Get Paid to Care for Your Spouse in Arkansas (2026)

Can you get paid to care for your spouse in Arkansas? Many husbands and wives are told no, but there are real yeses worth chasing.

Caring for a spouse is different from caring for a parent, and Medicaid's rules treat it that way. Programs that will pay an adult child to provide personal care often bar paying a husband or wife for the same work, because state law usually makes a spouse a "legally responsible relative." That single category turns many spouses away, in Arkansas and elsewhere. But it is not the whole story. Arkansas runs its Medicaid personal care through a self-directed model that gives you control over who you hire, and if the person you care for is a veteran, the VA pays spouses directly. This guide walks through where the door is closed, where it opens, and who to call to get a real answer.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Arkansas?
• The Medicaid Self-Directed Route
• When Arkansas Says No: The Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance
• How to Apply to Get Paid to Care for Your Spouse in Arkansas
• What About Taxes
• Frequently Asked Questions
• Learn More

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

The honest answer is a qualified yes, and it depends on which door you go through. There are two systems that can pay you to care for your spouse in Arkansas, and they work very differently.

The first is Medicaid. The ordinary Medicaid personal care benefit will not pay a "legally responsible relative," a category state law usually puts a husband or wife in, so a spouse usually cannot be the paid worker.1 But Arkansas does not deliver all of its personal care that way. Arkansas offers self-direction, a model in which you, not an agency, decide who provides the care, and self-direction runs on a different federal rule that lets a state open the door to spouses. That is where an Arkansas spouse's best Medicaid chance lives, and the section below explains how to ask about it.

The second is the VA. If the person you care for is a veteran, the picture changes entirely, because the VA is the one system built to pay spouses directly. A spouse is expressly allowed to serve as the paid Family Caregiver under PCAFC, and Veteran-Directed Care gives the veteran a flexible budget to hire and supervise their own workers.4,5 For many Arkansas couples, the VA is the clearer and faster yes.

The Medicaid Self-Directed Route

Arkansas Medicaid delivers self-directed personal care through two connected programs. IndependentChoices is a state plan option, first launched in Arkansas in the late 1980s, that gives a Medicaid recipient a cash allowance in place of agency-provided personal assistance, so the participant or their representative can hire, train, and supervise their own worker and decide how the allowance is spent.2 ARChoices in Homecare, the state's 1915(c) home and community-based waiver for people who need a nursing-facility level of care, delivers its attendant care through the same self-directed approach.3 In both, a Financial Management Services vendor handles payroll and taxes, but you are the one directing the care.2 This model, called self-direction or participant direction, is a way of delivering Medicaid services rather than a separate benefit: the participant or their representative controls the budget, planning, and purchase of services, including hiring, supervising, and scheduling the workers. Whether a family member can be one of those paid workers is a separate state option, not something self-direction guarantees, so Arkansas's own program rules decide it. One condition matters for spouses in particular: under the federal 1915(j) and Community First Choice rules, a person serving as the participant's appointed representative generally cannot also be the paid provider, so a spouse who would both direct the care and be paid for it should ask how Arkansas handles that.8

Why does that matter for a spouse? Because self-direction is the corner of Medicaid where a state is allowed to pay a husband or wife. Under the federal section 1915(j) self-directed personal assistance rules, a state may permit participants to hire "any individual capable of providing the assigned tasks, including legally liable relatives," and the regulation's definition of legally liable relatives expressly includes a spouse.1 Arkansas's IndependentChoices and ARChoices both operate under that 1915(j) authority.3 That is the authority that can make spousal pay possible in Arkansas where the plain personal care benefit would not.

There is one honest caveat. The federal rule permits a state to allow spouses, but each state decides whether and how far to open that door, and those policies can change. So the reliable move is not to assume, but to ask Arkansas DHS directly whether a spouse can be the paid attendant under IndependentChoices or ARChoices right now. Use the exact words "self-directed" and "spouse," because a general question often gets a general no. The Arkansas DHS Choices in Living Resource Center is the office that knows the current rule.3

When Arkansas Says No: The Legally Responsible Relative Rule

It helps to understand the rule that trips up most spouses before you make a single phone call, because it explains both the no and the workaround.

When Medicaid pays a family member to provide personal care, it distinguishes between relatives who happen to help and relatives who are already legally expected to help. A husband or wife falls into the second group. In Medicaid's language, a "legally responsible relative" is someone with a duty under state law to care for another person, and state law usually puts a spouse there.1 That status matters because of how the most basic Medicaid home-care benefit is written. Under the Medicaid state plan personal care services benefit, the services must be "provided by an individual who is qualified to provide such services and who is not a member of the individual's family," and for that benefit a family member "means a legally responsible relative." Two things narrow that exclusion, both on the face of the regulation: whether a spouse is a legally responsible relative is a question of state law, and a state may define "family member" differently for its own 1915(c) waiver, so the state-plan exclusion does not carry over automatically to waiver-funded care.1

So if you ask Arkansas about ordinary agency-provided personal care and get told a spouse cannot be paid, that is the default rule at work. The important thing to know is that this is not a judgment about you or the care you provide, and it is not the last word. The default has an exception, and in Arkansas that exception is self-direction, described above. This is exactly why an adult child can sometimes be paid in a program that turns away a husband or wife: the child is rarely in that category and a spouse often is. Ask about the self-directed option specifically, and the answer can change.

