How to Get Paid as a Family Caregiver in Arizona (2026)

If you want to become a paid family caregiver in Arizona, start with the state's Medicaid long-term care program, which can pay a relative, even a spouse within limits, for in-home care. The person you care for qualifies for the Arizona Long Term Care System (ALTCS), lives in their own home, and you are paid as their direct care worker. AHCCCS policy 1240-A names the relatives who may be paid: a spouse, adult children and stepchildren, sons- and daughters-in-law, grandchildren, siblings, parents, grandparents, and in-laws.1

A spouse's pay comes with conditions. The care has to be judged extraordinary, beyond what a spouse would ordinarily do in the household, and the spouse can be paid for no more than 40 hours in a seven-day period. That 40 hours is a household total: hours from the spouse and any other direct care worker together cannot exceed it.1

The Short Version

The Medicaid route is ALTCS direct care services: if your loved one qualifies for ALTCS and lives in their own home, you can be paid as their direct care worker, and the ALTCS case manager's assessment of the member's needs sets the authorized hours.2 Most members in their own home can also choose a member-directed model, Agency with Choice or Self-Directed Attendant Care, which differ in who is the legal employer.2

A spouse can be paid under the AHCCCS Spouse as Paid Caregiver model when the care is judged extraordinary, capped at 40 hours per seven-day period for the spouse and any other direct care worker combined. A parent can be paid for a son or daughter at any age, but by two different mechanisms: the Parent as Paid Caregiver model if the ALTCS member is a minor, and ordinary family direct care worker status if the member is an adult.1 If your loved one is a veteran, check the VA routes too. And a family paying a relative from its own funds should document that care, because an undocumented payment can be questioned under ALTCS's 60-month look-back.5

What Makes Arizona Different: Member-Directed Attendant Care

Arizona offers most ALTCS members who live in their own home member-directed options, which AHCCCS describes as giving members more control over how attendant care, personal care and homemaker services are provided. The member, or their representative, can take on recruiting, selecting, scheduling and supervising their own caregiver rather than leaving those choices to an agency.2 That caregiver can be a family member.1

The authority for paying family members is AHCCCS Medical Policy Manual policy 1240-A, which governs direct care services (attendant care, personal care and homemaker services). It applies to ALTCS for the Elderly and/or Physically Disabled, to DES Division of Developmental Disabilities contractors, and to fee-for-service Tribal ALTCS. One firm limit runs through all of it: direct care services are available only to members who live in their own home and are not reimbursable in any institutional or alternative HCBS setting. A member in a nursing facility or an alternative residential setting cannot receive these services there at all, not merely cannot self-direct them. The one carve-out is narrow: attendant care and personal care (not homemaker services) can continue during a hospital inpatient or emergency room stay when they are in the member's care plan, meet needs the hospital does not, and do not substitute for care the hospital must provide. Parents of minor children cannot be paid for services while the minor child is in a hospital inpatient or emergency room setting.1

ALTCS for the Elderly and/or Physically Disabled is delivered through AHCCCS-contracted health plans. For the contract year that began October 1, 2025, AHCCCS's ALTCS-EPD FAQ listed which plans were available by Geographic Service Area, and members who live in counties with more than one ALTCS-EPD health plan (Gila, Maricopa, Pinal and Pima) were offered a choice of plan. AHCCCS lists the current ALTCS health plans on its ALTCS page, and members can contact the ALTCS Member Services line at 1-888-621-6880. The ALTCS case manager assesses the member's needs with the member or their health care decision maker to set the number of authorized hours.2

Who sets the pay depends on the route. For a caregiver who works through a direct care worker (DCW) agency, it is the agency that hires the caregiver, supervises them, defines their tasks and sets their wage, so confirm the pay rate with that agency and the authorized hours with the case manager rather than relying on a figure you read secondhand.2

Training and Background Checks

A paid direct care worker who provides ALTCS attendant care, personal care, or homemaker services through a DCW agency, including a family member and including a worker under Agency with Choice, falls under the training and testing rules in AHCCCS policy 1240-A. Here is how they work:2

