How to Get Paid to Care for Your Spouse in Indiana

If you have called Indiana Medicaid to ask whether you can get paid to care for your spouse in Indiana, you may have already heard the word no. That answer is common, and it is only half true. Under Indiana's self-directed attendant care benefit, a husband or wife is a "legally responsible individual" who cannot be paid.1 But Indiana runs a separate Medicaid program, Structured Family Caregiving, that was built for exactly this situation and explicitly allows a spouse to be the paid live-in caregiver.2 This guide walks through where the yes lives, where the no comes from, and the VA routes that pay a spouse in every state.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Indiana?
• The Medicaid Route: Structured Family Caregiving
• When Indiana Says No: the Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Get Paid to Care for Your Spouse in Indiana Through Aid and Attendance
• How to Apply and Who to Call in Indiana
• Frequently Asked Questions
• Learn More

Can You Get Paid to Care for Your Spouse in Indiana?

The short answer: yes, but only through the programs designed to include spouses. The route matters more than almost anything else, because Indiana runs two different Medicaid pathways for paid family caregiving and they treat spouses in opposite ways.

Structured Family Caregiving (SFC) is the yes. Structured Family Caregiving pays a live-in caregiver a tax-free daily stipend through a contracted provider agency, and Indiana is one of a small number of states that explicitly allow a spouse who shares the home to be that paid caregiver.2,6

Self-directed Attendant Care (ATTC) is the no. Attendant Care is an hourly service the care recipient can direct themselves, and beginning in July 2024 a spouse may not provide it in either form.1 If a caseworker told you a spouse cannot be paid, they were almost certainly describing this benefit, not SFC.

If your husband or wife is a veteran, a third door opens that has nothing to do with Indiana Medicaid: VA programs pay spouses directly, and they can run alongside SFC. We cover those below.

This article is the spouse-specific companion to our broader guide on how to get paid as a family caregiver in Indiana, which covers adult children and other relatives. Here the focus stays on the husband-and-wife case, because that is where the rules pinch hardest.

The Medicaid Route: Structured Family Caregiving

Structured Family Caregiving is a Medicaid home- and community-based service. Instead of paying an outside agency to send an aide, it pays a family member or friend who lives full-time with the care recipient to provide the daily care themselves.6

Here is what makes it the right route for a spouse:

• A spouse is eligible. According to Indiana's Family and Social Services Administration (FSSA), a spouse who lives in the same home may be the paid SFC caregiver. A Power of Attorney or Attorney-in-Fact who lives with the recipient may also serve.2
• You must live together. SFC is a live-in model by design. The caregiver and the care recipient share one residence full-time, which most spouses already do.7
• It pays a daily stipend, not an hourly wage. SFC is paid as a tax-free daily amount set by the care recipient's assessed level of care, delivered through a contracted provider agency rather than as hourly payroll.6 The provider agency must pass a state-set minimum share of the Medicaid payment through to the caregiver; ask the agency you choose for the current daily figure before planning around a number.8
• You pass a background check and get support. The caregiver clears a criminal background check and is supported by a care coach or coordinator and a nurse, with training tailored to the care recipient's needs.2,6

SFC is available under the PathWays for Aging waiver (for Hoosiers age 60 and older on Medicaid, launched July 2024) and the Health and Wellness waiver (for adults under 60).7 The care recipient must be enrolled in Indiana Medicaid and qualify for the applicable waiver first; the paid-caregiver arrangement is set up through the person-centered service plan. To confirm the current eligibility standards and the daily-stipend amounts for your situation, work with the assigned Managed Care Entity or contact FSSA directly.

When Indiana Says No: the Legally Responsible Relative Rule

If you were told a spouse cannot be paid, you were not misinformed. You were hearing a real and specific rule, and understanding it is how you avoid being turned away twice.

Federal Medicaid law treats a spouse as a legally responsible relative: a person who, under state law, has a duty to care for another. Under the Medicaid state-plan personal care benefit, care must be provided by someone "who is not a member of the individual's family," and for that benefit a family member means a legally responsible relative, which includes a spouse.3 That is the default across the country, and it is why so many spouses are told no while other relatives qualify.

