How to Get Paid to Care for a Family Member

If you’re caring for a parent, spouse, or other relative, you may be able to get paid for it. The main programs are run through Medicaid and the U.S. Department of Veterans Affairs, and the rules depend on your state and the person you care for. Here is how each one works.

Medicaid self-directed care

Many state Medicaid programs offer self-directed services. Instead of an agency choosing the aide, the person receiving care (or their representative) can recruit, hire, train, and supervise their own workers. In many programs, that worker can be a family member.

Some programs also give the person a budget and let them decide how it is spent on approved services.

Can a spouse or parent be paid?

This is where the rules get specific:

• Most relatives: under Medicaid home and community-based services (HCBS) waivers, states may let relatives provide services, including personal care, if they meet the state’s provider requirements.
• Spouses and parents of minor children: federal rules call these “legally responsible” relatives. In traditional Medicaid state plan personal care, they can’t be paid caregivers, though states using the self-directed state plan option (section 1915(j)) may pay them. Under waivers, states may choose to pay them, but only for “extraordinary care,” meaning care beyond what a spouse or parent would normally provide.

Structured Family Caregiving

Some states offer a waiver service called Structured Family Caregiving, where a family caregiver who lives with the person is paid through an agency. Indiana, for example, offers it in several Medicaid waivers: the state pays the agency a daily rate, the agency pays the caregiver, and caregivers get coaching and up to 15 days of respite a year. Not every state has this program.

Programs for veterans

VA Program of Comprehensive Assistance for Family Caregivers

This program pays a monthly stipend to the primary family caregiver of an eligible veteran. Basic requirements from the VA:

• The veteran has a VA service-connected disability rating of 70% or higher and needs at least 6 continuous months of in-person personal care.
• The caregiver is at least 18 and is a spouse, child, parent, step-family member, or extended family member, or lives full-time with the veteran.

Primary caregivers may also get health coverage through CHAMPVA if they have no other insurance, at least 30 days of respite a year, and other support. You apply with VA Form 10-10CG.

Veteran-Directed Care

This VA program gives eligible veterans a budget to hire their own caregivers, which can include a family member or neighbor. It isn’t available everywhere; ask a VA social worker.

The VA Caregiver Support Line is 1-855-260-3274.

How to find programs in your state

1. Call your state Medicaid agency and ask about self-directed personal care and HCBS waivers that allow family caregivers.
2. Contact the Eldercare Locator, a public service of the Administration for Community Living, at 1-800-677-1116 or eldercare.acl.gov, to find your local Area Agency on Aging.
3. For veterans, call the VA Caregiver Support Line.
4. Ask about training. Some programs require caregivers to complete training, and becoming a home health aide or CNA can open more options.

Frequently asked questions

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