How to Get Paid as a Family Caregiver in Illinois

Illinois paid family caregiver programs treat spouses differently depending on the care recipient's age. If your loved one is 60 or older and enrolled in the Community Care Program, the In-Home Service providers that participate in the program may choose to hire a family member, including a spouse, as a home care aide.1

The program for younger adults is not settled on spouses. Under the Home Services Program for people with disabilities under 60, the customer hires their own Personal Assistant.2 Its current waiver lets a spouse be paid only for extraordinary care, but 89 Ill. Adm. Code 684.30 still bars paying a spouse, and neither source is shown to govern.3

This guide lays out every legitimate way to be paid as a family caregiver in Illinois for 2026: who can be hired under each program, how the money actually reaches you, and how to pick the route that fits your family.

The Short Version

If your loved one is 60 or older and might otherwise need nursing-home care, the route open to almost any relative, including a spouse, is the Community Care Program's In-Home Service. Eligibility rests on age, residency, citizenship, an asset limit, Medicaid enrollment if eligible, and an assessed need measured by the Determination of Need assessment; Care Coordination Units coordinate the services.4 An In-Home Service provider may choose to hire you as the home care aide, though not all providers employ family members. The CCP rules define a spouse hired this way as delivering "extraordinary care," as documented by the Care Coordination Unit.1

If your loved one is under 60 and has a severe disability, the Home Services Program lets them hire their own Personal Assistant.2 The HSP rule's list of people who cannot be paid does not name an adult child. For a spouse, the current waiver (extraordinary care only) and the rule (no) disagree, so ask the DRS rehabilitation counselor before counting on pay.3

If your loved one is a veteran, check the VA programs first. The VA caregiver stipend can be paid to a spouse who is the designated Primary Family Caregiver.6

If your family has enough private assets, a private personal services contract is another option. Illinois applies a 60-month Medicaid look-back to nursing-home residents, supportive living facility residents, and people applying for or receiving Department on Aging waiver services, and federal law excuses a transfer only in limited cases, such as a satisfactory showing to the state that the person intended to dispose of the assets at fair market value or for other valuable consideration, so talk to an elder-law attorney before any money changes hands.8

The rest of this guide walks through each pathway in detail.

What Makes Illinois Different: Two Programs Split by Age 60

Illinois does not run one paid-caregiver program. It runs two, divided by the care recipient's age, and the rules for hiring family differ sharply between them.

The Community Care Program, administered by the Illinois Department on Aging (IDoA), serves residents age 60 and older who might otherwise need nursing-home care. It was established in 1979, and applicants must apply for and, if eligible, enroll in Medicaid. Separately, CMS records Illinois's Medicaid waiver for persons who are elderly (the Elderly Waiver) as serving people 65 or older and people ages 60 to 64 with physical disabilities who meet a nursing facility level of care, a narrower group than CCP's own list, so your Care Coordination Unit settles which side applies to you.4

The Home Services Program, administered by the Illinois Department of Human Services, Division of Rehabilitation Services (DHS-DRS), serves people with severe disabilities who are under age 60 and need help with daily living activities in their homes.5 DHS says many are at risk of moving into a nursing home, but does not list that risk as an eligibility condition. HSP customers select, employ, and supervise their own Personal Assistant.2

The split matters for one reason above all: Community Care Program providers may hire a spouse, while the Home Services Program's own official sources disagree on whether it can pay one. That single difference, tied entirely to whether your loved one is 60, decides which door your family walks through.

The Illinois Paid Family Caregiver Pathways

1. Community Care Program In-Home Service: The Spouse-Eligible Route

Who pays: The Community Care Program, administered by the Illinois Department on Aging, with services coordinated by Care Coordination Units.4 The In-Home Service provider that hires you as a home care aide also supervises your work.1

Who can be paid: Here is the Illinois difference. In-Home Service providers participating in CCP may choose to hire any family member, including a spouse, as well as a Power of Attorney, representative payee, legal guardian, friend, or neighbor, to work as a CCP customer's home care aide. The person must meet qualifications, pass a background check, complete 24 hours of pre-service training, and agree to be supervised by the provider.1

