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

In the District of Columbia, Medicaid can pay an adult child or another relative, though not a spouse, to give hands-on care at home. To get paid as a family caregiver in DC, the relative works either as a home care agency's personal care aide or as a worker the care recipient hires directly.1

The District's Medicaid rules let "an individual or family member" be the paid worker and exclude, by relationship, a spouse, another legally responsible relative, and a court-appointed guardian.1 If you're the spouse of a veteran, VA's family caregiver program can pay you instead,2 and this guide covers that route too.

In This Guide

• The Short Version, by Your Situation
• Who Can Get Paid as a Family Caregiver in DC
• Route 1: Get Hired by a Home Care Agency as a Personal Care Aide
• Route 2: Services My Way, Where Your Loved One Hires You
• Does Your Loved One Qualify for the EPD Waiver?
• Comparing DC's Paid Caregiver Routes
• Paid Routes for Veterans' Families in DC
• If You Work: DC Paid Family Leave
• Paying a Relative From Family Funds
• How to Get Paid as a Family Caregiver in DC, Step by Step
• Taxes on DC Caregiver Pay
• Frequently Asked Questions

The Short Version, by Your Situation

You're an adult child, sibling, grandchild, or friend, and your loved one is on DC Medicaid. Either DC Medicaid route can work (the relationship rule is below). The agency route asks more of you up front (a Home Health Aide certification), and the agency is your employer. Services My Way asks less of you and more of your loved one, who becomes your employer.1,5,3

You're the parent of an adult child with a physical disability. The same two DC Medicaid routes are open to you.1

You're a spouse. Skip to the VA routes if your husband or wife is a veteran, because VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) expressly includes a spouse.2

Your loved one isn't on DC Medicaid yet. The paid routes start with eligibility. For the EPD Waiver in 2026, DC applies an income standard of $2,982 a month and a $4,000 limit on countable assets for one person, with a spend-down route for income above the standard.6,7

Who Can Get Paid as a Family Caregiver in DC

The District writes nearly the same relationship rule into both DC Medicaid routes.1

• Under DC's PCA rule (29 DCMR § 5006.5): "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," and "Legally responsible relatives shall not include parents of adult children."
• Under DC's Services My Way rule: participant-directed services "may be provided by family members and individuals other than a participant's spouse, other legally responsible relative, or court-appointed guardian," and parents of adult children are not precluded.1

DC's rules name exclusions rather than listing every relative who qualifies, so if your relationship is unusual confirm it with the case manager or agency before care begins; the FAQ covers a daughter who's also her parent's guardian.1 For the national picture on spouses, see How to Get Paid to Care for Your Spouse.

Route 1: Get Hired by a Home Care Agency as a Personal Care Aide

Who pays: DC Medicaid, through a home care agency that bills Medicaid for Personal Care Aide (PCA) services. DHCF administers DC Medicaid.8

How it works: DC's regular Medicaid program (the Medicaid State Plan) and the EPD Waiver both cover PCA services, meaning help with eating, dressing, bathing, using the bathroom, and moving around. Under DHCF Transmittal 17-29, State Plan PCA services run through home health agencies, which claim Medicaid reimbursement for aides enrolled in DC Medicaid.9 An EPD Waiver PCA provider must meet the same Chapter 50 provider requirements under 29 DCMR § 4226.1.1

How many hours: DHCF sets hours from a face-to-face assessment by its contractor, Liberty Healthcare. Under the DC Medicaid State Plan, DHCF may approve up to 8 hours of PCA services a day. If the assessment score reaches a nursing-facility level of care, DHCF may qualify the person for the EPD Waiver, which has a higher income cap and allows more than 8 hours a day.9

What you need as the aide: Under 29 DCMR § 5009.1, every DC Medicaid State Plan PCA, whether an agency employee or placed through a staffing agency, must obtain and keep a Home Health Aide certification, hold current CPR and first aid certification, pass a criminal background check and a reference check, show freedom from tuberculosis and hepatitis, have an individual NPI number, and complete at least 12 hours of in-service training a year.5

Which agencies: A home care agency in the District must be licensed under D.C. Code § 44-502, and DC Health lists home health agencies among the facilities it licenses.10

Why families choose it: DC's rule makes each PCA an employee of the provider or a worker placed through a staffing agency, so your loved one takes on no employer duties.5 The agency also supervises the care: for DC State Plan PCA, the agency's supervisory nurse re-evaluates the need for services at least once every 12 months or when health changes.9 If you'd like a sense of how home care differs from medical home health, see Home Care vs. Home Health in Washington, DC.

