Get Paid to Care for Your Spouse in Alabama

You can get paid to care for your spouse in Alabama through Medicaid's self-directed Personal Choices option, if your spouse qualifies for it and you meet its worker requirements.

Caring for a husband or wife is different from caring for a parent, and the programs treat it that way. Personal Choices is Alabama's self-directed option, where the person receiving care hires and manages their own worker instead of an agency assigning one. Alabama's Medicaid State Plan elects to let Personal Choices participants hire "legally liable relatives" as paid providers, a federal term that can include a spouse, and the Elderly and Disabled Waiver says a spouse who cannot be paid for traditional waiver personal care may provide personal care through Personal Choices if they meet its requirements. Your Personal Choices Counselor can confirm that you qualify. If your spouse is a veteran, a second set of doors opens through the U.S. Department of Veterans Affairs (VA).

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Alabama?
• The Medicaid Self-Directed Route: Personal Choices
• When Alabama Says No: the Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance
• How to Get Paid to Care for Your Spouse in Alabama: Who to Call
• Frequently Asked Questions
• Learn More

Can You Get Paid to Care for Your Spouse in Alabama?

The short answer is that it depends on which program you go through, and this is the single most important thing to understand before you make a phone call. Alabama's Elderly and Disabled Waiver delivers home care two ways: an agency sends an aide, or the participant self-directs through Personal Choices and hires their own. The second is the one that can pay a spouse, so it is where to start.3

That second route is Personal Choices. In it the participant, meaning the person receiving care, recruits, hires, trains and manages their own worker, and serves as the employer of record. Alabama's Medicaid State Plan, in the supplement that sets up this self-directed option, says "The State elects to permit participants to hire legally liable relatives, as paid providers" of the services in the participant's plan and budget, and the federal self-direction rule defines legally liable relatives as people with a duty under state law to care for another person, which may include a spouse. The Elderly and Disabled Waiver application spells out the result for a spouse: under traditional waiver personal care a legally responsible individual, a term it defines to include a spouse, may not provide personal care, but under Personal Choices that person may provide personal care if they meet the option's requirements.3 The Personal Choices Participant Handbook also contemplates a relative in the job: it devotes a section to setting boundaries "if you have hired a relative or friend to be your personal assistant," and its worked example of a Monthly Spending Plan pays an employee whose listed Employee Relationship is "Spouse."1

Those rules open the door; they do not hand you the job. Your spouse must qualify for the waiver and choose Personal Choices, and you must meet the worker requirements, including being at least 18, having two verified references and passing the required background checks.3 Work through the details with your Personal Choices Counselor before you count on the money.1 The ordinary agency-delivered route is different. Under Alabama's Elderly and Disabled Waiver rules, the agency worker providing personal care may not be a relative of the recipient, and no payment is made for personal care, respite or companion services furnished by a member of the recipient's family.3 If that is the route your spouse's case manager is arranging, ask about Personal Choices instead, or call Alabama AgeLine at 1-800-243-5463.7

The Medicaid Self-Directed Route: Personal Choices

Personal Choices is Alabama's self-directed, or consumer-directed, option within its Medicaid Home and Community-Based Services waivers. Alabama Medicaid offers it across seven waivers: the Elderly and Disabled, Alabama Community Transition (ACT), and Technology Assisted for Adults waivers through the local Area Agency on Aging; the State of Alabama Independent Living (SAIL) waiver through the Alabama Department of Rehabilitation Services; and the Intellectual Disabilities, Living at Home, and Community Waiver Program waivers through the Alabama Department of Mental Health. The program's rules come from the Personal Choices Participant Handbook published by the Alabama Department of Senior Services (ADSS).1,2

Here is how it works in practice. When your spouse enrolls, they develop an Individual Budget based on the needs assessed in their care plan, then decide how those funds are spent within program rules. As the participant, your spouse becomes the employer of record and hires, trains, and supervises the worker, and the handbook's own sample spending plan shows a spouse in that job. Two supports are required: a Personal Choices Counselor who meets your spouse to enroll them and works with them on the Personal Support Plan and Monthly Spending Plan, and a single contracted Financial Management Services Agency that processes timesheets and payments and files taxes, while your spouse remains the employer responsible for wages and employer tax filings. The budget starts from the hours authorized in the care plan at the CMS-approved rate, 15 percent of that is allocated to program administration including those two supports, and the remaining 85 percent is what is actually available for services and goods. Two rules are worth knowing before you plan around the role. If your spouse names you their Representative to help manage the program, you cannot also be the paid personal assistant, because the handbook says a Representative may not "Be paid for this service" or "Be hired by you to provide Personal Choices services." And a Personal Choices employee may not perform skilled medical or nursing services, including preparing or administering medications, tube feeding, suctioning or wound care, on pain of involuntary termination from the program; the worker may only remind the client to take medications.1

To reach Personal Choices, your spouse first needs to qualify for the underlying Medicaid waiver. For 2026, Alabama Medicaid sets the income limit at $2,982 a month for the Elderly and Disabled, SAIL, Intellectual Disabilities, and Technology Assisted for Adults waivers, the same figure it uses for nursing home Medicaid, with a resource limit of $2,000, and the person must also need an institutional level of care, such as a nursing facility provides. Where Alabama Medicaid states that $2,000 resource limit for nursing home Medicaid, it adds that special rules apply when a spouse remains in the home. If you are the spouse at home, ask how those rules treat your shared savings before you assume the $2,000 figure applies to the two of you. Alabama applies the federal five-year (60-month) look-back on asset transfers.2 Because eligibility rules change, the safest move is to confirm current rules with ADSS before you count on this route.

