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

Whether you can get paid to care for your spouse in Delaware comes down to one program whose rules stop just short of the answer. The state's Medicaid lets family members be paid home-care attendants but does not spell out whether a husband or wife specifically qualifies, so that one piece you confirm by phone. If your spouse is a veteran, a separate VA route pays spouses plainly.

Delaware's Medicaid program lets people who receive home care hire, train, and supervise their own attendants, and family members can be among those attendants. What is not spelled out in the public rules is whether a husband or wife specifically can be the paid attendant. That is the question to ask the state directly. And if the person you care for is a veteran, there is a separate route where the answer for spouses is a clear yes.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Delaware?
• The Medicaid Self-Directed Route: Personal Attendant Services
• When a Spouse Is Blocked: the Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance for a Veteran Spouse
• How to Get Paid to Care for Your Spouse in Delaware: Who to Call
• Frequently Asked Questions
• Learn More

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

The most accurate answer is: maybe through Medicaid, and yes through the VA if your spouse is a veteran. It is worth understanding why the Medicaid side comes with a question mark, because that is exactly the thing you will be asking the state to clear up.

When Medicaid pays a family member for personal care, federal rules draw a line between relatives who choose to help and relatives who are already legally expected to help. A husband or wife falls in the second group. In Medicaid's language a spouse is a "legally responsible relative," one of the people who have a duty under state law to care for another person, and that status can block payment under the most basic Medicaid home-care benefit.2 That is the rule that turns spouses away in a lot of states.

Delaware runs its home care through a self-directed model, which is the more permissive path. Under the state's Personal Attendant Services, delivered through the Diamond State Health Plan Plus long-term-care program, the person receiving care can hire, train, and supervise their own attendants, and family members and friends are allowed to be those attendants.1 What the public rules do not spell out is whether a spouse in particular can be the paid attendant. So the honest guidance is not a flat yes and not a flat no. It is: the self-directed option exists, family members can be paid through it, and you should ask the state specifically about a spouse before you build a plan around it.

The Medicaid Self-Directed Route: Personal Attendant Services

The Delaware Medicaid route rests on an idea called self-direction. Instead of an agency assigning a stranger to your home, self-direction lets the person receiving care, or their authorized representative, control the budget and choose, hire, train, and supervise their own attendant; in programs such as Community First Choice, a financial management entity handles payroll and taxes. Whether a family member can be that paid worker is a state option, not something self-direction guarantees, which is why Delaware's own rules matter. One federal limit is worth knowing: under the 1915(j) and Community First Choice rules, the person serving as the participant's representative generally can't also be the paid worker, so a spouse who wants to be paid should not also be the appointed representative in those programs.6

In Delaware, that model is delivered through Diamond State Health Plan Plus (DSHP+), the state's mandatory managed-care Medicaid program for long-term services and supports. Its Personal Attendant Services let participants hire, train, and supervise their own personal care attendants, including family members and friends. Delaware's Division of Medicaid and Medical Assistance (DMMA) developed DSHP+ in partnership with the state's Division of Services for Aging and Adults with Physical Disabilities (DSAAPD).1 The person you care for has to be enrolled in DSHP+ (or be able to qualify for it), because this is a Medicaid long-term-care benefit, not a standalone caregiver payment.

There is a clear limit to what the public rules tell us. They confirm that family members can be paid attendants, but they do not confirm that a spouse specifically qualifies, and they do not publish a spouse hour cap or an attendant pay rate you can plan around. Rather than guess at a figure, get those answers from the source: the Who to Call steps below give the exact questions to put to the Delaware ADRC at 1-800-223-9074, and naming the self-directed option rather than asking a general question is what gets you the real answer.1

When a Spouse Is Blocked: the Legally Responsible Relative Rule

It helps to understand the rule the self-directed option is designed to step around, both so you can explain your situation clearly on the phone and so you know what to avoid.

Under the standard Medicaid state plan personal care 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.2 That is the rule that produces a no in many states, and it is why a general question to a caseworker can get a general no.

