Can You Get Paid to Care for Your Spouse in the District of Columbia?

DC Medicaid does not pay a husband or wife to be their spouse's caregiver. The District's own Medicaid rules name the spouse as a relative who can't be the paid worker, whether the care comes through a home care agency, through the self-directed Services My Way program, or as respite. So if you're hoping to get paid to care for your spouse in the District of Columbia and have heard that DC Medicaid pays spouses, it's worth knowing before you change your work plans that the written rules say otherwise.

Other routes can still put money in a DC spouse caregiver's hands. If your spouse is a veteran, the VA can pay a spouse directly through its family caregiver program, and VA Aid and Attendance can add pension income to the household. If you work for a covered employer in DC, DC Paid Family Leave covers time off to care for a spouse. And if another relative, such as an adult child, can take on the paid role, DC Medicaid's rules don't exclude them. This guide walks through each route and how to start in the District.

Can a Spouse Get Paid to Care for a Husband or Wife in DC?

Through DC Medicaid, the short answer is no. The District's Medicaid program is run by the DC Department of Health Care Finance (DHCF), and its home-care rules live in Title 29 of the DC Municipal Regulations (DCMR). Each of the three DC Medicaid routes that pay a person to give hands-on care at home, under the Medicaid State Plan or the Elderly and Persons with Physical Disabilities (EPD) Waiver, names the spouse as someone who can't be that paid person.1

Outside DC Medicaid, the answer depends on your situation. A veteran's spouse may be paid through the VA's family caregiver program, and a working spouse may get partial wage replacement through DC Paid Family Leave while they care.2,4 The table below sets the routes side by side.

What DC Medicaid's Rules Say About Paying a Spouse

It helps to see the actual rules, because families in the District hear conflicting things. There are three DC Medicaid routes that pay a worker to help someone at home, and each has its own regulation. If someone tells you DC Medicaid pays spouses, ask which DCMR section they're relying on, and confirm with DHCF before you count on the income.1

Personal Care Aide services through a home care agency. 29 DCMR Chapter 50 sets the standards for home care agencies that provide DC Medicaid Personal Care Aide (PCA) services under the District's Medicaid State Plan. 29 DCMR § 5006.5 says an individual or family member "other than a spouse, parent of a minor child, any other legally responsible relative, or court-appointed guardian may provide PCA services." The DC EPD Waiver uses the same chapter for its own aide services: under 29 DCMR § 4226.1, an EPD Waiver PCA provider must meet the Chapter 50 requirements. So whether a DC resident gets aide hours through regular DC Medicaid or through the EPD Waiver, the spouse is excluded.1

Services My Way, the EPD Waiver's self-directed option. Self-direction doesn't open a door to paying a spouse in the District. DHCF describes Services My Way as giving DC EPD Waiver participants more choice and control over their Medicaid long-term care, with the participant, or an authorized representative, acting as the employer of their own Participant-Directed Worker. But 29 DCMR § 10103.3 says Services My Way's Participant-Directed Community Support services "may be provided by family members and individuals other than a participant's spouse, other legally responsible relative, or court-appointed guardian."1

EPD Waiver respite. Respite gives a primary caregiver a break. Under 29 DCMR § 4231.12, a DC EPD Waiver participant may choose a respite worker "other than a primary caregiver, the beneficiary's spouse, or other legally responsible relative, or court-appointed guardian." So DC EPD Waiver respite can't pay a spouse either.1

What DC Medicaid Can Still Do for Your Household

A spouse not being paid doesn't mean DC Medicaid can't help. It means the paid hands-on help has to come from someone else, and that can take real weight off the caregiving spouse.