• Timing. The agency has 90 calendar days from hire to train and test you, and you can provide care during that window. If it runs out before you pass the knowledge and skills tests, you must stop providing care until you do. The window does not cover everyone: a worker with no DCW-type work experience in the last two years must pass both tests before providing services.2
• What is mandatory. Passing the tests is required; taking a training course is recommended. Everyone, family caregivers included, completes Level I (fundamentals of caregiving). A worker caring only for a family member is exempt from the Level II specialized modules, but not from Level I. Registered nurses, LPNs, CNAs, LNAs and licensed health aides are exempt from the training and testing rules, though the agency can still require them.2
• CPR and first aid. All direct care workers, family members included, must hold CPR and first aid certification, and the agency verifies it before you provide care.2
• Background screening. The agency runs a nationwide criminal background check at hire and every three years, searches the Arizona Adult Protective Services and Department of Child Safety registries at hire and every year, and applies Fingerprint Clearance Card requirements where they apply. For a worker who serves only family members, the agency may allow an exception to the background check requirements after notifying the member in writing and getting the member's consent, but never to the registry search, and never under the Parent as Paid Caregiver model or for a member who cannot legally consent. A substantiated report on either registry, or being barred from a Fingerprint Clearance Card, rules a worker out.2

The training and testing rules above (the timing and the tests themselves) do not apply under the Self-Directed Attendant Care option (or DDD's Independent Provider Network option). That exemption is from training and testing only. AHCCCS policy 1320-A sets SDAC's own service requirements, so ask the member's case manager which background checks and certifications apply under SDAC. Under SDAC the member or the member's legal guardian is the legal employer, and a Fiscal Employer Agent handles taxes and payroll.2

For how training rules differ by program and in other states, see our guide to family caregiver training requirements.

The Arizona Paid Family Caregiver Pathways

1. ALTCS Attendant Care Through Agency with Choice (AWC)

Who pays: ALTCS, administered by AHCCCS and delivered through the member's contracted health plan (Tribal ALTCS is run separately as a fee-for-service program).2

Who can be paid: A relative 1240-A names, such as an adult child or stepchild, a son- or daughter-in-law, a grandchild, a sibling, a parent, a grandparent or an in-law, hired as the member's direct care worker. For an adult child, sibling or other relative who is not legally responsible for the member, 1240-A does not add the extraordinary-care test that applies to a spouse. A spouse is paid under the separate Spouse as Paid Caregiver rules in pathway #3 below.1

What it is: Under Agency with Choice, the member and a provider agency share employer responsibilities. The provider agency keeps the authority to hire and fire the caregiver and to provide or arrange the required training, while the member, or their representative, may take on one or more of the other employer tasks: recruiting and selecting caregivers, dismissing them, setting duties and schedules, supervising, and identifying special training needs.2

What it covers: Attendant care, personal care and homemaker services, the help with activities of daily living and household tasks that the member's assessment supports. The services must be medically necessary.1

How you get paid: The DCW agency hires or contracts you, defines your tasks and sets your wage, for the hours the ALTCS case manager's assessment authorizes. Ask the agency for its pay rate and schedule.2

Best for: A family that wants a say in the care but would rather an agency keep the employer role.

2. ALTCS Self-Directed Attendant Care (SDAC)

Who pays: ALTCS, through the member's contracted health plan.2

Who can be paid: A paid caregiver the member hires and employs. The defining difference from Agency with Choice is the employer structure. A spouse is the exception to watch: a paid spouse has to be employed through a DCW agency (or, for a DDD member, through the Independent Provider Network), so SDAC is not the spouse route.2,1

What it is: Under Self-Directed Attendant Care, available to ALTCS members since 2008, the member (or the member's legal guardian) is the legal employer of the caregiver and takes on all employer responsibilities. A Fiscal Employer Agent handles taxes, payroll withholding, and the caregiver's paychecks.2

Eligibility: Like Agency with Choice, Self-Directed Attendant Care is limited to members living in their own home. It is not available in an alternative residential setting or a nursing facility.2

How you get paid: The member is your employer; the Fiscal Employer Agent issues your paychecks and handles withholding.2

Best for: A family that wants the member (or guardian) to be the legal employer and control hiring, scheduling, and supervision directly.

3. A Spouse Paid Under Spouse as Paid Caregiver

Who pays: ALTCS, under AHCCCS Medical Policy Manual 1240-A.1

Who can be paid: A legally responsible spouse of an ALTCS member, for direct care services to that spouse.1

The conditions:

• Extraordinary care. Because a spouse is legally responsible for the member, the paid care must be judged extraordinary: care beyond what a spouse would ordinarily do in the household if the member did not have a disability or chronic illness. That is established through the service assessment.1
• A 40-hour household ceiling. The spouse cannot be paid for more than 40 hours in a seven-day period, and the hours from the spouse and any other direct care worker together cannot exceed 40 hours in a seven-day period either. Agency hours do not stack on top of the spouse's.1
• The rate. A paid spouse earns no more than a non-spouse caregiver would be paid for a similar level of attendant care.1

How you are hired: Through a DCW agency that subcontracts with the member's ALTCS contractor. If the member is served by DDD, the spouse can instead be employed by the member under DDD's Independent Provider Network; for an American Indian or Alaska Native member in fee-for-service, the agency must be AHCCCS-registered.1

Best for: A spouse already providing heavy daily care to a husband or wife on ALTCS.