The way past it is to ask specifically about self-direction. Federal rules give each state the option, under self-directed personal assistance authority, to let participants hire "any individual capable of providing the assigned tasks, including legally liable relatives," and the definition of legally liable relatives expressly includes a spouse.2 Whether a state actually takes that option for spouses varies, and that is the unconfirmed piece in Delaware. So if someone tells you a spouse cannot be paid, the follow-up question is: "What about the self-directed personal attendant option under DSHP+, and can a spouse be paid under it?"1

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, you have a second, entirely separate path, and the VA is the one system built to pay spouses directly. It applies anywhere in Delaware and does not depend on Medicaid.

The centerpiece is the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which 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's first screen has four conditions, and all of them must be true for the veteran: a VA disability rating (individual or combined) of 70 percent or higher, discharge from the 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 necessary but not the whole test. You and the veteran apply together, and the regulation adds further conditions VA checks during that process, including that the same personal care is not already being regularly provided by another person or program. Once approved, you must enroll in direct deposit through VA's customer engagement portal, or the stipend won't be paid.3 The stipend is not a single national figure. It starts from the federal pay scale for the veteran's local area: the Office of Personnel Management (OPM) GS-4, step 1 annual rate for that locality, divided by 12. That monthly base is then multiplied by a factor, and there is no single factor. 38 CFR 71.40(c)(4)(i) sets four of them across two schedules, and which one applies depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant:3

• Current program (the veteran meets 38 CFR 71.20(a)): 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), a household carried over from the program as it stood before October 2020): the factor is set instead by the sum of the veteran's 2019 clinical ratings, at 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. No self-sustain determination is required on this route, so a legacy Delaware household rated 21 or higher reaches the full 1.00 on the rating sum alone.3
• 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 VA has on record. The legacy schedule runs eight years from October 1, 2020 and lapses October 1, 2028.3

So the exact amount depends both on where in Delaware you live and on which schedule the veteran qualifies under. Ask your VA Caregiver Support Coordinator which factor VA applied, and on which schedule, before you assume the lower number.3

The second VA route is Veteran-Directed Care (VDC), which works on the same self-direction principle as Medicaid. The veteran gets a flexible budget, managed by the veteran or their representative, and uses it to hire and supervise their own workers, who VA says can be family, friends, or neighbors.4 The veteran works with a person-centered options counselor at an Aging and Disability Network Agency, such as an Area Agency on Aging, and a financial management service helps manage the employer duties.4 VA's description doesn't mention spouses, so ask the VA directly whether you can be the paid worker before you plan around VDC.

Aid and Attendance for a Veteran Spouse

Aid and Attendance comes up often in the same searches, so it is worth being clear about what it is and is not. 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.3

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 ceiling is $29,093 a year for a single veteran with no dependents who meets the VA pension's service requirements, or $18,697 a year for a surviving spouse; VA pays the difference between that ceiling and the claimant's countable income, so someone with income receives less than the maximum, and it is paid out monthly.7 Aid and Attendance requires that the veteran or survivor already qualify for a VA pension, which has income and net-worth tests (the 2026 net-worth limit is $163,699), so it reaches lower-income households.7 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 and can sometimes work together.

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

Because the Medicaid answer is not settled on paper, the first job is to get it settled by phone. Here is the order that works.

One caution before you set anything up informally. Getting paid through the Medicaid program, with a real employment arrangement and a financial management company, is safer than an informal handshake, so ask the ADRC how to set it up correctly rather than paying out of pocket on your own. And on taxes: when you live in the same home as the person you care for and are paid through a Medicaid waiver program, your pay may be excludable from federal gross income as "qualified Medicaid waiver payments" under IRS Notice 2014-7. The exclusion does not reach payments made directly from the care recipient's own private funds. If you're paid through a Medicaid program that isn't a waiver, the IRS says the answer depends on the nature of the payments and the purpose and design of the program, so confirm your program's treatment before you report the pay.9 Because spouses so often share a home, the same-home condition is usually met. State income-tax treatment varies, so ask a tax preparer familiar with Medicaid caregiver pay before you file.

Learn More

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