Under the District's Medicaid State Plan, DC Medicaid covers Personal Care Aide services for help with eating, dressing, bathing, using the bathroom and moving around. DHCF sets the hours from a face-to-face assessment by its contractor, Liberty Healthcare, and may approve up to 8 hours of State Plan PCA services a day. If the assessment shows a nursing-facility level of care, DHCF may qualify the person for the DC EPD Waiver, which has a higher income cap and allows more than 8 hours of PCA services a day.6

The DC EPD Waiver is for District residents who are 65 or older, or 18 to 64 with a physical disability, and who would otherwise need nursing-home care. DC EPD Waiver eligibility steps, as DACL lists them in 2026, include a Prescription Order Form from a DC Medicaid provider, a Liberty Healthcare assessment, and countable assets of no more than $4,000 for an individual, with a spend-down route if income is over the limit. DC EPD Waiver services include case management, PCA services, Services My Way and assisted living.7 For a married couple, the DC Medicaid rules on how much the at-home spouse keeps are explained in our guide to DC Medicaid spousal impoverishment.

Another relative can be the paid worker. The DC Medicaid rules that exclude a spouse don't exclude other family members. An adult child, for example, isn't barred by relationship from being the paid aide through a home care agency or the paid Participant-Directed Worker through Services My Way. Each route has its own worker requirements, so that relative should ask the agency or DHCF what they need before starting.1 For the full EPD Waiver picture, see how DC Medicaid pays for care at home.

The VA Route: PCAFC for a Veteran's Spouse

If the person you care for is a veteran, the VA is the main place a DC spouse can actually be paid. The PCAFC program pays an eligible veteran's approved Primary Family Caregiver a tax-free monthly stipend, and a spouse is expressly eligible to be that caregiver. The PCAFC stipend only starts once the caregiver enrolls in direct deposit through the VA customer engagement portal.2

VA lists four PCAFC requirements for the veteran as a first screen, and all four must be true: a VA disability rating of 70 percent or higher, 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. The regulation behind PCAFC, 38 CFR 71.20, adds further conditions VA checks during the application, including that the care isn't already being given regularly by another person or program, that the veteran receives care at home, and that the veteran has ongoing care from a primary care team. A DC household already getting regular aide hours through another program should ask how that affects a PCAFC application.2

The PCAFC stipend isn't a single national dollar amount. VA bases the PCAFC stipend on the federal General Schedule grade 4, step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by 0.625 or, when VA finds the veteran unable to self-sustain in the community, by 1.00. PCAFC legacy participants follow a separate schedule tied to the veteran's 2019 ratings, and that legacy schedule runs until October 1, 2028. PCAFC also provides caregiver training, mental health counseling, at least 30 days of respite care a year, and, if not otherwise covered, CHAMPVA health coverage.2 Our PCAFC caregiver stipend guide goes deeper on the application.

The VA also runs Veteran-Directed Care, a separate program built around a budget the veteran manages. Whether Veteran-Directed Care is available to your household, and who can be hired under it, is a question for the veteran's VA care team; our Veteran-Directed Care guide explains how the program works.

Aid and Attendance: Extra Income, Not a Wage

VA Aid and Attendance works differently from PCAFC. Aid and Attendance doesn't pay a spouse for caregiving. VA Aid and Attendance is an increased monthly payment added to a VA pension for a qualifying veteran or surviving spouse who needs another person's help with daily activities such as bathing, feeding and dressing.8 Helpfully for a DC couple, VA's rule at 38 CFR 3.352(c) says that care given by a relative or another member of the household won't prevent an Aid and Attendance award.8

For VA's 2026 rate year, December 1, 2025 through November 30, 2026, the VA Aid and Attendance maximum is $29,093 a year for a veteran with no dependents and $34,488 a year for a veteran with one dependent. A surviving spouse with no dependents can receive up to $18,697 a year in 2026 VA Aid and Attendance pension. These 2026 VA figures are ceilings: VA pays the maximum minus the household's countable income, and pays it monthly.3

To qualify for the underlying VA pension, a veteran needs qualifying wartime service, no dishonorable discharge, and at least one of these: age 65 or older, a permanent and total disability, nursing-home care because of a disability, or receipt of Social Security Disability Insurance or Supplemental Security Income. The 2026 VA pension net worth limit is $163,699, counting income as well as assets, but not the home or car. VA also looks back 36 months for asset transfers.8,3 For how a DC family uses this money for help at home, see VA Aid and Attendance for home care in DC.

