Arkansas's ARChoices waiver includes 1915(j) self-direction, which can allow spouses and relatives to be paid as Medicaid-funded caregivers.
Confirm the current rules before applying: the specific eligibility conditions for family-member hiring under Arkansas's 1915(j) implementation must be verified with the Arkansas Choices in Living Resource Center. For families of veterans, the VA programs offer additional pathways that operate under clear federal rules. This guide walks through every realistic option, with honest framing on what requires verification.
The Short Version
Arkansas stands out among its neighboring states. The ARChoices in Homecare Waiver operates a concurrent 1915(j) self-directed personal assistance authority that, by federal design, can permit legally liable relatives, including spouses and parents, to serve as paid attendants. Arkansas also ran the Independent Choices Program for decades, building administrative infrastructure for consumer direction that most southern states lack.
That history matters, but it does not mean the rules are simple or guaranteed. Current eligibility conditions for family-member hiring, any exclusions, and enrollment steps require direct confirmation with the Arkansas Choices in Living Resource Center.
For veteran families, the VA pathways are the most clearly grounded options, with federal rules that apply uniformly across the state.
For non-veteran families with private assets, a written personal services contract can protect payments from the Medicaid look-back, but it must be structured correctly before services begin.
What Makes Arkansas Different
ARChoices Waiver and 1915(j) Self-Direction
The ARChoices in Homecare Waiver is a federal 1915(c) waiver that provides attendant care services, adult day health, respite, and personal care to Arkansas Medicaid recipients ages 65+ and adults ages 21-64 with physical disabilities, all at a nursing-facility level of care.
What separates Arkansas is the concurrent 1915(j) self-directed personal assistant services authority. Under 1915(j), states may allow consumers to choose and direct their own attendants, and the federal authority explicitly permits legally liable relatives, including spouses and parents, to serve as the paid attendant. Arkansas's implementation of 1915(j) is grounded in a long institutional history: the Arkansas Choices in Living Resource Center has administered the Independent Choices Program since 1988, making Arkansas one of the earliest adopters of Medicaid consumer-direction in the country.
Can a spouse or parent be paid? Under the 1915(j) authority, yes, as a policy matter, legally liable relatives including spouses can be paid attendants. Confirm the current Arkansas implementation rules, any restrictions that apply, and enrollment requirements with the Arkansas Choices in Living Resource Center at choicesinliving.ar.gov before applying.
What to confirm:
- Does the current 1915(j) implementation allow spouses, and under what conditions?
- Are there hourly-rate caps or budget limits that apply when hiring a family member?
- What training, background check, and paperwork does the family-member attendant need to complete?
- Is there a waitlist for ARChoices, and if so, what is the current estimate for your county?
Service territory: ARChoices covers adults 65+ and adults 21-64 with physical disabilities. Confirm age and disability criteria with the Arkansas Choices in Living Resource Center.
VA Paid Caregiver Programs in Arkansas
For Arkansas veterans' families, these are the most reliably grounded compensation pathways in 2026.
VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated primary family caregiver: spouse, adult child, parent, stepfamily member, or extended family member of an eligible veteran. Up to two secondary caregivers can also be designated.
2026 stipend: Indexed to the OPM GS-4 Step 1 annual rate for the veteran's locality, divided by 12, with a tier factor applied. Level One (caregiver of a veteran needing personal care assistance) is 62.5% of the monthly base. Level Two (veteran unable to self-sustain in the community) is 100%. Most of Arkansas falls under the Rest of US locality. Confirm your specific stipend with your VA Caregiver Support Coordinator before relying on any figure.
Veteran eligibility: Service-connected disability rating of 70% or higher (single or combined); enrolled in VA health care; needs in-person personal care services for at least 6 continuous months. Both pre-9/11 and post-9/11 eras qualify.
Additional benefits for the primary caregiver: CHAMPVA health insurance if otherwise uninsured; at least 30 days of respite per year; mental health counseling; legal and financial planning; travel reimbursement.
How the caregiver is paid: Direct deposit from the VA after approval. The stipend is federal tax-free.
Apply: Through the Program of Comprehensive Assistance for Family Caregivers portal or with your VA Caregiver Support Coordinator at the Central Arkansas Veterans Healthcare System in Little Rock or the Fayetteville VAMC.
Best for: Families of Arkansas veterans providing substantial caregiving who meet the 70%+ service-connected rating threshold.
VA Veteran-Directed Care
Who can be paid: Any caregiver the veteran chooses, including a spouse, adult child, or friend. VA Veteran-Directed Care has the most permissive family-hire rules of the programs in this guide.
