About 63 million Americans are family caregivers for an aging or disabled relative, and half say it has hurt them financially. Most do not know they can get paid for that care.

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 (roughly 45 percent) since 2015. Forty-four percent provide high-intensity care. Nearly half report at least one major negative financial impact, and 23 percent report being in debt because of caregiving.

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. 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, who can often be a family member. A financial management agency handles payroll and taxes.

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 a veteran with a VA disability rating of 70 percent or higher who needs personal care for at least six continuous months and is enrolled in VA health care. It is federal tax-free and can pay a spouse. 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 four figures set in 38 CFR 71.40(c)(4)(i). Which figure 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. In a mid-range locality like Houston, Texas, the 2026 GS-4, Step 1 annual salary of $41,989 gives a monthly stipend rate of about $3,499. At 0.625 the stipend is roughly $2,187 a month, at 1.00 it is about $3,499 a month, and at 0.25 it is about $875 a month.
  • Veteran-Directed Care (VDC): the veteran receives a flexible budget, managed by the veteran or their representative, to arrange and pay for their own services.
  • Aid and Attendance pension: a wartime veteran or surviving spouse who meets the functional and net-worth criteria can qualify for a VA pension increased by Aid and Attendance, capped at a Maximum Annual Pension Rate (MAPR) VA sets each year, up to $29,093 a year for a single veteran with no dependents in 2026. That figure is a ceiling, not a flat payment: VA pays the difference between the recipient's countable income and the MAPR, so it works out to roughly $2,424 a month only at the maximum, and a family caregiver is paid from what's left.

A county Veterans Service Officer helps file these at no cost, and the VA Caregiver Support Line (listed under Where to Get Help below) answers questions about all three.

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 Medicaid applies a 60-month (five-year) look-back to asset transfers when it determines long-term-care eligibility; informal payments to a relative without a written agreement can be reclassified as gifts and trigger a penalty period during which Medicaid will not pay for care. An elder-law attorney can draft the agreement so it holds up.

4. What Does Not Pay a Family Caregiver

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.

1
Step 1

Confirm Medicaid eligibility

Check whether the person you care for already has Medicaid or could qualify. Self-direction is a Medicaid benefit, so this comes first. Most programs also require a nursing-facility level of care, which the state assesses separately.

2
Step 2

Ask about the self-directed option

Call your state Medicaid agency or your local Area Agency on Aging (reach one through the Eldercare Locator at 1-800-677-1116) and ask specifically about "self-directed" or "consumer-directed" personal care, and whether a family member (or a spouse) can be the paid caregiver.

3
Step 3

Request a level-of-care assessment

The state or its managed-care plan sends someone to evaluate how much help the person needs. This determines eligibility for the waiver or state-plan benefit and sets the number of paid care hours.

4
Step 4

Enroll and start payroll

Once approved, you are hired through the program's financial management agency, which handles the payroll, taxes, and timesheets. From there you are paid for the care you provide.

Find Your State's Guide

Paid family caregiving is governed state by state. Pick your state for the exact programs, who can be paid, the pay rates, and how to apply.

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All 50 states

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. The VA PCAFC stipend is separately federal tax-free. State income tax treatment varies. Talk to a tax preparer familiar with Medicaid waiver caregiver compensation before filing.

Not sure which pathway fits your family? Chat with Brevy's care navigator for a personalized comparison based on your state, your loved one's Medicaid eligibility and veteran status, and whether you are a spouse or non-spouse caregiver.

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.

Eldercare Locator A free, nationwide service of the federal Administration for Community Living that connects you to services in your community, including your local Area Agency on Aging, in-home help, and transportation. The Area Agency on Aging is where NFCSP respite and caregiver support are delivered. 1-800-677-1116 (Mon–Fri, 8 a.m.–9 p.m. ET) eldercare.acl.gov
VA Caregiver Support Line The VA's national line for family caregivers of veterans. It answers questions about PCAFC, Veteran-Directed Care, and Aid and Attendance, and makes referrals. 1-855-260-3274 (Mon–Fri, 8 a.m.–8 p.m. ET)
Your State Medicaid Agency Where you apply for Medicaid and ask about the self-directed personal care option that lets a family member be paid. medicaid.gov contact page

Frequently Asked Questions

Can I get paid to take care of my parent?