Route 2: Services My Way, Where Your Loved One Hires You

Services My Way is the self-directed option inside DC's EPD Waiver: your loved one, or an authorized representative, hires and directs you instead of receiving an agency aide. Under 29 DCMR § 10100.2, Services My Way is open only to EPD Waiver enrollees who live in their own home or in the home of a family member or friend.1,3 Services My Way is the do-it-yourself option, not the only one: in Route 1 a home care agency is the employer.5

Who is the employer: Under 29 DCMR § 10102, the Services My Way participant (or authorized representative) is the "common law employer" of the Participant-Directed Worker (PDW), responsible for recruiting, hiring, supervising, and discharging workers. A Vendor Fiscal/Employer Agent Financial Management Services-Support Broker entity helps with the employer duties, enrolls the worker in its payroll system, and signs a Medicaid provider agreement with each worker on DHCF's behalf.3

What the job covers: Services My Way covers cueing, safety monitoring, and hands-on help with activities of daily living and instrumental activities of daily living, but not chores such as laundry for other family members or money management.3

Hours: A Services My Way participant needs a DHCF authorization for personal care aide hours and is limited to 16 hours a day of participant-directed care. Any additional authorized hours, up to 8 a day, come from a home health agency under DC's State Plan PCA benefit. DHCF or its agent must prior-authorize every hour.3

Pay: Services My Way pay comes out of your loved one's participant-directed budget, at an hourly wage your loved one sets. Under 29 DCMR § 10102.9, that wage can be no lower than the District living wage and no higher than the wage DHCF pays for personal care aide services under Chapter 42 of Title 29 DCMR. The rule names no dollar amount, so ask the support broker for the current range.3

What you need as the worker: Under 29 DCMR § 10103.4, a Services My Way worker must be at least 18; pass a criminal background check; receive training from your loved one or their representative on their needs and goals; be able and willing to do the work in their plan; hold current CPR and First Aid certification from an in-person course approved by the American Red Cross (or an alternative DHCF approves); and have an individual National Provider Identifier (NPI). The participant can't be their own worker.3 Home Health Aide certification isn't on that list, which is the practical difference from the agency route.

How to start: The first step to enroll in Services My Way is a meeting with your loved one's EPD Waiver case manager, who amends the person-centered service plan to add it.11 Every Services My Way participant must also follow federal and District electronic visit verification rules, so expect to clock hours electronically.3

Does Your Loved One Qualify for the EPD Waiver?

The EPD Waiver, DC Medicaid's Elderly and Persons with Physical Disabilities Waiver, is a Section 1915(c) home and community-based services waiver overseen by DHCF. It lets a District resident who would otherwise need nursing-home care get services at home or in assisted living.12 DACL lists seven conditions for the EPD Waiver:12

1. Be a U.S. citizen or have a qualified immigration status for Medicaid.
2. Live in the District of Columbia.
3. Be 65 or older, or 18 to 64 with a physical disability.
4. Have a DC Medicaid provider complete a Prescription Order Form (POF).
5. Have Liberty Healthcare complete a face-to-face assessment to establish "level of need."
6. Have countable assets, such as a savings or checking account, of no more than $4,000 for one person.12
7. Have countable income under the monthly limit, or be able to meet a spend-down obligation.

The income figure to use in 2026: DC applies an HCBS waiver income standard of 300% of the SSI federal benefit rate, which is $2,982 a month for one person in 2026.6 DACL's EPD Waiver page still prints an older 2023 figure of $2,743.12

Income above the standard: DHCF's Medically Needy spend-down pathway serves people with high medical costs; each spend-down period runs six months, and the person must then file a new application to keep coverage.7

Assets: For DC Medicaid long-term care, DHCF's $4,000 limit for one person counts only countable resources: the home, one vehicle, and ordinary household and personal goods are excluded. A person already receiving Supplemental Security Income (SSI) has no income or asset limit to meet, because DHCF treats SSI recipients as categorically eligible.7 If a spouse will stay at home, don't read DHCF's $6,000 married-couple figure as the at-home spouse's ceiling; see DC Medicaid Spousal Impoverishment Rules.

Where to apply: Apply for DC Medicaid online through District Direct, by phone through the DHS Economic Security Administration's Public Benefits Call Center at (202) 727-5355, by mail, or in person at an ESA Service Center; DC requires no in-person interview.8 EPD Waiver applicants enroll through DACL's Medicaid Services Enrollment Unit, which submits the application and links the person to EPD Waiver case management.12 More: DC Medicaid Income and Asset Limits.

Comparing DC's Paid Caregiver Routes

Paid Routes for Veterans' Families in DC

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: Under VA's PCAFC, a Family Caregiver must be at least 18 and be the veteran's spouse, son, daughter, parent, stepfamily member, or extended family member, or someone who lives full time with the veteran (or is willing to).2

Veteran eligibility: For PCAFC, VA lists four veteran requirements that must all be true: a VA disability rating of 70% or higher; a military discharge or a date of medical discharge; a need for at least 6 months of continuous, in-person personal care; and enrollment in VA health care. Those four are a first screen: 38 CFR 71.20 adds conditions VA checks during the joint application, including that the same personal care isn't already regularly provided by another person or entity.2

How the PCAFC stipend is set: The PCAFC stipend is the federal GS-4, step 1 annual rate for the veteran's locality, divided by 12, times 0.625 (Level One) or 1.00 (Level Two, when VA finds the veteran unable to self-sustain in the community). PCAFC legacy participants and legacy applicants under 38 CFR 71.20(b) or (c) are paid on a separate clinical-rating schedule that runs for eight years from October 1, 2020 and lapses October 1, 2028. There's no single national dollar amount, so ask the VA Caregiver Support team for the DC figure. VA says the stipend is nontaxable, and an approved caregiver must enroll in direct deposit through VA's customer engagement portal to be paid.2 More detail: VA Caregiver Stipend (PCAFC).