For the full spouse walkthrough: Getting Paid to Care for Your Spouse in Arizona.

4. A Parent Paid to Care for Their Own Son or Daughter

Who pays: ALTCS, including through the DES Division of Developmental Disabilities for the members DDD serves.1

Who can be paid: A parent can be paid to provide direct care to their own child at any age. What changes with the child's age is the mechanism, so ask for the right one.1

• If the ALTCS member is a minor child, the route is the Parent as Paid Caregiver (PPCG) service model. AHCCCS Medical Policy Manual 1240-A permits legally responsible parents and legal guardians who hold formal physical and/or legal custody to be compensated for providing paid direct care and habilitation services to their minor child who is an ALTCS member, limited to no more than 40 hours of paid services in a seven-day period to a single minor child member. DES/DDD states that PPCG applies specifically to parents who provide paid care to their minor children.1
• If the ALTCS member is an adult child, PPCG does not apply, and you do not need it. A parent of an adult member is not a legally responsible individual, so no special exception is required to pay you. AHCCCS Medical Policy Manual 1240-A lists "Parents/Stepparents/Adoptive Parents" among the relatives who may get paid to provide services to AHCCCS members, and you are hired as an ordinary family member direct care worker, on the same footing as an adult child or a sibling.1

The cap that applies at every age: a parent can provide no more than 16 hours of paid care within a 24-hour period, for any member regardless of the member's age.1

How you are hired: A parent providing paid direct care is employed or contracted by a DCW agency that subcontracts with the member's ALTCS contractor; for an American Indian or Alaska Native member in fee-for-service, it must be an AHCCCS-registered DCW agency. A paid parent's rate cannot exceed what a non-parent caregiver would be paid for a similar level of care.1

The extra test for a parent of a minor: because a parent of a minor child is legally responsible for them, the paid care must also be judged extraordinary, beyond what a parent would ordinarily do for a child without a disability or chronic illness, and that is established through the service assessment.1

Best for: A parent of an ALTCS-enrolled son or daughter, minor or adult, who is already providing daily care.

5. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a family member (a spouse, son, daughter, parent, stepfamily member, or extended family member) or someone who lives full time with the veteran, or is willing to if VA designates them, so an unrelated live-in partner or friend can qualify too.3

How the stipend works: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12 to give a monthly base. That monthly base is then multiplied by a factor, and which factor applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant under the pre-October 2020 rules.3

• Current program (the veteran was approved under 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community.3
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead, and no self-sustain determination is required. A sum of 21 or higher pays 1.00; a sum of 13 to 20 pays 0.625; a sum of 1 to 12 pays 0.25. This legacy tiering runs for eight years beginning October 1, 2020, so it lapses October 1, 2028.3
• A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher. A legacy participant under 71.20(b) also has a floor: the stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still resides at the address on record with PCAFC on that date.3

So 0.625 is only the current program's starting factor, not the ceiling. If your household came into PCAFC before October 2020, ask which schedule VA is paying you on; if you are in the current program and the veteran cannot self-sustain in the community, ask your Caregiver Support Coordinator for that determination, because it is what moves the factor to 1.00. Because the base also varies with the veteran's locality, confirm your exact stipend with your VA Caregiver Support Coordinator.3

Veteran eligibility: VA's first screen has four requirements, all of which must be true: a VA disability rating (individual or combined) of 70 percent or higher, a 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, and enrollment in VA health care. Those four don't settle it: you and the veteran apply together, and VA decides eligibility through that application. Once approved, the caregiver must enroll in direct deposit through the VA customer engagement portal to receive the stipend.3

Why it stands out: A spouse is one of the relatives who can be the paid primary caregiver, primary caregivers can receive CHAMPVA coverage if they don't already qualify under another health care plan, and the program includes mental health counseling and at least 30 days of respite care per year for primary caregivers.3

Best for: Families of an eligible veteran where one person provides substantial daily care.

