Arizona pays family members to provide in-home care through its Medicaid long-term care program, and it does it in a way that gives families more control than most states. The person you care for qualifies for the Arizona Long Term Care System (ALTCS), chooses a member-directed service model, and hires you as their paid direct care worker. A family member, an adult child, sibling, other relative, or a friend, can be that worker.

Arizona also does something many states do not: it lets a legally responsible spouse be paid to care for a husband or wife, within limits. Under AHCCCS policy a spouse can provide paid attendant care, but no more than 40 hours in any seven-day period.

This guide lays out every legitimate way to be paid as a family caregiver in Arizona for 2026: who can be hired under each program, how the two member-directed models differ, what the spouse and parent rules say, and how to pick the route that fits your family.

The Short Version

For most families, the route is ALTCS attendant care: if your loved one qualifies for ALTCS and lives in their own home, you become their paid direct care worker, and the member's health plan assesses need and authorizes the hours. You then pick one of two member-directed models, Agency with Choice or Self-Directed Attendant Care, which differ only in who is the legal employer.

A spouse is not shut out the way many states do it: under the AHCCCS Spouse as Paid Caregiver model a spouse can be paid for attendant care, capped at 40 hours per seven-day period. A parent of a child enrolled in DDD and ALTCS can be paid for that child at any age. If your loved one is a veteran, check the VA routes first, since several allow paid spouses. And a family with private assets can use a written personal care agreement to pay a caregiver now while documenting it for later Medicaid planning.

The rest of this guide walks through each pathway in detail.

What Makes Arizona Different: Member-Directed Attendant Care

Arizona delivers most of its Medicaid in-home care through member-directed service models, where the person receiving care, the ALTCS member, chooses, schedules, and supervises their own direct care worker rather than accepting whoever an agency sends. That worker is very often a family member or friend.

The authority for this is AHCCCS Medical Policy Manual policy 1240-A, which governs direct care services (Attendant Care, Personal Care, Homemaker, and Respite). It applies to ALTCS for the Elderly and/or Physically Disabled, to the DES Division of Developmental Disabilities program, and to Tribal ALTCS. One firm limit runs through all of it: member-directed options are available only to members who live in their own home. A member in an assisted living facility or a nursing facility cannot use them.

ALTCS for the Elderly and/or Physically Disabled is delivered through AHCCCS-contracted managed care organizations, called program contractors. The member's specific health plan, plans such as Banner-University Family Care/ALTCS, Mercy Care, and UnitedHealthcare Community Plan depending on the member's geographic service area, administers the care plan, authorizes the weekly service hours, and processes the family caregiver's enrollment and pay.

That structure has one practical consequence: there is no single statewide published hourly wage for a paid family caregiver in Arizona. The direct care worker wage and the authorized weekly hours are set through the member's assessed care plan and the contractor's provider agreements, so confirm both with the member's ALTCS health plan or case manager rather than relying on a figure you read secondhand.

Training and Background Checks

Any paid direct care worker delivering ALTCS attendant care, personal care, or homemaker services, including a family member, must complete AHCCCS direct care worker training and competency testing before starting, and must pass the required background and fingerprint clearance checks. The training covers a standardized core curriculum plus skills-based competency testing through approved programs. You do not need to be a certified nursing assistant. A family caregiver hired under a member-directed model completes the same requirements, arranged through the provider agency under Agency with Choice or coordinated for the self-directing member under Self-Directed Attendant Care.

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.

Who can be paid: An adult child, sibling, other relative, or friend hired as the member's direct care worker. A legally responsible spouse can use this route under the separate Spouse as Paid Caregiver rules described below.

What it is: Under Agency with Choice, the member and a provider agency share employer responsibilities. The provider agency keeps the legal authority to hire, fire, and arrange the required direct care worker training, while the member may recruit, select, schedule, supervise, and dismiss the caregiver. It is the lighter-touch model: the agency handles the employer mechanics, and you focus on care.

What it covers: Attendant Care, Personal Care, Homemaker, and Respite, meaning hands-on help with activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental tasks (meal preparation, light housekeeping, shopping), depending on the member's assessed plan.

How you get paid: The provider agency is your employer of record. It runs payroll, withholds taxes, and pays you on its schedule for the hours the member's plan authorizes.

Best for: A family caregiver who wants to direct the care but would rather not take on payroll and employer paperwork.

2. ALTCS Self-Directed Attendant Care (SDAC)

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

Who can be paid: The same family members and friends as under Agency with Choice. The difference is the employer structure, not who is eligible to be hired.

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. It is the model for a family that wants the fullest control over hiring and managing the worker.

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.

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

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

3. The DDD Pathway for Children With Disabilities

Who pays: ALTCS through the DES Division of Developmental Disabilities.

Who can be paid: A parent or guardian of a child who is enrolled in DDD and ALTCS. Under the DDD Parent Provider pathway, that parent can be a paid provider of Attendant Care and/or Habilitation services for their own child, at any age.

