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

If you are caring for an aging parent or spouse in Delaware, you may be able to get paid as a family caregiver. The state route runs through Diamond State Health Plan Plus (DSHP-Plus), Delaware's managed care Medicaid program for long-term care, whose benefits include consumer-directed attendant care: a member who elects to self-direct it has choice and control over who provides the service. Delaware's DSHP-Plus page does not say whether a family member, or a spouse in particular, may be paid as the attendant, so confirm the hiring rules with the Delaware Aging and Disability Resource Center (ADRC) at 1-800-223-9074 before building a plan around it.1

For veteran households where the caregiver is a spouse, VA programs are often the stronger starting point. The Program of Comprehensive Assistance for Family Caregivers pays a federally tax-free monthly stipend with no spousal exclusion, and VA Aid and Attendance sets a 2026 maximum annual pension rate of $34,488 for a veteran with one dependent who qualifies for Aid and Attendance.2,3

The Short Version

If the care recipient is a wartime veteran, start with VA programs. PCAFC pays spouses and other family members a federally tax-free stipend.2 Veteran-Directed Care gives the veteran a flexible budget for services and lets them hire their own personal care aides, which VA says might include their own family member.4 Aid and Attendance pension adds income the veteran can use to pay a family caregiver privately.

If the care recipient qualifies for Delaware Medicaid long-term care through DSHP-Plus, self-directed attendant care is the state path to explore. Delaware's DSHP-Plus page does not say whether a family member or a spouse may be the paid attendant, so confirm with the Delaware ADRC at 1-800-223-9074.1

If neither VA benefits nor Medicaid applies, a private personal services contract is the remaining route. It requires a written agreement before care begins, a fair-market rate, and careful planning around Medicaid's 60-month look-back window.

Delaware Self-Directed Attendant Care: How It Works

Delaware's Medicaid long-term services and supports are delivered through the Diamond State Health Plan Plus managed care program, which the state's Division of Medicaid and Medical Assistance (DMMA) developed in partnership with the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD). Its benefits include consumer-directed attendant care. Under the federal terms that approve the program, Personal Care/Attendant Care is among the services a member may elect to self-direct, with choice and control over who provides the service.1

Those terms set one limit on who may be paid: a person who serves as a member's representative for directing these services cannot also serve as the paid provider for that member. So if the relative who would direct the care also hopes to be the paid attendant, raise that first. Delaware's DSHP-Plus page does not say whether a family member, or a spouse in particular, may be paid as the attendant. Confirm the current rules with the Delaware ADRC at 1-800-223-9074 or through Delaware Long-Term Care Medicaid.1

Five Ways to Get Paid as a Family Caregiver in Delaware

Pathway 1: Delaware Medicaid Self-Directed Attendant Care

Self-directed attendant care under DSHP-Plus is a Delaware Medicaid route for residents who are elderly or physically disabled. Here is how the process generally works.1

Medicaid financial eligibility requirements, authorized hours, and attendant pay rates should be confirmed with the Delaware ADRC, as these can change and vary by individual care plan and MCO contract.

Pathway 2: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a family member of the veteran (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 there is no spousal exclusion, and a partner or friend living with the veteran can qualify too.2

A 70% rating is necessary but nowhere near the whole test. VA lists four conditions that must all be true for the veteran: a VA disability rating (individual or combined) of 70% 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. Even then, you and the veteran apply together and VA decides eligibility through its application process. Once approved, the caregiver must enroll in direct deposit through VA's customer engagement portal to receive the stipend.2 The monthly stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's geographic locality, divided by 12. That monthly figure is then multiplied by one of four factors set at 38 CFR 71.40(c)(4)(i), and which one applies turns on whether the veteran is in the current program or is a legacy participant or legacy applicant.2

• Current program (38 CFR 71.20(a)). The multiplier is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."2
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)). The multiplier is set by the sum of the veteran's 2019 clinical ratings instead: 1.00 if the sum is 21 or higher, 0.625 if it is 13 to 20, and 0.25 if it is 1 to 12. No self-sustain determination is needed on this route, so a legacy household can reach the full 1.00 on the rating schedule alone.2
• Meeting both. A veteran who qualifies under the current and the legacy criteria is paid whichever amount is higher. A legacy participant's stipend also cannot fall below what the caregiver was eligible for the day before October 1, 2020, while the veteran remains at the address on record. The legacy schedule lapses October 1, 2028.2

If your household may be on the legacy side, ask the Caregiver Support Coordinator which paragraph of 71.20 your approval sits under and what the 2019 rating sum on file was.

The PCAFC stipend is federally tax-free under 38 U.S.C. § 1720G and not reported on a W-2. Primary Family Caregivers may also get CHAMPVA health care benefits if they don't already qualify under another health plan, at least 30 days of respite care a year, and free legal and financial planning help; both Primary and Secondary Family Caregivers get caregiver training and mental health counseling.2 Contact the Wilmington VA Medical Center's Caregiver Support Coordinator for current Delaware locality stipend figures and enrollment details.

