About 63 million Americans care for an aging or disabled family member, and half say it has hurt them financially. You may be able to get paid for that care.

How you get paid 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 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 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, up 45 to 50 percent since 2015. Over 40 percent provide high-intensity care. Half report a negative financial impact, and about a quarter have taken on caregiving-related debt.

The toll is not only financial. Around 64 percent of family caregivers report high emotional stress and 45 percent high physical strain; one in five say their own health has declined because of caregiving, with dementia caregivers and live-in spousal caregivers at 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.

What varies by state:

  • Who can be paid. Some states let a spouse be paid (for example, Colorado, Wisconsin, Oregon's Spousal Pay Program, New Mexico's Mi Via, and Alabama's Personal Choices). Many states bar a spouse but allow adult children and other relatives. A few states 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 service-connected disability rating of 70 percent or higher who needs personal care for at least six continuous months. The stipend is calculated from the federal GS-4, Step 1 rate for the veteran's locality. It is federal tax-free and can pay a spouse.
  • Veteran-Directed Care (VDC): the veteran receives a flexible monthly budget and hires their own caregivers, including a spouse, at a self-set rate.
  • Aid and Attendance pension: a wartime veteran or surviving spouse who meets the functional and net-worth criteria can receive up to ,424 per month (single veteran, 2026), from which a family caregiver is paid.

A county Veterans Service Officer helps file these at no cost. Call the VA Caregiver Support Line at 1-855-260-3274.

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. The agreement must be signed before care begins, pay a fair-market rate, and document the hours and tasks. This matters because every state applies a Medicaid look-back period (usually 60 months); informal payments to a relative without a written agreement can be treated as gifts and create a penalty period later. Work with an elder-law attorney to draft it.

4. What Does Not Pay a Family Caregiver

  • Medicare does not pay family caregivers. It covers short-term skilled home health through certified agencies only.
  • The National Family Caregiver Support Program (NFCSP) is genuinely valuable, but it funds respite, training, counseling, and supplemental services through Area Agencies on Aging, not a wage to the caregiver. There is no income test for its respite services.

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.

Taxes for Paid Family Caregivers

If you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excluded from federal gross income 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.

Frequently Asked Questions

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.

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.

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.

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.

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 is based on the federal GS-4 rate for the veteran's locality. Your state's guide has the current figures.

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.

BC

Brevy Care Team

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