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, but they bar a husband or wife from the same job. Florida is one of the exceptions. Under its Medicaid long-term-care waiver, Florida lets a spouse 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
• When Florida Says No: the Legally Responsible Relative Rule
• 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 to "can I be paid to care for my spouse" is "it depends on your state, and usually no." That surprises people, because the same state will happily pay an adult child or a friend. The block is specific to spouses (and parents of minor children), and Florida is one of the states that lifts it.

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, is not a program that "pays" a spouse so much as a way to compensate one legally while protecting a future Medicaid application. That path, and the full six-pathway map for every kind of relative, lives in our companion guide, How to Get Paid to Care for a Family Member in Florida. This page stays on the spouse question.

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 consumer direction) means the person receiving care, or their representative, controls the budget and hires, trains, schedules, and supervises their own workers, which is the mechanism that lets a family member be paid.2,1

Florida's waiver goes a step further than many states by explicitly electing to pay a spouse. The state's approved waiver application says recipients may select a person who is legally responsible, and it names "a spouse of a waiver participant" as an example.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 self-directed list, so a spouse cannot be the paid respite worker.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.6

There is one welcome tax wrinkle for spouses specifically. 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 the details with a tax professional, but for a co-resident spouse this often means the caregiving pay is not federally taxed.7

When Florida Says No: the Legally Responsible Relative Rule

To understand why Florida's "yes" is unusual, it helps to see the default rule it overrides. 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, which includes a spouse. That single phrase is why so many husbands and wives are told no.1

Home and community-based waivers and self-direction authority (Sections 1915(c) and 1915(j) of the Social Security Act) let a state choose to pay a legally responsible relative anyway, but each state decides for itself, and many decline for spouses. Florida elected to allow it. So the doctrine that blocks spouses elsewhere is exactly the rule Florida's waiver sets aside.2,1

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

• Ordinary care is not paid. Federal guidance limits paid family care to "extraordinary care," meaning services beyond what a spouse would normally provide for free. Cooking dinner and keeping company is not paid; hours of bathing, transferring, toileting, and medication help that would otherwise need a hired aide can be. Florida documents this through the care-plan assessment and authorized hours.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 off-limits to the spouse. Because in-home respite is not a self-directed service under the current contract, a spouse cannot be the paid respite provider even though they can be the paid personal-care 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.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, which is roughly 1.6 times the 0.625 amount. Nobody will hand you that comparison.3

Two further rules protect legacy households, and a family can be talked out of either one:

• 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 whole legacy apparatus is time-boxed. It runs "for eight years beginning on October 1, 2020" and lapses on 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 a spouse can be among them. Ask your VA medical center's social work or geriatrics office about VDC eligibility and how the budget is managed in your area.4

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. That is the worst way to find out, because you find out 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 and works differently: 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 however it chooses, including to compensate a spouse for care. A&A requires that the veteran or survivor already qualify for the underlying VA pension.3

For the pension year running December 1, 2025 through November 30, 2026, the VA's maximum annual pension rates at the A&A level 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, paid out monthly at one-twelfth of the annual rate. Eligibility is also subject to a net-worth limit of $163,699 and a 36-month look-back on asset transfers, so plan filings carefully.8

Because A&A flows to the veteran or survivor and PCAFC flows to the caregiver, a couple can often benefit from both at once. One caution if you draw both: 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 "pay me to care for my spouse." 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.