Delaware's Personal Attendant Services let Medicaid-eligible participants hire family members and friends as their paid attendants. Whether a spouse can serve as the paid attendant depends on the specific program; confirm the current spousal eligibility rule with the Delaware Aging and Disability Resource Center (ADRC) at 1-800-223-9074 before building a plan around it.
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 provides up to $2,874 per month for a married veteran with one dependent in 2026.
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. Veteran-Directed Care gives the veteran a flexible monthly budget to hire any caregiver they choose, including a spouse. Aid and Attendance pension adds income the veteran can use to pay a family caregiver privately.
If the care recipient qualifies for Delaware Medicaid LTSS, Personal Attendant Services is the primary state path. Family members and friends may be hired; confirm spouse rules with the Delaware ADRC at 1-800-223-9074.
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.
What Delaware Offers
Delaware's Medicaid LTSS programs are administered by the Division of Aging and Disability Services Administration (DASA/DSAAPD) and delivered through the Diamond State Health Plan Plus managed care program. Eligible adults can self-direct their personal care under the Personal Attendant Services option, choosing who provides that care.
The critical program feature: participants can hire family members and friends, not just agency workers. Who exactly qualifies, and whether a spouse falls within that group, varies by program. Confirm the current rules with the Delaware ADRC at 1-800-223-9074 or through Delaware Long-Term Care Medicaid.
The Five Pathways
Pathway 1: Delaware Personal Attendant Services
Delaware's Personal Attendant Services programs are the primary state route to paid family caregiving for Medicaid-eligible adults. The general enrollment steps:
- The care recipient applies for Delaware Medicaid LTSS through the Delaware ADRC (1-800-223-9074) or through Delaware Long-Term Care Medicaid.
- Once enrolled, the participant selects the self-direction option and identifies a personal care attendant.
- Family members and friends are eligible to serve as attendants. Spouse eligibility should be confirmed with the ADRC at 1-800-223-9074, as rules vary by program.
- Payroll runs through a fiscal management service, which handles tax withholding and W-2 issuance for the attendant.
- The family caregiver receives regular pay at the authorized rate.
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. Spouses, adult children, parents, and other family members all qualify, with no spousal exclusion.
Eligibility requires the veteran to have a service-connected disability rating of at least 70% (single or combined) and a need for at least six months of personal care assistance. The monthly stipend is calculated from the OPM General Schedule grade 4, step 1 annual salary for the veteran's geographic locality, divided by 12, then multiplied by a care-level factor (0.625 for Level 1, 1.00 for Level 2).
The PCAFC stipend is federally tax-free under 38 U.S.C. § 1720G and not reported on a W-2. Primary caregivers also receive CHAMPVA health coverage (if otherwise uninsured), mental health counseling, and respite care support. 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. The veteran is given a monthly care budget and can hire any caregiver, including a spouse, at a worker rate set within that budget.
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.
2026 Aid and Attendance rates (effective December 1, 2025 through November 30, 2026):
- Single veteran: up to $2,424 per month
- Married veteran with one dependent: up to $2,874 per month
- Surviving spouse (no dependents): up to $1,558 per month
The net worth limit is $163,699. 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.
| Pathway | Administered by | Spouse eligible? | Typical monthly value | Key requirement |
|---|---|---|---|---|
| Personal Attendant Services | Delaware Medicaid (DSAAPD/DSHP+) | Confirm with ADRC at 1-800-223-9074 | Authorized hours x attendant rate | Medicaid LTSS financial eligibility |
| VA PCAFC | VA (federal) | Yes | Varies by locality; tax-free | 70%+ service-connected disability |
| VA Veteran-Directed Care | VA + AAA | Yes | Monthly budget set by VA team | VAMC VDC availability |
| VA Aid and Attendance | VA (federal) | Veteran pays family member | Up to $2,874/mo (married veteran) | Wartime service; net worth under $163,699 |
| Personal Services Contract | Private | Not recommended for Medicaid planning | Negotiated rate | Written contract before care begins |
How to Choose
Veteran household: If the veteran has a 70%+ service-connected rating and needs daily personal care, start with PCAFC. The stipend is tax-free, spouses qualify, and the primary caregiver also receives health coverage. 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 Personal Attendant Services and whether the specific family caregiver relationship is permitted. Non-spouse family members and friends can often be hired; spouses must confirm current program rules.
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.
Not sure which pathway fits your situation? Brevy's care navigator can help you sort through Delaware's options. Chat at brevy.com.
IRS Notice 2014-7 and Taxes
If Delaware's Personal Attendant Services program authorizes payments to a live-in family caregiver, those payments may qualify for the IRS Notice 2014-7 difficulty-of-care income exclusion. When the caregiver and care recipient share a household and payments come from a qualifying Medicaid program, the income may be excludable from federal gross income. Delaware conforms to federal AGI as the starting point for state income tax, so excluded federal income is generally excluded for state purposes as well, but families should verify with a tax professional.
PCAFC stipends are excluded from federal gross income under 38 U.S.C. § 1720G and are not reported on a W-2.
Personal services contract wages are ordinary taxable income.
Common Misconceptions
"Any family member can be paid under Personal Attendant Services." Family members and friends are generally eligible as attendants, but spouse eligibility varies by program. Confirm the current rules with the Delaware ADRC at 1-800-223-9074 before enrolling.
"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.
Frequently Asked Questions
Possibly, through Delaware's Personal Attendant Services programs, if your parent qualifies for Delaware Medicaid LTSS. Family members and friends may serve as paid personal care attendants. Contact the Delaware ADRC at 1-800-223-9074 to confirm current eligibility rules for your specific relationship. If your parent is a veteran, PCAFC and Veteran-Directed Care are often a more direct route.
Spouse eligibility as a paid personal care attendant under Delaware's Medicaid programs depends on the specific program. Confirm the current rule with the Delaware ADRC at 1-800-223-9074 before assuming spousal pay is available. For veteran households, PCAFC and VA Veteran-Directed Care both permit spouses to be paid without restriction.
The 2026 VA Aid and Attendance rate for a veteran with one dependent is $2,874 per month (effective December 1, 2025 through November 30, 2026). For a single veteran, the rate is $2,424 per month. Surviving spouses with no dependents can receive up to $1,558 per month. Rates are updated annually by cost-of-living adjustment.
No. The PCAFC monthly stipend is excluded from federal gross income under 38 U.S.C. § 1720G and is not reported on a W-2. By contrast, wages paid through state Medicaid attendant services programs are generally subject to payroll taxes and federal income tax, though the IRS Notice 2014-7 exclusion may apply for live-in caregivers receiving qualifying Medicaid waiver payments.
Learn More
- How to Get Paid as a Family Caregiver in Maryland
- Caregiver Burnout: Signs and Support
- VA Aid and Attendance in Delaware
- Medicaid Planning Strategies
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.