How it works: The veteran receives a flexible monthly budget based on VA-assessed care needs. The veteran directs who to hire and sets the hourly rate within that budget, working with a Financial Management Services agency contracted with the VA.
Veteran eligibility: Enrolled in VA health care; needs help with ADLs; Veteran-Directed Care must be offered at the veteran's local VAMC. Availability varies by facility. Confirm with the social work or geriatrics team at your Arkansas VAMC whether VDC referrals are currently available.
Best for: Arkansas veterans who want full flexibility in caregiver selection, especially a spouse, and do not meet the PCAFC criteria.
VA Aid and Attendance Pension
Who is paid: The veteran or surviving spouse receives the pension. Family caregivers are typically compensated from it through a written private arrangement.
2026 benefit maximums (effective Dec 1, 2025 through Nov 30, 2026):
- Single veteran with Aid and Attendance: up to $2,424/month ($29,093/year)
- Veteran with one dependent: up to $2,874/month ($34,488/year)
- Two married veterans both with Aid and Attendance: up to $3,845/month ($46,143/year)
- Surviving spouse with Aid and Attendance: up to $1,558/month ($18,697/year)
- Each additional dependent child adds $2,984/year
Net worth limit (2026): $163,699 combined assets and annual income, excluding the primary home, one vehicle, and basic household items.
Eligibility: Wartime veteran (90+ days active duty with at least one day during a recognized wartime period) or surviving spouse; needs help with ADLs, is housebound, resides in a nursing facility, or is legally blind.
36-month look-back: VA pension is subject to a 36-month look-back on asset transfers for less than fair market value made on or after October 18, 2018, under 38 CFR 3.276.
Apply: Through va.gov/pension/aid-attendance-housebound or free of charge through an Arkansas Veterans Service Officer. Avoid for-profit pension consultants who charge a percentage.
Best for: Wartime veterans or surviving spouses with income and assets under the net worth limit who need ADL assistance and want to apply pension income toward caregiver pay.
Private Caregiver Agreement (Personal Services Contract)
A written caregiver agreement formalizes payment of a family member from private funds. It is used primarily as a Medicaid planning tool when the care recipient has assets and may eventually need Medicaid.
The look-back issue: Arkansas enforces the standard 60-month Medicaid look-back on asset transfers. Without a written contract, informal payments from an elder to a family caregiver can be treated as uncompensated gifts and trigger a transfer penalty. A properly written personal services contract at a fair market rate converts the arrangement into a documented exchange of value.
What the contract must include:
- A start date (the contract must be signed before services begin)
- Specific services and a weekly schedule
- A reasonable, customary hourly rate documented against local market rates
- Payment terms and method
- Daily caregiver logs of hours and tasks
- The caregiver reports wages as income on their tax return
Interaction with ARChoices: If you are also pursuing the ARChoices 1915(j) family-attendant route, a private contract may not be necessary on the Medicaid side. An elder-law attorney can help you decide which structure fits your family's situation and asset picture.
Best for: Families with private assets paying a non-spouse family member who want to protect against the look-back when the care recipient eventually applies for Medicaid.
Comparison Table
| Pathway | Pay spouses? | Pay non-spouse family? | 2026 pay | Waitlist? | Key step |
|---|---|---|---|---|---|
| ARChoices 1915(j) Self-Direction | Possibly, confirm with Choices in Living | Yes, confirm with Choices in Living | Confirm hourly rate/budget with Choices in Living | Varies | choicesinliving.ar.gov |
| VA PCAFC | Yes | Yes | GS-4 indexed, locality-adjusted; tax-free | None | 70%+ service-connected rating |
| VA Veteran-Directed Care | Yes | Yes | Vet-set within VA budget | Varies by VAMC | Enrolled in VA health care |
| VA Aid and Attendance | Paid to veteran | Paid to veteran | Up to $2,424/mo single veteran | None | Wartime service, A&A criteria |
| Private Caregiver Agreement | Not for look-back purposes | Yes (with written contract) | Fair market rate | None | Elder-law attorney recommended |
How to Choose
Medicaid-eligible, not a veteran? Start with the Arkansas Choices in Living Resource Center at choicesinliving.ar.gov. Ask specifically about 1915(j) self-direction and whether your family member qualifies as a paid attendant. Given Arkansas's long history with consumer direction, this is the strongest Medicaid-side option in the state.
Caring for a veteran? The PCAFC stipend is tax-free, comes with CHAMPVA, and is the most structured pathway for qualifying families. Contact your VA Caregiver Support Coordinator at the Central Arkansas VA in Little Rock or the Fayetteville VAMC.
