How to Get Paid to Care for Your Spouse in Florida

If you have searched for how to get paid to care for your spouse in Florida, you have probably been told no. Many states will pay an adult child, a sibling, or even a neighbor to be a Medicaid caregiver, and turn a husband or wife away. Florida is one of the exceptions: under its Medicaid long-term-care waiver, a spouse can be hired and paid, and the VA pays qualifying spouses too.

In This Guide

• Can You Get Paid to Care for Your Spouse in Florida?
• The Medicaid Self-Directed Route: Florida's PDO
• The Legally Responsible Relative Rule Florida Sets Aside
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance for a Veteran's Spouse
• Who to Call
• Frequently Asked Questions
• Learn More

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

For most families the honest answer is "it depends on your state, and often no," which surprises people, because the same state will happily pay an adult child or a friend. The sticking point is the "legally responsible relative" category, which a state's own law may or may not extend to a husband or wife. Florida has answered it in a spouse's favor.

In Florida there are two realistic ways a spouse gets paid:

1. Florida Medicaid, through the SMMC LTC waiver's Participant-Directed Option, if the person receiving care is enrolled in Medicaid long-term care.1
2. The VA, through the caregiver stipend, Veteran-Directed Care, or Aid and Attendance, if the person receiving care is a veteran.3

A third path, a private Personal Care Agreement paid from your own savings, compensates a spouse legally while protecting a future Medicaid application. It, and the full map for every kind of relative, lives in our companion guide, How to Get Paid to Care for a Family Member in Florida.

The Medicaid Self-Directed Route: Florida's PDO

Florida's Medicaid answer for a paid spouse runs through the Participant-Directed Option (PDO), the self-direction track inside the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) waiver. Self-direction (also called participant direction) means the person receiving care, or their representative, controls the budget and hires, trains, schedules, and supervises their own workers. Whether a family member can be a paid worker is a state option, not a feature of self-direction itself.6,1

Two documents govern the PDO, and they say different amounts about spouses.

The October 2025 SMMC LTC contract (Attachment II, Exhibit II-B) is the operative one, and it is generous about family without naming spouses. The plan must make the PDO available to every enrollee who has one or more of five services on their plan of care, and enrollees may hire any individual meeting the contract's minimum qualifications, "including but not limited to neighbors, family members, or friends." The plan may not restrict that choice or require a worker from its own network. Those minimum qualifications are lighter than most families expect: adult companion, homemaker and personal care each carry "None" in the contract's PDO Provider Qualifications table, while attendant nursing care and intermittent and skilled nursing must be furnished by an RN or LPN licensed under Chapter 464, F.S.1

The spouse election specifically comes from the older document: the 1915(c) LTC waiver application AHCA publishes, FL.0962.R01.00, approved effective December 28, 2016. There Florida answers "Yes" to paying legally responsible individuals, stating that "Recipients may select a person legally responsible to provide personal care, adult companion, respite, attendant care or intermittent and skilled nursing services under the Participant Direction Option of the LTC Waiver," with legally responsible individuals typically including "a spouse of a waiver participant." That is a real, sourced yes, and it is nine years old and not repeated in the 2025 contract, so ask the enrollee's SMMC LTC plan to confirm it still applies before you budget around it.1

What has to be true first

• The person receiving care must be enrolled in the SMMC LTC waiver, not just regular Medicaid. Enrollment starts with a screening through the Florida Department of Elder Affairs and its aging network, and functional eligibility (nursing-facility level of care) is confirmed by the Comprehensive Assessment and Review for Long-Term Care Services (CARES) program.5
• They must live in the community, their own or a family home. PDO is not used while someone lives in an assisted living facility, adult family-care home, or nursing home.1
• There must be a PDO-directable service on the care plan. Under the current Agency for Health Care Administration (AHCA) long-term-care contract, the services a member can self-direct are adult companion care, attendant nursing care, homemaker services, intermittent and skilled nursing, and personal care. In-home respite is not on that contract list, although the 2016 waiver application does name respite, so treat paid respite as a question for the plan rather than a settled yes or no.1

What the spouse-worker has to do

To be paid, the spouse must be at least 18, pass a Level 2 (fingerprint-based) background screening under Florida law, and sign a Direct Service Worker agreement. A Fiscal/Employer Agent handles payroll and tax withholding, and federal Electronic Visit Verification records each shift's time, service, and location.1