When Alabama Says No: the Legally Responsible Relative Rule

If a spouse can be paid through Personal Choices, why are so many spouses turned away elsewhere? The answer is a federal Medicaid rule worth understanding, because it explains both the no and the yes.

Medicaid distinguishes between relatives who happen to help and relatives whom state law already expects to help, a group called legally responsible relatives. Under the Medicaid state plan personal care services benefit, the services must be provided by someone "who is not a member of the individual's family," and for that benefit a family member "means a legally responsible relative." So that benefit will not pay a legally responsible relative.4

Two things keep that from being the flat federal no it gets quoted as. The same federal section lets a state agency define a family member differently for its section 1915(c) home and community-based services waivers, so the state plan exclusion does not carry across to those waivers on its own. Self-direction uses a different term with its own rule: the federal self-direction regulation defines "legally liable relatives" as people with a duty under state law to care for another person, a group that "may include" a spouse, and a state may elect to let participants hire such relatives as paid providers.4 Self-direction gives the person, or their representative, choice and control over recruiting and hiring their own workers. Under that federal self-direction option, whether a relative such as a spouse can be the paid worker is a choice each state makes, and the person serving as the participant's representative cannot also be the paid provider.9 In Alabama, the opening is Personal Choices, which runs under Alabama's section 1915(j) State Plan election permitting participants to hire legally liable relatives as paid providers.3 So if you are ever told flatly that a spouse "can never be paid," the follow-up question is: what about Personal Choices, the self-directed option?

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, the picture changes, because the VA's main family caregiver program expressly allows a spouse to be the paid caregiver.5

The centerpiece is the Program of Comprehensive Assistance for Family Caregivers (PCAFC). It pays an eligible veteran's approved Primary Family Caregiver a monthly stipend, which VA has described as a nontaxable benefit, and a spouse is expressly allowed to be that caregiver. VA's first screen has four requirements for the veteran, and all four must be true: a VA disability rating (individual or combined) of 70% or higher, discharge from the U.S. military or a date of medical discharge, a need for at least six months of continuous, in-person personal care services, and enrollment in VA health care. Those four are necessary but are not the whole test: you and the veteran apply together, and the federal regulation adds four more conditions VA checks during the application, including that the care is given at home and that the same personal care is not already being regularly provided by another person or agency. Once approved, you must enroll in direct deposit through the VA customer engagement portal, because the monthly stipend is not paid without it.5 The stipend is not a single national number; it is calculated from the federal pay scale for the veteran's local area, so the dollar amount depends on where in Alabama you live.5

The second VA route is Veteran-Directed Care, which works on the same self-direction principle as Personal Choices. The veteran receives a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers, and they may hire family, friends, or neighbors. A veteran enrolled in VA health care qualifies if they are eligible for community care, meet the clinical criteria for the service, and the program is available to them. If you hope to be the paid worker as a spouse, confirm that with the program before you plan around it.6 To ask about either program, call the VA Caregiver Support Line at 1-855-260-3274.8

Aid and Attendance

Aid and Attendance is worth understanding on its own terms, because families often find it while searching and it works differently from the programs above. It is not a wage paid to you as the spouse. It is an increase to a veteran's or surviving spouse's VA pension: someone who gets that pension may be eligible if they meet at least one of VA's listed requirements, such as needing another person's help with daily activities like bathing, feeding, and dressing.10

What it does is add household income a couple can put toward care however they choose, including making up for income a spouse gave up to provide that care. For 2026, the Aid and Attendance ceiling is a maximum annual pension of $29,093 for a wartime veteran with no dependents, $34,488 for a veteran with one dependent, and $18,697 for a surviving spouse with no dependents; VA pays that ceiling minus the claimant's income for VA purposes, so a household with income receives less, and the monthly payment is that remainder divided by 12, rounded down to the whole dollar.11 Aid and Attendance requires that the veteran or survivor qualify for a VA pension, which has wartime-service, age-or-disability, and income and net-worth tests (the $163,699 net-worth limit counts income as well as assets).10 In Alabama, the Alabama Department of Veterans Affairs (ADVA) runs Veterans Service Offices in 62 Alabama counties, and its Veterans Service Officers help file pension and Aid and Attendance claims at no cost; find the office nearest you at va.alabama.gov or call ADVA at 334-242-5077.12

How to Get Paid to Care for Your Spouse in Alabama: Who to Call

Because the answer turns on which program you use, the fastest path is to ask the right office the right question. Here is how to get to a real answer.

One note on taxes: if Alabama does pay you to care for your spouse through a Medicaid waiver and you live in the same home, your wages may be excludable from federal gross income as "qualified Medicaid waiver payments" under IRS Notice 2014-7. The IRS tests where you actually live, so a spouse living in the same home as the person they care for meets that part of it. The exclusion does not cover direct payments the person you care for makes from their own private funds, and for a Medicaid program that is not a waiver, the IRS says the answer depends on the nature of the payments and the purpose and design of the program.15 A spouse paid through Personal Choices is paid under Alabama's section 1915(j) State Plan option rather than traditional waiver personal care, so ask a tax preparer familiar with Medicaid caregiver pay which IRS answer fits your payments before you file.3

Learn More

Find personalized help getting paid to care for your spouse in Alabama at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.