6. VA Veteran-Directed Care (VDC)

Who can be paid: Workers the veteran hires, which VA says might include their own family member or neighbor. VA's description does not single out a spouse either way, so a spouse should confirm with the VA medical center whether they can be the paid worker rather than assume it.4

How it works: Veteran-Directed Care delivers home and community-based services in a consumer-directed way: the veteran or their representative gets help developing a spending plan and hiring workers. VA says enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and it is available, and that services may vary by location.4

Availability in Arizona: ACL's Veteran-Directed Care program list pairs three Arizona VA systems with local partners: the Carl T. Hayden VA Health Care System (the Phoenix VA medical center) with Ability360, Area Agency on Aging 1, and the Central Arizona Area Agency on Aging; the Southern Arizona VA Health Care System with the Pima Council on Aging and the Central Arizona Area Agency on Aging; and the VA Northern Arizona Health Care System with the Pima Council on Aging and the Northern Arizona Council of Governments. A listing is not a guarantee the medical center is referring veterans, so contact your local VA medical center about availability and eligibility before counting on VDC as caregiver income.4

Best for: An Arizona veteran with daily-living needs who wants to choose and direct their own workers.

7. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension, not the caregiver; VA bases the payment on the gap between the claimant's income for VA purposes and the maximum rate.6

2026 maximums (effective December 1, 2025 through November 30, 2026, published by VA as annual ceilings): a single veteran with Aid and Attendance can receive up to $29,093 per year; a veteran with one dependent up to $34,488 per year; two veterans married to each other who both qualify for Aid and Attendance up to $46,143 per year combined. A surviving spouse with Aid and Attendance can receive up to $18,697 per year. VA pays the difference between countable income and the ceiling, so income lowers the amount received. Some expenses, like non-reimbursable medical expenses, may reduce income for VA purposes, though only the amount above 5% of the claimant's maximum rate can be deducted. The 2026 net worth limit is $163,699.6

Eligibility: Aid and Attendance is added to a VA pension, so the veteran must first qualify for pension: qualifying wartime service (for a veteran who entered active duty before September 8, 1980, at least 90 days with at least one day during wartime; later entrants generally need 24 months or their full call-up period), no dishonorable discharge, and at least one of age 65 or older, a permanent and total disability, nursing home care for a disability, or SSDI or SSI. Income and net worth must fall within the limits. On top of that, at least one Aid and Attendance need must be met, such as needing another person's help with daily activities like bathing, feeding and dressing, or limited eyesight. VA's rules also say that care given by a relative or another household member does not prevent the added allowance.7 VA pension carries its own 36-month look-back on asset transfers, separate from the Medicaid rule.6

Best for: A veteran or surviving spouse who meets VA's pension tests and needs regular help with daily activities.

8. Private Personal Care Agreement

Who can be paid: A family member, such as an adult child or sibling, paid from the care recipient's own funds. It matters most for a non-spouse relative: AHCCCS states there is no penalty for transfers to a spouse or to a disabled child.5

What it is: A written agreement, drafted by an Arizona elder-law attorney, documenting the services, a reasonable and customary rate, the schedule and payment terms, with the caregiver keeping logs and reporting the income. AHCCCS's published member guidance does not set out what the agreement must contain (those rules sit in its Eligibility Policy Manual, Chapter 900), so have the attorney confirm what AHCCCS's own policy requires.5

Why the documentation matters: Arizona's ALTCS applies a 60-month (five-year) look-back: AHCCCS reviews transfers made in the 60 months before the month of application, by the applicant or their spouse, including giving away money or income. There is no penalty if the applicant received something of equal value, so paying a family member for care is not automatically a gift. But an undocumented payment is at risk, because the applicant is the one who has to show equal value was received. When a penalty does apply, AHCCCS divides the uncompensated amount by the private pay rate in the applicant's county; that rate changes, so confirm the current figure with AHCCCS or an Arizona elder-law attorney.5

The caregiver-child exception for the home: federal law, which binds Arizona, excepts a transfer of the home to a son or daughter who lived there for at least two years immediately before the parent was institutionalized and who, as the state determines, provided care that let the parent live at home rather than in an institution.5

Best for: Families paying a relative for care from the care recipient's own funds when an ALTCS application could follow within 60 months. Work with an Arizona elder-law attorney to draft the agreement; see our Medicaid planning strategies for the wider picture.

How to Apply for ALTCS (the Main Route)

Every ALTCS pathway above starts with getting your loved one enrolled, and an applicant must qualify both financially and medically.8 Here is the sequence.