Pay is hourly, set within a budget the managed-care plan's case manager authorizes based on the assessed care plan. Rates start at Florida's minimum wage, which is $14.00 per hour in 2026 and scheduled to rise to $15.00 per hour on September 30, 2026, with skilled nursing tasks paying more. Total monthly pay depends entirely on the authorized hours.7

There is a welcome tax wrinkle for spouses. Because a husband or wife almost always lives in the same home as the person they care for, PDO wages can qualify as "qualified Medicaid waiver payments" that the IRS treats as difficulty-of-care payments excludable from federal gross income under IRS Notice 2014-7. Confirm with a tax professional, but for a co-resident spouse this often means the pay is not federally taxed.8

The Legally Responsible Relative Rule Florida Sets Aside

To understand why Florida's "yes" matters, it helps to see the default rule it works around. Federal Medicaid law says ordinary state plan personal care may not be paid to a member of the person's family, and it defines "family member" as a legally responsible relative. That phrase is why so many husbands and wives are told no.1

It settles less than it appears to. Whether a spouse is a legally responsible relative is a question of state law, and the federal self-direction regulation says the category may include a spouse rather than always including one. And the state plan rule itself opens with "Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter," which is the 1915(c) waiver program, so the exclusion does not carry over to a waiver automatically.2 That HCBS-waiver power (the Section 1915(c) waiver authority of the Social Security Act) is exactly what Florida used when it answered "Yes" on paying legally responsible individuals under the PDO.6,1

Even in Florida, the "no" survives in a few specific places:

• There is an extraordinary-care limit, and Florida did not spell it out. The waiver application's CMS template text reads: "Except at the option of the State and under extraordinary circumstances specified by the State, payment may not be made to a legally responsible individual for the provision of personal care or similar services that the legally responsible individual would ordinarily perform or be responsible to perform on behalf of a waiver participant." Florida's answer in that appendix does not specify those circumstances. What it does state is a cap: the amount reimbursed "shall be limited to the executed Participant Direction Service Work Agreement," and relatives and legal guardians "may be paid for waiver services covered only by the PDO service option" and only where a PDO Work Agreement is signed. So the hours you are paid for are the hours the work agreement authorizes.1
• No waiver enrollment, no PDO. If your spouse is not enrolled in Medicaid long-term care, there is no PDO to hire you into.
• Respite is where the two documents disagree. In-home respite is not among the five self-directable services in the October 2025 contract, though the 2016 waiver application does list respite among the services a legally responsible individual may provide. Ask the plan which controls before you plan on paid respite.1
• You cannot be both the representative and the paid worker. Under the October 2025 contract the enrollee holds employer authority and may delegate it to a representative, but that representative can neither be paid as a representative nor be a direct service worker.1
• The couple's income math can shift. Adding a spouse's wages to the household can affect Medicaid budgeting for the couple. It rarely cancels the benefit, but it is worth modeling with a Florida Medicaid planner before you elect a spouse-worker.

The VA Route: PCAFC and Veteran-Directed Care

If your spouse is a veteran, you have options that do not depend on Florida's rules at all, because they are federal and apply in every state.

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a tax-free monthly stipend to a veteran's Primary Family Caregiver, and a spouse is explicitly eligible to serve in that role. Eligibility is not a two-part test. The VA states that a veteran or service member "may be eligible for a Family Caregiver if all of the following requirements are met," and 38 CFR 71.20(a) lists seven of them. All seven have to be true:4

1. The person is a veteran, or a service member undergoing medical discharge.
2. They have a serious injury or illness "incurred or aggravated in the line of duty in the active military, naval, or air service." For PCAFC, serious injury means a service-connected disability rated 70% or more by the VA, alone or combined with others; the regulation also ties it to service on or after September 11, 2001, on or before May 7, 1975, or (since October 1, 2022) between those dates.4,3
3. They need in-person personal care services for at least six continuous months, based on an inability to perform an activity of daily living, a need for supervision or protection, or a need for regular or extensive instruction or supervision.4
4. Taking part in the program is in their best interest.
5. The personal care services the Family Caregiver would provide "will not be simultaneously and regularly provided by or through another individual or entity." This is the requirement families trip over, and the caution further down this section is about it.4
6. They receive care at home, or will do so once the VA designates a Family Caregiver.
7. They receive ongoing care from a Primary Care Team, or will do so once a caregiver is designated.

