How to Get Paid as a Family Caregiver (2026 Guide)

About 63 million Americans are family caregivers, giving ongoing care to an adult or child with a medical condition or disability, and nearly half have taken at least one major financial hit. Some of that care can be paid for, if you know where to look.1

How you get paid as a family caregiver depends on two things: your state's Medicaid program, and whether the person you care for is a veteran. There is no single national program that pays family caregivers, but most families have at least one route open to them. This guide explains the four main pathways (Medicaid self-direction, VA caregiver programs, a private personal care agreement, and knowing which programs do not pay) and links you to the detailed guide for your state.

You are not alone in this, and you do not have to fund all of it from your savings.

Why Getting Paid as a Family Caregiver Matters

Family caregiving is not a small favor. The 2025 AARP and National Alliance for Caregiving report counts about 63 million family caregivers in the United States, roughly one in four adults, an increase of about 20 million since 2015. Forty percent provide high-intensity care. Nearly half report at least one major financial impact, such as taking on debt, stopping savings, or being unable to afford food.1

The toll is not only financial. Nearly 1 in 5 family caregivers reports fair or poor health, and frequent mental distress is markedly higher among caregivers than non-caregivers (20.5 percent versus 13.6 percent), with dementia caregivers and those providing constant care at the highest risk.8 Getting paid for the care you already provide, and accessing respite so you can rest, is not a luxury. It is what makes sustained care possible.

The Four Ways to Get Paid as a Family Caregiver

1. Medicaid Self-Direction (Consumer Direction)

This is the most common route, explained in depth in our Medicaid self-direction guide. Most state Medicaid programs offer a "self-directed" or "consumer-directed" option within their home and community-based services (HCBS) waivers or state plan personal care benefit. The person receiving care (or their representative) becomes the employer: they recruit, hire, train, schedule, and supervise their own personal care worker. Whether that worker can be a family member is a choice each state makes, so the answer comes from your state's own program rules. One limit applies under the two federal self-direction options that define a representative role (the section 1915(j) personal assistance option and Community First Choice): the person appointed as the care recipient's representative, who directs the care on their behalf, cannot also be the paid caregiver. A relative can still be the paid worker where the state allows it, as long as someone else holds the representative role or the care recipient directs their own services. If you are your parent's guardian, see whether a guardian can be paid to care for a parent. A financial management agency handles payroll and taxes.3

In practice, self-directed pay is an hourly wage, usually at or above your state's home-care base rate, for hours you already spend helping. Paid through the program's financial management agency, it arrives as regular W-2 income, so a family member covering roughly 30 hours a week earns a steady part-time paycheck rather than a lump sum.

What varies by state:

• Who can be paid. Some states let a spouse be paid (for example, Colorado, Wisconsin, and Oregon), though the rules vary sharply by state. Many states bar a spouse but allow adult children and other relatives, and a few also restrict co-resident relatives.
• The program name. It is called CDASS in Colorado, IRIS in Wisconsin, CDPAP in New York, CFSS in Minnesota, Personal Choices in Alabama, CDPASS in Oklahoma, and many other names.
• Eligibility. The person receiving care must qualify for Medicaid and usually meet a nursing-facility level of care.

Your state's guide below explains exactly which program applies and who can be paid.

2. VA Caregiver Programs (for Veterans)

If the person you care for is a veteran enrolled in VA health care, the VA runs the most generous paid-caregiver programs in the country, and they are separate from Medicaid:

• Program of Comprehensive Assistance for Family Caregivers (PCAFC): a monthly stipend to the Primary Family Caregiver of an eligible veteran. VA's first screen has four requirements, 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. Those four are necessary but not the whole test: you and the veteran apply together, and the federal regulation adds further conditions, including that the same personal care is not already being regularly provided by another person or program. It can pay a spouse, VA has described the stipend as a nontaxable benefit, and it is paid only once the caregiver enrolls in direct deposit through VA's customer engagement portal.4 The stipend is not a flat national figure. VA starts from the OPM GS-4, Step 1 annual salary for the locality pay area where the veteran lives and divides it by 12 to get a monthly stipend rate, then multiplies that rate by one of three multipliers (0.625, 1.00 or 0.25) set in 38 CFR 71.40(c)(4)(i). Which multiplier applies turns on whether the veteran is in the current program or is a legacy participant or legacy applicant:
  • Current program (the veteran meets 38 CFR 71.20(a)): the multiplier is 0.625, or the full 1.00 if VA determines the veteran is "unable to self-sustain in the community." On this track that determination is the only route to 1.00, so it is worth asking the VA caregiver support coordinator whether it has been assessed.
  • Legacy participant or legacy applicant (the veteran meets 38 CFR 71.20(b) or (c)): the multiplier comes from the sum of the veteran's 2019 clinical ratings instead, and no self-sustain determination is required. 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.
  • A veteran who meets both the current and the legacy requirements is paid whichever of the two amounts is higher. A legacy participant under 71.20(b) also has a floor: the stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, for as long as the veteran still lives at the address on record with PCAFC on that date. Relocating gives up that protection.
  • The legacy schedule is temporary. It runs for eight years beginning October 1, 2020, so it lapses on October 1, 2028, after which the current-program rules govern everyone.
  • What that means in dollars. Because the base rate is the GS-4, Step 1 rate for the veteran's locality pay area, the dollar amount depends on where the veteran lives, and VA adjusts the stipend going forward when OPM updates that locality rate. Your VA caregiver support team can tell you the current figure for your area.4
• Veteran-Directed Care (VDC): the veteran is given a budget for services that is managed by the veteran or the veteran's representative. It is open to enrolled veterans who are eligible for community care, meet the clinical criteria for the service, and live where it is available.5
• Aid and Attendance pension: a veteran or surviving spouse who meets VA's pension requirements, including a net worth limit of $163,699, and qualifies for Aid and Attendance can receive a higher VA pension, capped at a Maximum Annual Pension Rate (MAPR): up to $29,093 a year for a veteran with no dependents, for December 1, 2025 through November 30, 2026. That figure is a ceiling, not a flat payment: VA bases the payment on the difference between the recipient's income for VA purposes and the MAPR, so the more countable income, the smaller the pension.6

The VA Caregiver Support Line (listed under Where to Get Help below) can connect you directly to your local VA Caregiver Support Program team.9

3. Private Personal Care Agreement

If the family has private assets, a written personal care agreement (also called a personal services or caregiver contract) lets you pay a relative for care now. Three details do the real work. It should be signed before care begins, because a Medicaid caseworker later needs to see that the payments were compensation for actual care, not a retroactive gift. It should pay a fair-market rate, because paying far above the going rate for home care can be treated as a disguised transfer of assets. And it should document the hours and tasks, so there is a record of what was provided. All of this matters because, when it determines long-term-care eligibility, Medicaid looks back 60 months (five years) from the date of the Medicaid application at assets transferred for less than fair market value; informal payments to a relative without a written agreement risk being counted that way and triggering a penalty period. The penalty is not a denial of Medicaid: for the penalty months, Medicaid will not pay for nursing facility care, an equivalent level of institutional care, or home and community-based waiver services. California is an exception, with a 30-month Medi-Cal look-back that counts only transfers made on or after January 1, 2026.10 An elder-law attorney can draft the agreement so it holds up.

4. What Does Not Pay a Family Caregiver

• Original Medicare does not pay family caregivers. Its home health benefit pays a Medicare-certified home health agency, never a relative, and only when the patient is homebound, needs part-time or intermittent skilled services, and has care ordered by a doctor or other provider who saw them in person. While a skilled service continues, it can also cover an agency aide's help with bathing, walking or feeding. Hospice covers personal care for a terminally ill patient and respite for the family caregiver, but it does not pay a relative a wage either.7
• The National Family Caregiver Support Program (NFCSP) is genuinely valuable, but it funds information, help getting services, counseling, support groups, caregiver training, respite care, and limited supplemental services through Area Agencies on Aging, not a wage to the caregiver. For a family caregiver of an older person, respite and supplemental services require that the older person be frail: unable to perform at least two activities of daily living without substantial help, or, because of a cognitive or other mental impairment, needing substantial supervision because they behave in a way that poses a serious health or safety hazard to themselves or someone else.2

How to Get Paid as a Family Caregiver Through Medicaid: Step by Step

Because self-direction runs through your state, the first move is always the same: find out whether the person you care for qualifies and whether your state's program lets you be the paid worker. These four steps get you to an answer, usually over a few weeks rather than a single call.3

Taxes for Paid Family Caregivers

If you live in the same home as the person you care for and are paid through a Medicaid waiver program, your wages may be excluded from federal gross income as "qualified Medicaid waiver payments" under IRS Notice 2014-7.12 That exclusion does not reach payments the person you care for makes from their own private funds. If you are paid through a Medicaid program that is not a waiver, Notice 2014-7 does not settle the question either way: the IRS says the answer depends on the nature of the payments and the purpose and design of the program, so confirm your program's treatment with a tax professional or the program administrator before reporting the pay as taxable income.12 VA has separately described the PCAFC stipend as a nontaxable benefit. State income tax treatment varies. Talk to a tax preparer familiar with Medicaid waiver caregiver compensation before filing.

Where to Get Help

If you are not sure where to begin, these free, government-run services can point you to the right program and to help in your area.

Learn More

Find personalized help getting paid as a family caregiver 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.