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, the VA is the one system built to pay spouses directly, and it applies in Arkansas the same as everywhere else.

The centerpiece is PCAFC. It pays an eligible veteran's approved Primary Family Caregiver a tax-free monthly stipend, and a spouse is expressly allowed to be that caregiver. VA lists four requirements for the veteran, and all of them 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 are a first screen, not the whole test. You and the veteran apply together, and the federal regulation adds conditions VA assesses during the application, including that the same personal care is not already being regularly provided by another person or agency. Once approved, the stipend is paid only after the caregiver enrolls in direct deposit through the VA customer engagement portal.4 The stipend is not a single national figure. It starts from the OPM General Schedule grade 4, step 1 annual rate for the locality where the veteran lives, divided by 12 to give a monthly base, so the dollar amount depends on where in Arkansas you live. It is not an hourly wage. 38 CFR 71.40(c)(4)(i) then multiplies that base by a factor, and there is more than one factor. In the current program a Primary Family Caregiver receives 62.5 percent of the monthly base, or the full 100 percent if the VA determines the veteran is unable to self-sustain in the community. For a legacy participant or legacy applicant, meaning a household already connected to PCAFC before the program's October 1, 2020 restructuring, the factor comes instead from the sum of the veteran's 2019 clinical ratings, and no self-sustain determination is required: 100 percent at a sum of 21 or higher, 62.5 percent at 13 to 20, and 25 percent at 1 to 12. A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still lives at the address PCAFC has on record. The legacy schedule lapses October 1, 2028.4 If your spouse is a legacy participant, do not treat 62.5 percent as your ceiling: ask your VA Caregiver Support Coordinator which paragraph of the rule your household is paid under, and what 2019 rating sum it used. Our Arkansas guide to getting paid as a family caregiver lays out the full schedule. PCAFC also provides the caregiver training, counseling, at least 30 days of respite care a year, and, if not otherwise covered, CHAMPVA health coverage.4

The second VA route is Veteran-Directed Care, which works on the same self-direction principle as Medicaid. 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. VA's description does not address a spouse either way, so ask the options counselor to confirm your spouse can be the paid worker.5 A person-centered options counselor at an Aging and Disability Network Agency, such as an Area Agency on Aging, helps set it up.5

Aid and Attendance

Aid and Attendance is worth understanding on its own terms, because it is often mentioned alongside caregiver pay but works differently. 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 for someone who needs another person's help with daily activities such as bathing, dressing, and eating.4

What it does is add household income that a couple can put toward care however they choose, including making up for income a spouse gave up to provide that care. For 2026, a single wartime veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year, and a surviving spouse can receive up to $18,697 a year. VA publishes these ceilings as annual amounts, and a monthly payment is the yearly award divided by 12.6 Aid and Attendance requires that the veteran or survivor already qualify for a VA pension, which has income and net-worth tests, so it reaches lower-income households.6 If your spouse is a veteran, it is worth checking whether PCAFC, Veteran-Directed Care, or Aid and Attendance fits your situation, since they serve different needs.

How to Apply to Get Paid to Care for Your Spouse in Arkansas

Because the Medicaid answer is set by state policy, the only way to know for certain is to ask the right office the right question. Here is how to get to a real answer, usually over a few weeks rather than a single call.

One more note worth setting expectations on: the National Family Caregiver Support Program, which some families find while searching, funds respite, training, and counseling through Area Agencies on Aging rather than a wage to the caregiver.10 It is genuinely useful for a stretched spouse, but it is not a paycheck.

What About Taxes

If Arkansas does pay you to care for your spouse through Medicaid, the pay is real income, and how it is taxed depends on your living situation. When you live in the same home as the person you care for and are paid through a Medicaid waiver program, your wages may be excludable from federal gross income as "qualified Medicaid waiver payments" under IRS Notice 2014-7.11 The test is where you actually live, and a caregiver who keeps a separate home they return to loses the exclusion. Payments made directly from the care recipient's own private funds are not excludable. If you are paid through a Medicaid program that is not a home and community-based waiver, such as a state plan option, the IRS says the answer depends on the nature of the payments and the purpose and design of the program, so confirm the treatment with a tax professional or the program before you report the pay as taxable income.11 The VA PCAFC stipend is separately tax-free.4 State income tax treatment varies, so it is worth talking to a tax preparer familiar with Medicaid waiver caregiver compensation before you file.

Learn More

Find personalized help getting paid to care for your spouse in Arkansas 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.