When the aide is a spouse: The Department on Aging's CCP rules (89 Ill. Adm. Code 240.160) define a Legally Responsible Individual as someone with a legal duty to provide care, including the participant's spouse, power of attorney, or representational payee, who is hired by a CCP in-home service provider to deliver "extraordinary care." Extraordinary care means care that exceeds what would ordinarily be provided to a person of the same age without a disability or chronic condition and is necessary for the participant's health and welfare and to avoid institutionalization, as documented by the Care Coordination Unit. It also covers cases where the Care Coordination Unit documents that no other qualified homecare aides are available, or that the spouse has a unique ability to meet the participant's needs and the spouse's services are in the participant's best interest. Ask your Care Coordination Unit how it will document this for your family.1

The catch to plan around: Not all In-Home Service providers employ family members as home care aides. Hiring a family member is at the provider's option, so do not assume the spouse route is open. Your Care Coordination Unit will discuss options with you, and you are free to change your mind at any time.1

What it is: CCP helps older adults who might otherwise need nursing-home care remain in their homes. IDoA lists its services as care coordination, adult day services, in-home services, emergency home response, and an automated medication dispenser.4

Eligibility, recipient: The applicant must be age 60 or older, an Illinois resident, a U.S. citizen or eligible non-citizen, have non-exempt assets of $17,500 or less (the home, car, and personal furnishings are exempt), and have an assessed need for long-term care, meaning a risk of nursing-facility placement as measured by the Determination of Need (DON) assessment. IDoA's program page does not give a DON threshold, but the CCP rule does: under 89 Ill. Adm. Code 240.727, a participant needs a minimum score of 29 points on the DON, 15 of which must be scored on Total Impairment (Part A and the MMSE). Applicants must also apply for and, if eligible, enroll in Medicaid. Confirm the asset limit and your loved one's DON score with your Care Coordination Unit.4

Eligibility, caregiver: Meet qualifications, pass a background check, complete 24 hours of pre-service training, and agree to be supervised by the provider.1

How you get paid: You work for the In-Home Service provider that hires you, under its supervision, so ask the provider about your pay.1

Best for: A relative, including a spouse, caring for someone 60 or older who qualifies for CCP and needs help at home.

2. Home Services Program: Personal Assistants for Adults Under 60

Who pays: The Home Services Program, administered by DHS Division of Rehabilitation Services, with Personal Assistants paid directly by the State of Illinois.2,5

Who can be paid: The customer selects, employs, and supervises their own Personal Assistant.2 But 89 Ill. Adm. Code 684.30 lists who "shall not be paid through HSP to be a Customer's service provider." First on the list are the customer's legally responsible family members. 89 Ill. Adm. Code 676.30 defines a legally responsible family member as a spouse, a parent of a child under 18, or a legal guardian of an individual under 18. 684.30 also bars the customer's minor child, the customer's foster parents if the customer is under 18, and the customer's stepparents if the customer is a minor child. Its list does not name an adult child, though the cited sources do not say in so many words that an adult child can be paid. A COVID-19 exception let those individuals be paid during the Gubernatorial Disaster Proclamations, subject to federal approval; the cited sources do not show those proclamations in force today.3

The spouse question is unsettled. HFS posts the Persons with Disabilities 1915(c) waiver renewal, effective July 1, 2026, as its current active waiver. It lets a spouse furnish personal care through individual provider services only when the care meets the definition of extraordinary care: care beyond what a spouse would ordinarily do in the household for someone without a disability or chronic illness, and necessary to ensure the customer's health and welfare and avoid institutionalization. Before a spouse provides service, the HSP Rehabilitation Counselor or the MCO's Care Coordinator must document that there are no other viable provider alternatives, and the person-centered plan sets the extraordinary-care tasks and allowable hours per task. 684.30 still bars paying a spouse, and neither source is shown to govern, so ask your DRS rehabilitation counselor which rule applies before counting on spousal pay.3

What it is: HSP serves people with severe disabilities under 60 who need help with daily living activities in their homes.5 It provides services so they can remain in their homes and be as independent as possible. The customer develops a service plan jointly with a DRS rehabilitation counselor, then selects, employs, and supervises their Personal Assistant, who helps with household tasks, personal care, and, with a physician's approval, certain health-care procedures. Customers age 60 and older are served by the Department on Aging instead.2

How you get paid: The customer selects, employs, and supervises you, but the State runs the payroll. Personal Assistants are Individual Providers, their wages are set by HSP's collective bargaining agreement with SEIU, and they are paid on the published HSP Individual Provider Payroll Schedule: the Illinois Office of the Comptroller issues the payment, you submit your tax-withholding forms to DHS Payroll, and your W-2 is mailed to your address on file. The IDHS HSP Rates & Fees table lists the Personal Assistant service at $20.00 per hour as of its July 1, 2026 update, up from $19.50 on January 1, 2026, and the bargained schedule raises it to $20.75 per hour on January 1, 2027. A seniority add-on pays an extra $1.00 per hour at 10,000 career hours, $2.00 at 20,000, and $4.00 at 30,000; career hours are every hour you have worked and been paid for by HSP as an Individual Provider. Because the bargained scale steps up on set dates, confirm the current wage with DRS when you apply rather than relying on a figure you read secondhand.5

Best for: A relative not on 684.30's list of people who cannot be paid, such as an adult child (confirm with DRS), caring for someone under 60 with a severe disability who qualifies for HSP.

3. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, which can be a spouse, adult child, parent, or other family member.6

2026 stipend: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12. That monthly base is then multiplied by a factor, and which factor applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant.6

• Current program (the veteran meets 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if VA determines the veteran is unable to self-sustain in the community.6
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor is set instead by the sum of the veteran's 2019 clinical ratings, with no self-sustain determination 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. This legacy schedule runs for eight years from October 1, 2020, so it lapses October 1, 2028.6

If the veteran meets both sets of criteria, the caregiver is paid whichever of the two amounts is higher. A legacy participant's stipend also cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, for as long as the veteran remains at the address VA has on record. Because the base rate keys to the veteran's locality, the stipend differs between the Chicago locality and the Rest of U.S. locality that covers much of downstate Illinois. Confirm your exact stipend with your VA Caregiver Support Coordinator.6

Veteran eligibility: VA lists four conditions that must all be true, and they are a first screen rather than the decision:6

• A VA disability rating, individual or combined, of 70 percent or higher.6
• Discharge from the U.S. military, or a date of medical discharge.6
• A need for at least six months of continuous, in-person personal care services.6
• Enrollment in VA health care.6

The veteran and caregiver then apply together and take part in an application process that determines whether they are eligible.6

Why it stands out: VA treats the stipend as a non-taxable benefit.9 It allows paid spouses, and the Primary Family Caregiver also gets CHAMPVA health coverage (if otherwise uninsured), mental health counseling, and at least 30 days of respite care per year.6

Best for: Families of an eligible veteran where one person provides substantial daily care.

4. VA Veteran-Directed Care (VDC)

What it is: The Veterans Health Administration began using the Aging and Disability Resource Center (ADRC) initiative to deliver the Veteran-Directed Home and Community Based Services program, giving veterans the opportunity to self-direct their long-term services and supports.7

Who can be paid: Confirm with the VA medical center serving the veteran who can be hired, including whether a spouse can be paid, before counting on it.

Eligibility: All enrolled veterans are eligible for Veteran-Directed Care if they are eligible for community care, meet the clinical criteria for the service, and it is available.7

Availability in Illinois: Because eligibility depends on the service being available, ask at the VA medical center where the veteran gets care whether VDC is offered there.

Best for: An Illinois veteran who wants to self-direct their home care, where the veteran's VA medical center offers VDC.

5. VA Aid and Attendance Pension

Who is paid: VA pension is a benefit for the veteran or surviving spouse, with rates set for each.10

2026 maximums (effective December 1, 2025 through November 30, 2026): VA publishes these as annual Maximum Annual Pension Rates (MAPR), a ceiling, not a flat payout. VA pays the MAPR less the claimant's countable income, and the monthly payment is that remainder divided by 12, rounded down to the whole dollar. A single veteran with Aid and Attendance has a MAPR of $29,093 per year; a veteran with one dependent, $34,488; two veterans married to each other who both qualify for Aid and Attendance, $46,143 combined. A surviving spouse with Aid and Attendance has a MAPR of $18,697 per year. Countable income is not gross income: unreimbursed medical expenses above 5% of the MAPR can be deducted. The net worth limit is $163,699. Confirm current figures on the VA pension rate page before applying.10

Eligibility: The veteran or surviving spouse must qualify for Aid and Attendance and have countable income and net worth under the limits; VA sets its other pension requirements, so confirm them with an accredited Veterans Service Officer. VA pension carries its own 36-month look-back on asset transfers, separate from the Medicaid look-back.10

How caregivers get paid: If the family uses the pension toward a relative's care, put the arrangement in a written caregiver agreement. Illinois county Veterans Assistance Commissions and accredited Veterans Service Officers help file at no cost; avoid for-profit pension consultants who charge a fee.

Best for: A veteran or surviving spouse with income and assets under the limit who needs help with daily activities.

6. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income on their taxes.

