rebalancing Toolkit, November 2020, checked November 2, 2026). New Jersey's FamilyCare Comprehensive Demonstration, a section 1115 demonstration approved through June 30, 2028, gives members the option to self-direct their home and community-based services (CMS approval letter, checked November 2, 2026). Texas's STAR+PLUS, which "provides acute and long-term service and supports to older adults and adults with disabilities," runs under the Texas Healthcare Transformation and Quality Improvement Program, a section 1115 demonstration approved through September 30, 2030 (CMS approval, January 15, 2021, checked November 2, 2026). Programs under these and other authorities carry their own rules, which is one more reason to ask for your program by its state name.
So there are three separate questions, and each has its own answer: does your parent qualify for Medicaid, does your parent need enough care for a waiver, and does that waiver let a relative be the paid worker. Our state pages answer the third. Only the state Medicaid agency can answer the first two for your parent.
Federal policy treats a spouse differently from an adult child. CMS calls a spouse or the parent of a minor child a "legally responsible individual" (that is the typical case; state law defines who counts), and its policy is that paying one for personal care is not eligible for federal Medicaid matching funds, on the presumption that they "may not be paid for supports that they are ordinarily obligated to provide" (CMS 1915(c) waiver technical guide, Appendix C-2, checked November 2, 2026).
A waiver can make an exception. A state may pay a spouse for care that counts as "extraordinary," which CMS defines as care beyond what a spouse would ordinarily do for a person of the same age without a disability, and which is needed to keep the person out of an institution. Paying a spouse this way "is a state option, not a Federal requirement," and states may add limits, such as a cap on weekly hours; CMS gives 40 hours a week as an example (CMS technical guide, checked November 2, 2026).
An adult child caring for a parent is not a legally responsible individual under that policy. CMS says the term does not include the parent of an adult or "other types of relatives, except as provided in state law" (CMS technical guide, checked November 2, 2026). Each state still decides whether relatives can be paid at all, and it may limit which relatives, for example only those who do not live in the same household.
What this looks like in practice varies widely, sometimes inside one state:
If you are caring for your husband or wife, ask the state about each program by name, and ask specifically whether a spouse can be the paid worker. A "no" from one program is not the answer for every program in your state.
The VA has two programs that can pay a family caregiver. Neither depends on Medicaid, and the first names a spouse among the caregivers it pays.
This program pays a monthly stipend to the primary family caregiver of a veteran who needs a lot of help. The veteran must have a VA service-connected disability rating, individual or combined, of 70 percent or higher, must have been discharged or have a date of medical discharge, must be enrolled in VA health care, and must need at least six months of continuous, in-person personal care services. The caregiver must be at least 18 and be the veteran's spouse, son, daughter, parent, stepfamily member or extended family member, or live with the veteran full time or be willing to (VA, Program of Comprehensive Assistance for Family Caregivers, page updated February 11, 2026, checked November 2, 2026).
The stipend is set from the federal pay scale. VA starts from the General Schedule annual rate for grade 4, step 1 in the locality where the veteran lives, divided by 12. A caregiver at Level 1 gets 62.5 percent of that monthly rate. A caregiver at Level 2 gets 100 percent, which applies when VA decides the veteran is "unable to self-sustain in the community" (VA Caregiver Support Program, PCAFC stipend, page updated September 14, 2026, checked November 2, 2026). Because the rate follows the veteran's locality, the dollar amount differs by where you live.
The primary caregiver can also get health coverage through CHAMPVA if not already covered by another health plan, at least 30 days of respite care a year, and mental health counseling (VA, checked November 2, 2026).
To apply, the veteran and the caregiver complete and sign one joint application, VA Form 10-10CG, online, by mail or at the caregiver support team of a VA medical center. Caregiver education and training and a home care assessment come before approval. VA says: "We'll assign you as a caregiver no later than 90 days after we get your application" (VA, checked November 2, 2026).
Deadline once you are in the program: report a change of address, a hospital or facility admission, or a death to the caregiver support team within 30 days of the event, so the stipend is not overpaid (VA, checked November 2, 2026).
Veteran-Directed Care gives a veteran "a budget for services that is managed by the Veteran or the Veteran's representative," and the veteran hires their own workers, who VA says might include "their own family member or neighbor." Any veteran enrolled in VA health care can be considered if they are eligible for community care and meet the clinical criteria, but "services may vary by location," so the first step is to ask a VA social worker whether it is offered where the veteran lives (VA, Veteran-Directed Care, checked November 2, 2026).
A veteran who does not meet the 70 percent rating for the stipend program may still qualify for Veteran-Directed Care, and both can be raised in the same conversation with the VA social worker. For any VA caregiver question, the Caregiver Support Line is 1-855-260-3274, Monday to Friday, 8 a.m. to 8 p.m. Eastern. VA's general caregiver support program, with training, coaching and peer support, is open to caregivers of enrolled veterans of any era (VA Caregiver Support Program, checked November 2, 2026).
Pay from a Medicaid waiver program for caring for someone who lives with you may not be taxable income. The IRS treats certain Medicaid home and community-based waiver payments as "difficulty of care payments excludable from gross income" under Notice 2014-7. The exclusion "only applies to payments for care in the individual care provider's home," meaning the home you share with the person you care for, and it does not apply if you have a separate home of your own. Relatives qualify, and more than one caregiver living in the home can use it. For open tax years you may choose to count these payments as earned income for the earned income credit, but you must include "all, but not part" of them (IRS, Certain Medicaid waiver payments may be excludable from income, page reviewed April 29, 2026, checked November 2, 2026).
Whether a particular payment counts depends on how your program is set up and where you live. A tax professional, or the IRS itself, decides that for your return; we cannot.
Write down the name of each person you speak to, the date, and what they told you. If an answer from a caseworker does not match what the state's own rules say, the written rule linked on your state's page is what you can point to.
We can tell you which programs exist in your state, what their rules say about paying relatives and spouses, and where those rules are written. We cannot tell you whether your parent qualifies, how many hours they will be given, or whether a waiver has room this year. The state Medicaid agency decides those for Medicaid programs, and the VA decides them for VA programs. If an agency's answer and its written rule seem to disagree, ask the agency to show you the rule it is applying.
Every federal fact on this page was read on November 2, 2026 at the official page linked beside it. The state examples come from our State Records, where each fact was checked at the state's own source on the date its state page shows. The counts and state lists near the top are read from those records each time this page loads, so they always match the state pages. Sources:
Something here wrong or out of date? Tell us through the contact form and we will check it against the source. Fixes are listed on Corrections.
Guide
Guide
Short-term care for the person you look after, so you can take a break. Medicaid, the VA, Medicare and state programs each pay for it in some cases. Who pays, how much, and how to get it in your state.