Comparing the Arizona Pathways

How to Choose an Arizona Pathway

Start with the care recipient's situation:

1. Is your loved one a veteran? Check the VA pathways too. PCAFC pays a stipend to a primary family caregiver, and a spouse can qualify.3 Veteran-Directed Care helps a veteran build a spending plan and hire workers, but whether a spouse can be the paid worker is something to confirm with the VA medical center.4

2. Are you a spouse caring for a spouse? Arizona's Spouse as Paid Caregiver model lets you be paid through ALTCS when your care is judged extraordinary, with the spouse and any other direct care worker together capped at 40 hours per seven-day period, through a DCW agency.1 If your spouse is a veteran, look at PCAFC as well.

3. Are you a parent of a son or daughter on ALTCS? You can be paid at either age, but ask for the right thing. If the member is a minor, the Parent as Paid Caregiver (PPCG) model pays you for direct care and habilitation when the care is judged extraordinary, capped at 40 hours of paid services per seven-day period. If the member is an adult, PPCG does not apply and you do not need it: you are hired as an ordinary family member direct care worker, the same as any other paid relative. Either way, a parent is capped at 16 hours of paid care in any 24-hour period.1

4. Are you another relative, and is your loved one on or likely eligible for ALTCS? Become their paid direct care worker, then choose between Agency with Choice (the agency shares the employer role) and Self-Directed Attendant Care (the member is the employer).2 Start by applying for ALTCS: you can register an application online through Health-e-Arizona Plus (HEAplus), and the ALTCS toll-free line is 1-888-621-6880.8

5. Will you be paid from your loved one's own money? Talk to an Arizona elder-law attorney about a written personal care agreement, so the payments are documented if an ALTCS application follows within 60 months.5

Tax Considerations

Who handles the paperwork depends on the route. Under Self-Directed Attendant Care, the Fiscal Employer Agent takes care of taxes, payroll withholding and paychecks; under a personal care agreement, the caregiver keeps logs and reports the income.2,5

IRS Notice 2014-7: The IRS lets a care provider exclude from federal gross income certain payments for care under a state Medicaid home and community-based services waiver described in section 1915(c) of the Social Security Act. The exclusion reaches only care given in the provider's own home, where the care recipient also lives; a provider who keeps a separate home cannot use it. Whether the payments arrive on a W-2 or a 1099 does not by itself decide the question.9

Arizona caregivers should not assume the exclusion applies. For a state Medicaid program that is not a section 1915(c) waiver, the IRS says only that its treatment depends on the nature of the payments and the purpose and design of the program, so confirm the authority behind your own program with a tax professional before filing. Excluded or not, the payments generally remain wages for Social Security and Medicare tax, though where the care recipient is the employer, the domestic-service rules generally exempt pay for caring for a spouse or child, and care for a parent by a child under 21.9

Arizona state income tax: Arizona levies a flat individual income tax of 2.5 percent. Caregiver wages that are not excluded under Notice 2014-7 are taxed at that flat 2.5 percent rate in addition to federal tax.9

Common Misconceptions

"Arizona won't let me get paid to care for my own husband." It can. Arizona's AHCCCS Spouse as Paid Caregiver model permits a legally responsible spouse to be paid for direct care when the care is judged extraordinary, with the spouse and any other direct care worker together capped at 40 hours per seven-day period, through a DCW agency.1

"If Mom has Medicare, I can get paid through Medicare." Original Medicare does not pay family members or friends a wage to provide personal or custodial care. Its home health benefit pays a Medicare-certified agency, never a relative.10

"I can just start getting paid out of Dad's bank account." Paying a family member for care is not automatically a gift, but an undocumented payment is at risk under Arizona's 60-month ALTCS look-back, because the applicant has to show equal value was received. Get a written agreement in place with an elder-law attorney.5

Related Terms

• Consumer Directed Services (CDS): A general term for self-directed programs like Arizona's member-directed attendant care, where the care recipient directs their own worker.
• HCBS waiver: A state Medicaid home and community-based services waiver program; IRS Notice 2014-7 covers payments under the section 1915(c) kind.
• Activities of Daily Living (ADLs): Everyday self-care activities like bathing, dressing and using the bathroom.
• Nursing Facility Level of Care: The clinical threshold a member meets to qualify for ALTCS long-term care.

Learn More

Find personalized help getting paid as a family caregiver in Arizona 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.