Often, yes. Most state Medicaid programs offer a self-directed option in which your parent can hire you as their paid personal care worker, provided they qualify for Medicaid and meet the care criteria. If your parent is a veteran, the VA programs may pay even more. See your state's guide above for the specifics.

Can I get paid to care for my spouse?

It depends on your state and whether your spouse is a veteran. Some state Medicaid programs allow paid spousal caregiving (such as Colorado, Wisconsin, Oregon, New Mexico, and Alabama); many do not. The VA's PCAFC stipend and Veteran-Directed Care do pay spouses if your loved one is an eligible veteran.

Does Medicare pay family caregivers?

No. Medicare does not pay family caregivers. It covers short-term skilled home health through certified agencies only. Paid family caregiving runs through Medicaid and the VA.

What is the National Family Caregiver Support Program?

The NFCSP is a federally funded program (Older Americans Act, Title III-E) that provides respite, caregiver training, counseling, and supplemental services through Area Agencies on Aging, with no income test for respite. It does not pay a caregiver a wage, but it is one of the most underused sources of free respite in the country.

How much do paid family caregivers earn?

It varies widely by state and program. Medicaid self-directed pay is typically an hourly wage at or above the state's home-care base wage; some states pay a live-in caregiver a daily stipend instead. The VA PCAFC stipend works differently: it is the OPM GS-4, Step 1 annual rate for the veteran's locality divided by 12, then multiplied by 0.625, 1.00, or 0.25. Which multiplier applies depends on whether the veteran is in the current program or is a legacy participant or applicant, and then on either a self-sustain determination or the sum of the veteran's 2019 clinical ratings. See the VA section above for the full schedule. Your state's guide has the current figures.

What if none of these programs apply to me?

If the person you care for is not on Medicaid and is not a veteran, and private pay is not realistic, you still have options. Call the Eldercare Locator at 1-800-677-1116 (or visit eldercare.acl.gov) to reach your local Area Agency on Aging, which can tell you about respite, caregiver support, and any state-funded (non-Medicaid) caregiver programs that some states run as a bridge. It is also worth rechecking Medicaid eligibility, since spending down on care costs can bring a household under the limits over time.

Learn More

CaregiverSigns Your Aging Parent Needs Help: What to Watch ForHow to tell when an aging parent needs help: warning signs in daily tasks, personal care, safety, medications, and memory, plus what to do and where to start. CaregiverGetting Started as a Family Caregiver: A First-Steps GuideNew to caregiving? A first-steps guide with a week-one checklist, caregiver tasks, how to share the load, the legal documents you need, and where to find help. CaregiverHow to Find and Hire In-Home Care for an Aging ParentHow to hire in-home care for an older adult: home care agency vs hiring directly, what to screen for, and the household-employer tax rules most families miss. CaregiverLong-Distance Caregiving: A Practical GuideHow to care for an aging parent from a distance: what you can do from afar, the family meeting to have first, staying connected, and finding local help. CaregiverFMLA for Family Caregivers: Your Right to Job-Protected LeaveHow the Family and Medical Leave Act lets you take job-protected leave to care for a parent or spouse: who qualifies, what it covers, and the unpaid catch. CaregiverCaregiver Programs by State: The 50-State DirectoryA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverRespite Care for Family Caregivers: The 50-State GuideWhat respite care is and how to pay for it in 2026: the main types, free NFCSP grants, Medicaid and VA respite, and a link to every state guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house. VA BenefitsHow VA Benefits and Medicaid Work TogetherHow VA benefits and Medicaid work together for long-term care in 2026: the $90 nursing-home pension cap, how each counts income, and why state rules matter.

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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.