Want maximum flexibility? VA Veteran-Directed Care, if available at your VAMC, lets the veteran set the hourly rate and hire any caregiver, including a spouse. Ask the VAMC social work team about a referral.
Have private assets and concerned about Medicaid later? Work with an Arkansas elder-law attorney to draft a personal services contract before any large informal payments begin. The 60-month look-back applies, and undocumented informal arrangements are the most common source of Medicaid planning problems.
Both a veteran family and ARChoices-eligible? Layering programs is sometimes possible but requires coordination. Talk to your VA Caregiver Support Coordinator and the Choices in Living Resource Center before attempting to combine them.
Not sure where to start in Arkansas? Chat with Brevy's care navigator for a personalized look at veteran status, Medicaid eligibility, and which pathway fits your family's situation.
Tax Considerations
- ARChoices 1915(j) attendant wages (if authorized through self-direction): confirm tax treatment with the Arkansas Choices in Living Resource Center and a tax preparer when you enroll.
- VA PCAFC stipend is federal tax-free income and does not count as income for most federal benefit programs.
- VA Veteran-Directed Care wages are paid through an FMS agency, generally as W-2 wages.
- VA Aid and Attendance is tax-free to the veteran; a family caregiver paid from that pension receives ordinary taxable income.
- Private caregiver agreement wages are ordinary taxable income; employment classification matters.
IRS Notice 2014-7: Medicaid waiver payments to a caregiver who lives with and provides care to the Medicaid recipient may be excluded from the caregiver's federal gross income. If Arkansas authorizes family-member attendant pay under the ARChoices 1915(j) authority and the caregiver lives in the same home, this exclusion may apply. Confirm with a tax preparer familiar with the rule before filing.
Common Misconceptions
"The 1915(j) authority automatically makes all family members eligible attendants." The 1915(j) federal authority allows states to permit legally liable relatives, but each state sets its own implementation rules, approval conditions, and any restrictions. Arkansas's current rules must be confirmed with the Arkansas Choices in Living Resource Center. Do not assume the rules without calling.
"Medicare pays family caregivers." Medicare does not pay family caregivers. Medicare covers short-term skilled home health through certified agencies for homebound beneficiaries. Family caregiver pay comes from Medicaid, the VA, or private arrangements.
"I can start paying myself from my parent's savings and document it later." Documentation must precede services. For both Medicaid look-back protection and IRS purposes, the caregiver agreement must be written and signed before services begin. Backdating does not work.
"VA Aid and Attendance is only for combat veterans." The requirement is wartime service, meaning at least one day of active duty during a recognized wartime period, not combat participation. Many veterans stationed stateside who served during a designated wartime era qualify.
Frequently Asked Questions
Under the federal 1915(j) self-directed personal assistant services authority that runs concurrent with the ARChoices Waiver, states may allow legally liable relatives, including spouses, to serve as paid attendants. Arkansas has a long history of consumer-directed caregiving through the Independent Choices Program. Confirm whether a spouse is currently eligible under Arkansas's 1915(j) implementation, and what conditions apply, with the Arkansas Choices in Living Resource Center at choicesinliving.ar.gov.
The PCAFC stipend is indexed to the OPM GS-4 Step 1 annual rate for the locality where the veteran lives, divided by 12, with a tier factor applied. Most of Arkansas falls under the Rest of US locality. The exact amount changes with annual GS salary adjustments. Confirm your current stipend with your VA Caregiver Support Coordinator at the Central Arkansas VA or the Fayetteville VAMC before relying on a specific figure.
The Independent Choices Program, first implemented in 1988, was Arkansas's pioneering consumer-directed caregiving initiative. The ARChoices in Homecare Waiver is the current primary 1915(c) HCBS waiver for adults with physical disabilities and elderly individuals. The 1915(j) self-direction authority that allows consumer direction today, including potential family-member hiring, operates as a concurrent authority alongside the ARChoices 1915(c) waiver. Contact the Arkansas Choices in Living Resource Center for details on how the current program is structured.
The VA PCAFC and Medicaid personal care are separate programs. Layering them may be possible, but how each program counts income and whether services overlap are details that require review with both programs. Talk to your VA Caregiver Support Coordinator and the Arkansas Choices in Living Resource Center before combining programs to avoid unintended consequences.
Learn More
- How to Get Paid as a Family Caregiver in Missouri
- How to Get Paid as a Family Caregiver in Tennessee
- Caregiver Burnout: Signs, Stages, and How to Get Support
- Arkansas VA Aid and Attendance Benefits
- Medicaid Planning Strategies (National)
Find personalized help navigating Arkansas paid family caregiver options 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.