VA Veteran-Directed Care

VA Veteran-Directed Care gives an enrolled veteran a flexible budget, managed by the veteran or the family caregiver, to hire their own personal care aides, which VA says "might include their own family member or neighbor." VA says the program "is only available in certain locations" and a copay may apply, so ask your VA social worker whether it's offered for a DC veteran.13 See VA Veteran-Directed Care.

VA Aid and Attendance

VA Aid and Attendance is an increased pension paid to the veteran or surviving spouse, not to the caregiver. For December 1, 2025 through November 30, 2026, the maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents, $34,488 for a veteran with one dependent, and $18,697 for a surviving spouse with no dependents. VA pays the difference between that ceiling and countable income, divided by 12 each month.14 For December 1, 2025 through November 30, 2026, the VA pension net worth limit, which Aid and Attendance claimants must also meet, is $163,699, and VA doesn't count the primary residence, a car, or basic home items as assets. Under 38 CFR 3.352(c), care given by a relative or another household member doesn't prevent VA from granting the allowance.15 Paying a relative out of that pension is a private family arrangement, so put it in writing. DC-specific detail: Using VA Aid and Attendance for Home Care in DC.

Free help filing in DC: The Mayor's Office of Veterans Affairs (MOVA) helps DC veterans and families with VA claims, including non-service-connected pension, at (202) 724-5454.16

If You Work: DC Paid Family Leave

DC Paid Family Leave doesn't pay you to be a caregiver, but it replaces part of your paycheck while you take time off to care for a family member with a serious health condition. The DC Department of Employment Services runs it.17

• The benefit changes on October 1, 2026. From that date, DC Paid Family Leave's Family Leave covers up to 6 weeks a year (down from 12), and the maximum weekly benefit is $1,100 (down from $1,190).17
• How much: DC Paid Family Leave replaces 90% of wages up to 1.5 times DC's minimum wage and 50% of wages above that, up to the weekly maximum.17
• Who's covered: DC Paid Family Leave covers private-sector workers whose job is in the District and whose employer pays the DC paid leave tax, wherever they live; federal and District government employees aren't covered. Covered relatives include a parent, parent-in-law, grandparent, and sibling, among others.17
• Limits: DC Paid Family Leave doesn't protect your job, and you can't work while receiving it. If your leave straddles October 1, 2026, confirm with the Office of Paid Family Leave which rule applies.17

For how state paid leave programs compare, see Paid Family Leave for Caregivers.

Paying a Relative From Family Funds

A written personal care agreement lets a person who isn't on DC Medicaid, or who prefers to pay privately, pay a relative for care. For scale, CareScout's 2025 survey puts the Washington, DC median for in-home care from a non-medical caregiver at $86,944 a year, based on 44 hours a week.18

The paperwork matters because of Medicaid's transfer rule. Federal Medicaid law applies a 60-month look-back: money given away for less than fair market value in the 60 months before a long-term care application can trigger a penalty period during which Medicaid won't pay for nursing facility care or 1915(c) waiver services, such as the EPD Waiver. The rest of the person's Medicaid coverage isn't withdrawn by that penalty.19,12 A written agreement signed before care starts, a rate in line with local agency prices, and daily care logs help show that payments bought services rather than being gifts. Talk with a DC elder-law attorney before any money changes hands, and read Personal Care Agreements.

How to Get Paid as a Family Caregiver in DC, Step by Step

Taxes on DC Caregiver Pay

• EPD Waiver pay, including Services My Way: Under IRS Notice 2014-7, the IRS treats qualified payments for personal care under a state's Section 1915(c) waiver as difficulty-of-care payments excluded from federal gross income, when you and the person you care for live in the same home and it's your primary residence. The exclusion doesn't apply if you keep a separate home where you regularly live.20 DC's EPD Waiver is a Section 1915(c) waiver.12
• State Plan PCA pay through an agency: Notice 2014-7 is written for 1915(c) waiver payments, and DC's State Plan PCA benefit is the regular Medicaid program, not the EPD Waiver.20,9 Take your pay records and the program name to a tax preparer rather than assuming either answer.
• VA PCAFC: VA says the PCAFC stipend is nontaxable.2

Learn More

Find personalized help getting paid as a family caregiver in DC 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.