DC Paid Family Leave for a Working Spouse

If you have a job, DC Paid Family Leave may replace part of your pay while you care for your spouse. DC Paid Family Leave is run by the DC Department of Employment Services (DOES), and its Family Leave benefit is for a worker caring for a family member with a serious health condition. DOES lists your spouse among the eligible family members.4

The DC Paid Family Leave benefit changes on October 1, 2026. From October 1, 2026, DOES says DC Paid Family Leave's Family Leave pays up to 6 weeks in a year, down from 12, and the maximum weekly benefit for all claim types is $1,100. The DC Paid Family Leave benefit replaces 90 percent of wages up to 1.5 times DC's minimum wage and 50 percent of wages above that, up to the weekly maximum.5

A few DC Paid Family Leave rules trip people up. DC Paid Family Leave coverage depends on where you work, not where you live, so a Maryland or Virginia resident working for a covered DC employer can qualify, while federal and District government employees aren't covered. DC Paid Family Leave doesn't protect your job, and you may not work while receiving DC Paid Family Leave benefits. And DOES says you must wait until after the event has occurred to apply, and apply no more than 30 days after it.5 Our national guide to paid family leave for caregivers compares DC's program with other states'.

Caregiver Support From the DC Department of Aging and Community Living

The District has no separate Area Agency on Aging. The DC Department of Aging and Community Living (DACL) serves as both the State and Area Agency on Aging, and its Information & Referral/Assistance unit is the front door for older adults, adults with disabilities, and their caregivers.9

DACL's caregiver support services include caregiver education and training, respite, stipends, and transportation services for eligible caregivers. DACL doesn't publish the stipend amount or who qualifies on the pages we reviewed, so ask DACL directly whether a spouse caregiver in your situation is eligible.9 DACL case managers can also help fill out public benefits applications, including applications for long-term programs such as the EPD Waiver.9

How to Get Paid to Care for Your Spouse in DC: What to Do Next

Here's a practical order of operations for a DC couple.

• Build your budget without DC Medicaid pay for the spouse. Plan on the District's Medicaid rules keeping you out of the paid role, and put your effort into the routes below.1
• Still get DC Medicaid aide hours if your spouse qualifies. Agency PCA hours through DC Medicaid, or more hours through the EPD Waiver, take hands-on work off your plate even though you aren't the one paid.6
• Ask whether an adult child could be the paid worker. DC Medicaid's rules don't exclude them by relationship, through an agency or through Services My Way.1
• If your spouse is a veteran, check PCAFC and Aid and Attendance. PCAFC can pay a spouse a stipend, and Aid and Attendance adds pension income.2,8
• If you work, ask your employer about DC Paid Family Leave. A spouse is an eligible family member, and from October 1, 2026 DC Paid Family Leave's Family Leave pays up to 6 weeks a year.4,5
• Call DACL about caregiver support. Ask about respite and whether you qualify for a caregiver stipend.9

Who to Call

• DACL Information & Referral/Assistance: 202-724-5626, Monday through Friday, 9:30 AM to 4:30 PM, or askthedirector.dacl@dc.gov. Ask about caregiver support, stipends, and help applying for the EPD Waiver.9
• DC DHS Public Benefits Call Center: (202) 727-5355, 7:30 am to 4:45 pm, Monday to Friday. This is the number DACL gives for applying for DC Medicaid.9
• VA caregiver program: start at the PCAFC benefits page and ask the veteran's VA care team about applying together.2

Learn More

Find personalized help figuring out how to get paid to care for your spouse in the District of Columbia 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.