The veteran also has to be enrolled in VA health care. Apply with VA Form 10-10CG. Once approved, the stipend is paid only after you enroll in direct deposit through the VA customer engagement portal.3,4

How the VA calculates the stipend

The stipend is not a flat national figure. It starts from the federal OPM General Schedule grade 4, step 1 annual rate for the veteran's locality, divided by 12. That result is the "monthly stipend rate," and 38 CFR 71.40(c)(4)(i) multiplies it by one of four values. Which value applies turns first on whether the veteran is in the current program or came into PCAFC as a legacy participant or legacy applicant.3

• Current program, meaning a veteran who meets the requirements of 38 CFR 71.20(a): the multiplier is 0.625 (62.5%), or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."3,4
• Legacy participant or legacy applicant, meaning a veteran under 38 CFR 71.20(b) or (c): under 38 CFR 71.40(c)(4)(i)(B) the multiplier comes instead from the sum of the veteran's 2019 clinical ratings. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25. No self-sustain determination is required on this route.3

That second route is where families lose money without ever knowing it. If you have been told the only road to the full stipend is a VA finding that your spouse cannot self-sustain in the community, that is the current-program rule, and it is not yours if you came in as a legacy household. A legacy household whose 2019 ratings sum to 21 or higher reaches the full 1.00 on the rating schedule alone, roughly 1.6 times the 0.625 amount.3

Two further rules protect legacy households:

• You get the higher of the two. Where a veteran meets both the current-program test and the legacy test, 38 CFR 71.40(c)(4)(i)(C) pays whichever of the two calculations produces the larger amount.3
• A legacy participant has a floor. Under (c)(4)(i)(D), the caregiver of a legacy participant is paid not less than what that caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still resides at the address on record with PCAFC as of that date. Relocating forfeits that floor, so raise it with your caregiver support coordinator before a move, not after.3

The legacy apparatus is time-boxed: it runs "for eight years beginning on October 1, 2020" and lapses October 1, 2028. Until then, if your household came into PCAFC as a legacy participant or legacy applicant, ask the VA which of the two schedules your stipend is calculated under and what rating sum it used, and get the answer in writing.3

Veteran-Directed Care (VDC) is the VA's own self-direction program. It gives an eligible veteran a flexible, participant-controlled budget that can be used to hire their own workers, and VA says those workers may include family, friends, and neighbors. VA's own VDC materials do not address a spouse specifically, in either direction, so ask your VA medical center's social work or geriatrics office both whether VDC is offered there and whether a spouse can be hired on the budget.9

A household may qualify for more than one of these programs, but do not assume they stack. Requirement 5 above is the one that catches families: the personal care services the Family Caregiver would provide "will not be simultaneously and regularly provided by or through another individual or entity," so a household already receiving regular paid personal care through another program, agency, or hired aide can fail PCAFC on that ground alone, and usually learns it at denial. Before you count on drawing more than one, tell your VA caregiver support coordinator about every other program the household receives or has applied for, Florida Medicaid services included, and ask in plain terms how requirement 5 applies to your arrangement. Ask your Medicaid managed-care case manager the same question from their side, since adding a spouse's wages also affects the couple's Medicaid budgeting.4

Aid and Attendance for a Veteran's Spouse

Aid and Attendance (A&A) is a different VA benefit: it is an increased pension paid to the veteran (or a surviving spouse), not a wage paid to the caregiver. The household can then use that money to compensate a spouse for care. A&A requires the veteran or survivor to qualify for the underlying VA pension.3

For the pension year running December 1, 2025 through November 30, 2026, VA's maximum A&A rates include $34,488 a year for a veteran with one dependent (such as a spouse) and $18,697 a year for a surviving spouse with no dependents. These are ceilings, not flat payments: VA pays the difference between that maximum and the claimant's own income, so someone with income receives less than the maximum. Eligibility is also subject to a net-worth limit of $163,699 and a 36-month look-back on asset transfers.10

Because A&A flows to the veteran or survivor and PCAFC to the caregiver, a couple can often draw both. One caution: if you plan to spend pension money on regular paid help from an agency or an outside aide, raise requirement 5 with the VA first, because PCAFC conditions the caregiver stipend on the same personal care not being provided regularly by or through another individual or entity.4

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

There is no single hotline for this. The right first call depends on which door fits your household.

Learn More

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