Why it matters: In many states a parent cannot be paid for their own child, or only while the child is a minor. Arizona's DDD Parent Provider option removes that barrier for children enrolled in DDD and ALTCS, regardless of the child's age.

Best for: A parent of a DDD- and ALTCS-enrolled child who is already providing daily care.

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

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, which can be a spouse, adult child, parent, or other family member.

How the stipend works: The PCAFC stipend is calculated from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by a level factor. Level One (caregivers of veterans needing personal care assistance) uses a factor of 0.625; Level Two (when the veteran is determined unable to self-sustain in the community) uses 1.00. Because the figure depends on the veteran's locality, confirm your exact stipend with your VA Caregiver Support Coordinator.

Veteran eligibility: A service-connected disability rated at 70 percent or higher, a need for in-person personal care, and enrollment in VA health care.

Why it stands out: The stipend allows paid spouses, primary caregivers can receive CHAMPVA coverage if otherwise uninsured, and the program includes mental health counseling and at least 30 days of respite care per year. It can also be combined with VA Aid and Attendance and Medicaid pathways.

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

5. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse. Veteran-Directed Care has the most permissive family-hire rules of any program in this guide.

How it works: The veteran receives a flexible monthly budget set by their VA care team based on assessed need and uses it to hire and pay caregivers at a rate they set within that budget. A fiscal agent handles the payroll.

Availability in Arizona: Veteran-Directed Care is offered through participating VA medical centers partnering with community organizations. The Phoenix VA Health Care System offers it in partnership with Ability360, and the Southern Arizona VA Health Care System in Tucson offers it in partnership with the Pima Council on Aging. Availability and the partner organization can change and it is not offered at every site, so confirm with your VA medical center's Caregiver Support Coordinator or social worker.

Best for: An Arizona veteran with daily-living needs who wants to pay a spouse or set their caregiver's schedule and rate directly.

6. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension directly, and a family caregiver is typically paid out of it under a private arrangement.

2026 maximums (effective December 1, 2025 through November 30, 2026): a single veteran with Aid and Attendance receives up to $2,424 per month ($29,093 per year); a veteran with one dependent up to $2,874 per month ($34,488 per year); two married veterans both receiving Aid and Attendance up to $3,845 per month combined. A surviving spouse with Aid and Attendance receives up to $1,558 per month ($18,697 per year). The 2026 net worth limit is $163,699. Confirm current figures on the VA pension rate page before applying.

Eligibility: A wartime veteran (90 days of active duty including at least one day during a recognized wartime period) or a surviving spouse, who also meets the Aid and Attendance functional criteria (needs help with daily activities, is housebound, is in a nursing facility, or is legally blind), and whose countable income and assets fall under the limit. VA pension carries its own 36-month look-back on asset transfers, separate from the Medicaid rule.

How caregivers get paid: The pension goes to the veteran, who then pays the family caregiver, ideally under a written caregiver agreement. Arizona's county Veterans Service Officers help file at no cost; avoid for-profit pension consultants.

Best for: A wartime veteran or surviving spouse with income and assets under the limit who needs help with daily activities.

7. Private Personal Care Agreement

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, because transfers between spouses are treated differently.

What it is: A written, arm's-length personal care agreement between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, a reasonable and customary rate, the schedule, payment terms, and a requirement that the caregiver keep logs and report the income on their taxes.

Why the format matters: Arizona's ALTCS applies a 60-month (5-year) look-back on asset transfers made for less than fair market value before a long-term-care application. Paying a family member for care without a written, arm's-length agreement can be treated as an uncompensated transfer (a gift), creating a period of ineligibility; a properly drafted agreement converts the payment into a documented exchange of value. The transfer-penalty divisor AHCCCS uses to turn a disqualifying transfer into a length of ineligibility is set administratively and changes periodically, so confirm the current divisor with AHCCCS or an Arizona elder-law attorney rather than relying on a fixed figure.

Best for: Families with enough assets to private-pay a caregiver who also want to preserve eligibility for future Medicaid planning. Work with an Arizona elder-law attorney to draft the agreement; see our Medicaid planning strategies for the wider picture.