How the Medicaid look-back applies: Illinois applies a 60-month Medicaid look-back, measured from the request for the state to pay for long-term-care services. Its transfer rules reach nursing-home residents, supportive living facility residents, and people applying for or receiving Department on Aging waiver services, not other people living in the community. Some transfers affect eligibility and some do not, depending on when the transfer happened, its type, and its reason. Federal law excuses a transfer if a satisfactory showing is made to the state that the person intended to dispose of the assets at fair market value or for other valuable consideration, that the transfer was made exclusively for a purpose other than qualifying for Medicaid, or that all the assets have been returned. Where a transfer does count, the penalty period is the uncompensated value divided by the average monthly private-pay cost of nursing facility care in the state at the time of application, so get the current Illinois figure from the state or an Illinois elder-law attorney.8

Best for: Families with enough assets to private-pay a caregiver who also want to preserve eligibility for future Medicaid planning. Work with an Illinois elder-law attorney to draft the contract.

Comparing the Illinois Paid Family Caregiver Pathways

How to Choose an Illinois Pathway

Start with two questions: how old is the care recipient, and is your loved one a veteran? Then work through the steps below in order.

Where to Get Help in Illinois

Each pathway has one place to start. These are the intake lines that connect you to the right office; ask them about current wait times and next steps when you call.

Tax Considerations

Most Illinois caregiver pay is reportable income, but two federal rules, covered below, can change that.

• CCP In-Home Service aides work for the provider that hires them; ask it how your pay is reported.
• HSP Personal Assistants receive W-2 wages from the State payroll.
• VA PCAFC is a stipend VA treats as a non-taxable benefit.9
• VA Aid and Attendance is a pension for the veteran or surviving spouse; ask a tax preparer how any pay you receive from them is reported.
• Personal services contracts pay W-2 or 1099 income depending on how the caregiver is classified.

IRS Notice 2014-7: Certain payments for personal care under a state Medicaid section 1915(c) home and community-based services waiver can be excluded from the caregiver's federal gross income, but only when the care is given in the caregiver's own home and the care recipient lives there too. A caregiver who keeps a separate home does not qualify. The exclusion covers federal gross income only; Social Security and Medicare taxes depend on how the caregiver is employed.11 For a Medicaid program that is not a 1915(c) waiver, the exclusion is not automatic: the IRS says it depends on the nature of the payments and the purpose and design of the program. Ask a tax professional whether your CCP or HSP pay qualifies before filing.11

Illinois state income tax: The Illinois Department of Revenue lists the individual income tax as a single rate of 4.95% of net income, with no bracket schedule, and requires 4.95% to be withheld from employee compensation, so caregiver wages on a payroll have Illinois tax withheld at that rate. Whether a payment excluded from federal income under Notice 2014-7 also leaves Illinois net income is a separate question the rate table does not answer, so ask your tax preparer. Verify the current rate at tax.illinois.gov.12

Common Misconceptions

"My spouse and I are both retired, so I can finally be paid to care for him." In Illinois you may be able to, through the Community Care Program, if he is 60 or older and enrolled:4 its In-Home Service providers may choose to hire a spouse as a home care aide, though not all employ family members. The CCP rules define a hired spouse's work as "extraordinary care," as documented by the Care Coordination Unit. For younger adults in the Home Services Program, the current waiver allows spousal pay only for extraordinary care while the HSP rule still bars it, so ask DRS.1,3

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. Paid family caregiving in Illinois comes through the Community Care Program, the Home Services Program, the VA, or a private contract.

"The Home Services Program pays me out of my relative's account." No. The State runs the HSP payroll: Personal Assistants are paid on the published HSP Individual Provider Payroll Schedule, and the Illinois Office of the Comptroller issues the payment.5

"I can just start getting paid out of Dad's bank account." Not without planning first. If Dad later needs Medicaid long-term care, Illinois looks back 60 months at transfers, and a payment the family cannot show was for fair market value can count against his eligibility.8

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs like Illinois's Home Services Program, where the care recipient hires and supervises their own worker.
• HCBS waiver: The federal Medicaid authority behind Illinois's Elderly Waiver, which CMS records as serving people 65 or older and people 60 to 64 with physical disabilities who meet a nursing facility level of care.
• Activities of Daily Living (ADLs): The functional basis for authorizing personal care across Illinois's programs.
• Nursing Facility Level of Care: The clinical threshold Illinois's Elderly Waiver uses to define who it serves.

Learn More

Find personalized help getting paid as a family caregiver in Illinois 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.