Pathway 3: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care is the VA's self-direction program, operated jointly with the Administration for Community Living through Area Agency on Aging partnerships. Veterans in the program are given a flexible budget for services and can hire their own personal care aides, which VA says might include their own family member or neighbor. Ask the VA social worker whether a spouse can be the paid aide in your case.4

VDC availability depends on whether the veteran's VAMC offers the program. Contact the Caregiver Support Coordinator at the Wilmington VA Medical Center to confirm current VDC availability in Delaware. If available, the hired family caregiver receives payroll through a Financial Management Services contractor and is issued a W-2.

Pathway 4: VA Aid and Attendance

VA Aid and Attendance is a pension enhancement for wartime veterans who need help with daily living, and for surviving spouses with similar needs.3

2026 Aid and Attendance rates, which the VA publishes as maximum annual pension rates (effective December 1, 2025 through November 30, 2026):3

• Veteran with no dependents: up to $29,093 per year3
• Veteran with one dependent: up to $34,488 per year
• Surviving spouse (no dependents): up to $18,697 per year

VA bases the payment on the difference between that annual maximum and the claimant's income for VA purposes, so someone with income receives less than the rate shown above. Some expenses, like non-reimbursable medical expenses, may reduce income for VA purposes, but only the amount above 5% of that maximum rate can be deducted.3

The net worth limit is $163,699.3 VA pension is subject to a 36-month look-back on asset transfers under 38 CFR 3.276 for transfers made on or after October 18, 2018.

The veteran receives the pension. To pay a family caregiver from those funds, the family can use a private arrangement or a personal services contract. Aid and Attendance has no Delaware Medicaid enrollment requirement, making it available to families outside the state program.

Pathway 5: Private Personal Services Contract

For families outside both the VA and Medicaid systems, a personal services contract converts informal care into documented, compensated work. The agreement must be:

• Written and signed before care begins
• Specific about services, schedule, and rate
• Priced at or below what local home care agencies charge for equivalent services
• Supported by daily service logs

Delaware, like all states, applies a 60-month Medicaid look-back on asset transfers. Undocumented cash payments to family members can appear as gifts and trigger a penalty period. A written contract executed at a fair-market rate before care begins demonstrates the payments were for real services. Confirm current Delaware look-back rules with a Delaware elder-law attorney before proceeding.

Spouses are generally not recommended as parties to a personal services contract for Medicaid planning purposes, because inter-spousal transfers receive different treatment under Medicaid rules.

How to Choose

Veteran household: If the veteran has a 70%+ rating and needs daily personal care, PCAFC is the first program to screen for, though VA checks more than the rating.2 The stipend is tax-free, spouses qualify, and the primary caregiver can get CHAMPVA health coverage if not already covered by another plan. Layer Aid and Attendance pension on top if the veteran qualifies for both. Ask the Wilmington VAMC Caregiver Support Coordinator about Veteran-Directed Care as a flexible supplement.

Non-veteran Medicaid-eligible household: Call the Delaware ADRC at 1-800-223-9074 and confirm whether the care recipient qualifies for DSHP-Plus self-directed attendant care and whether the family member you have in mind may be the paid attendant. Delaware's DSHP-Plus page does not settle that for a family member or a spouse, so get the answer before arranging care around it.1

Private-pay household: A personal services contract is the right structure for families outside both systems. Involve a Delaware elder-law attorney if the care recipient might apply for Medicaid within the next five years.

IRS Notice 2014-7 and Taxes

If a Delaware Medicaid program pays a family caregiver who lives with the care recipient, see the IRS's guidance on IRS Notice 2014-7 for when certain Medicaid waiver payments may be excludable from income. Ask a tax professional how the payments are treated for federal and Delaware income tax.

PCAFC stipends are excluded from federal gross income under 38 U.S.C. § 1720G and are not reported on a W-2.2

Personal services contract wages are ordinary taxable income.

Common Misconceptions

"Any family member can be paid as a Delaware Medicaid attendant." Delaware's DSHP-Plus page does not say whether a family member, or a spouse in particular, may be the paid attendant under DSHP-Plus self-directed attendant care, and one person is ruled out: whoever serves as the member's representative for directing the services cannot also be paid to provide them. Confirm the current rules with the Delaware ADRC at 1-800-223-9074 before enrolling.1

"Medicare pays for ongoing home care." Medicare does not cover personal care or custodial care on a long-term basis. It covers short-stay post-hospital skilled nursing and home health for homebound patients with a skilled need. For daily ADL assistance, Medicaid and VA programs are the relevant routes.

"A verbal agreement with a family member is enough." For both tax and Medicaid purposes, the exchange needs to be in writing, executed before services start, at a fair-market rate. An undocumented payment looks like a gift and can trigger a Medicaid look-back penalty.

"Aid and Attendance only covers nursing home care." Not so. A veteran receiving Aid and Attendance can use the pension income to pay a family caregiver at home, including through a private personal services contract.

Learn More

Find personalized help choosing the right Delaware paid-caregiver pathway 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.