Comparing the Arizona Pathways

Pathway Pay a spouse? Who pays Who is the employer Best fit
ALTCS Agency with Choice Yes, capped at 40 hrs/week ALTCS via health plan Provider agency (shared) Family caregiver who wants help with payroll
ALTCS Self-Directed Attendant Care Generally via agency, not SDAC ALTCS via health plan Member / guardian Family wanting full control of hiring
DDD Parent Provider N/A (parent of a child) ALTCS via DDD Per DDD model Parent of a DDD + ALTCS child, any age
VA PCAFC Yes VA (monthly stipend) VA program Eligible veteran's primary caregiver
VA Veteran-Directed Care Yes VA (veteran-set budget) Veteran (with fiscal agent) Veteran wanting to pay a spouse
VA Aid and Attendance Pension paid to veteran VA (pension) Private arrangement Wartime veteran under income/asset limits
Personal care agreement No Private funds Private contract Family with assets, planning ahead

How to Choose an Arizona Pathway

Start with the care recipient's situation:

  1. Is your loved one a veteran? Check the VA pathways first. PCAFC pays a stipend and allows paid spouses, Veteran-Directed Care lets you pay a spouse and set the rate, and Aid and Attendance can stack with a Medicaid program. Your county Veterans Service Officer helps for free.
  2. Are you a spouse caring for a spouse? Arizona's Spouse as Paid Caregiver model lets you be paid for attendant care through ALTCS, capped at 40 hours per seven-day period, generally through a provider agency. If your spouse is a veteran, compare that against Veteran-Directed Care and PCAFC, which do not carry the 40-hour cap.
  3. Are you a parent of a child with a developmental disability? If the child is enrolled in DDD and ALTCS, the DDD Parent Provider pathway can pay you for Attendant Care or Habilitation, at any age.
  4. Are you a non-spouse relative or friend, 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 handles employer duties) and Self-Directed Attendant Care (the member is the employer). Start by contacting AHCCCS about ALTCS eligibility and an assessment.
  5. Do you have substantial private assets and want to plan ahead? Talk to an Arizona elder-law attorney about a personal care agreement before any money changes hands.

Not sure which Arizona pathway fits your family? Chat with Brevy's care navigator for a side-by-side comparison based on your situation: whether you are a spouse, a parent, or another relative, the care recipient's veteran status, and whether they qualify for ALTCS.

Tax Considerations

Most Arizona caregiver pay is reportable income, with one valuable federal exception.

  • ALTCS attendant care under Agency with Choice or Self-Directed Attendant Care pays W-2 or 1099 income through the provider agency or the Fiscal Employer Agent.
  • VA Veteran-Directed Care pays the caregiver through the veteran's budget; the caregiver receives ordinary taxable income.
  • VA Aid and Attendance is tax-free to the veteran; when the veteran uses it to pay a caregiver, the caregiver receives ordinary taxable income.
  • Personal care agreements pay W-2 or 1099 income depending on how the caregiver is classified.

IRS Notice 2014-7: If you live in the same home as the person you care for and you are paid through a Medicaid program, your qualified Medicaid waiver payments may be excluded from your federal gross income. This applies to many Arizona ALTCS member-directed arrangements where the paid caregiver lives with the member, and the IRS has clarified the exclusion can apply whether the payments are reported on a W-2 or a 1099. Talk to a tax preparer familiar with the rule before filing.

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.

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 attendant care, with a 40-hour cap per seven-day period, generally through a provider agency. That is more than many states allow.

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. Paid family caregiving in Arizona comes through ALTCS, the VA, or a private agreement.

"I can just start getting paid out of Dad's bank account." Not without a written personal care agreement signed before care begins. An informal transfer of a parent's money to a child for care can be treated as a gift under Arizona's 60-month ALTCS look-back and can delay the parent's eligibility later.

Frequently Asked Questions

Yes, within limits. Arizona's AHCCCS Spouse as Paid Caregiver service model lets a legally responsible spouse be compensated for providing attendant care to a spouse who is an ALTCS member, but the member cannot have more than 40 hours of that care from the legally responsible spouse in any seven-day period. A spouse is generally retained through a provider agency rather than the full Self-Directed Attendant Care model. If your spouse is a veteran, VA Veteran-Directed Care and PCAFC also allow paid spouses without that 40-hour cap.

Both let an ALTCS member living in their own home hire a family caregiver; the difference is who is the legal employer. Under Agency with Choice, a provider agency shares the employer role, keeping the authority to hire, fire, and arrange training, while the member recruits, schedules, and supervises. Under Self-Directed Attendant Care, the member (or their guardian) is the legal employer and a Fiscal Employer Agent handles payroll and taxes. Agency with Choice is the lighter-paperwork option; Self-Directed Attendant Care gives the member the most control.

Yes, through the DDD pathway. A parent or guardian of a child enrolled in both the DES Division of Developmental Disabilities and ALTCS can be a paid provider of Attendant Care or Habilitation services for their own child, at any age.

You do not need to be a certified nursing assistant. To be a paid direct care worker you must complete AHCCCS direct care worker training and competency testing and pass background and fingerprint clearance checks before delivering services. Under Agency with Choice the provider agency arranges the training; under Self-Directed Attendant Care it is coordinated for the self-directing member.

There is no single statewide published rate. The direct care worker hourly wage and the number of authorized weekly hours are set through the member's assessed ALTCS care plan and the contractor's provider agreements, so they vary by health plan and by the member's assessed need. Confirm the current pay rate and authorized hours with the member's ALTCS health plan or case manager.

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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.