Federal law does leave each state a choice here. Under the section 1915(j) self-directed personal assistance option, a state may choose to let participants hire legally liable relatives, including a spouse, as paid providers. That is a state option, not a feature of self-direction everywhere, so the answer always turns on the state's own program rules.9 Indiana's rules are explicit: a legally responsible relative, defined to include a spouse and the parent of a minor, is precluded from being paid for self-directed (participant-directed) attendant care.1 Since July 1, 2024, a spouse can no longer begin a new ATTC arrangement at all.1

So the "no" is narrow. It applies to self-directed and state-plan attendant care, where a spouse is a legally responsible individual. It does not extend to Structured Family Caregiving, which Indiana deliberately built to include spouses. When you call, name the program: ask about Structured Family Caregiving, not attendant care.

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, you have options that do not depend on Indiana Medicaid at all, and both of the main ones pay a spouse.

Program of Comprehensive Assistance for Family Caregivers (PCAFC). This VA program pays an eligible veteran's approved Primary Family Caregiver a tax-free monthly stipend, and a spouse can serve as that caregiver. VA's first screen has four requirements for the veteran, and all four must be true: a VA disability rating (individual or combined) of 70 percent or higher, a 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 services, and enrollment in VA health care.4 Meeting those four is necessary but not the whole test. You and the veteran apply together, and the governing regulation, 38 CFR 71.20(a), adds conditions VA assesses during the application: that taking part is in the veteran's best interest, that the same personal care is not already being provided simultaneously and regularly by another person or entity, that the veteran receives care at home, and that the veteran receives ongoing care from a primary care team (or will, once a Family Caregiver is designated).4 Approval alone does not start the money: VA pays the monthly stipend only after the caregiver enrolls in direct deposit through the VA customer engagement portal.4 The stipend is not a flat national figure: it starts from the federal 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 set in 38 CFR 71.40(c)(4)(i), and which factor applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant.10

• Current program (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.10
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor comes instead from 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 lapses October 1, 2028.10

A veteran who meets both sets of criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend 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.10 Because the base is tied to locality, confirm the current amount for your area with a VA Caregiver Support Coordinator. PCAFC also brings caregiver training, mental-health counseling, at least 30 days of respite care a year, and CHAMPVA coverage if the caregiver is otherwise uninsured.4

Veteran-Directed Care (VDC). This gives a veteran at risk of nursing-home placement a flexible budget, managed by the veteran or their representative, to hire their own workers. VA describes those workers as possibly including "their own family member or neighbor," so ask the veteran's VA social worker directly whether a spouse may be hired under the budget.5

Start with the veteran's VA Medical Center, not with a provider agency. VDC is purchased by the VA and reached by VA referral, so an approved provider nearby does not by itself mean the program is open to you. Indiana does have approved providers: CICOA Aging and In-Home Solutions, the Area 8 Agency on Aging serving the Indianapolis region, has completed a VA Readiness Review and is listed as a qualified VDC provider, as a subcontractor under the Pennyrile Area Agency on Aging (a Kentucky agency, which holds the Veteran Care Agreement). What the federal listing says about Indiana is genuinely unsettled: ACL publishes that directory in two live editions, and they do not match. The older edition marks all three Indiana entries, Richard L. Roudebush VAMC in Indianapolis and both VA Northern Indiana Health Care System campuses in Fort Wayne and Marion, as not yet having referred a veteran to VDC. The newer edition adds a fourth Indiana entry, Jesse Brown VA Medical Center in Chicago, which serves northwest Indiana, and does not repeat that marking in a form we can read, so it neither confirms nor contradicts the older one. Treat the referral gateway as unconfirmed rather than closed: your VAMC may already refer veterans to VDC, and asking is the only way to find out.5 The VA's own conditions point the same way in policy terms: enrolled veterans are eligible for VDC "if they are eligible for community care, meet the clinical criteria for the service, and it is available," that "Services may vary by location," and that you should "talk with your VA social worker and find out if it is available in your location."5 The route is real, but the first call is to the veteran's VAMC, before you gather records or contact an agency.

VA caregiver benefits and Indiana Medicaid are separate programs run by different agencies, so a veteran's spouse may be able to receive VA support while the veteran is also enrolled in Indiana's SFC or PathWays services. One PCAFC condition bears directly on that: the personal care the Family Caregiver would provide must not already be provided simultaneously and regularly by another person or entity, so a household already receiving regular personal care through another program can fail PCAFC on that ground alone.4 The interaction can be complex, so talk to both the VA Caregiver Support Coordinator and the Medicaid case manager before layering programs.

Get Paid to Care for Your Spouse in Indiana Through Aid and Attendance

Aid and Attendance is a third VA route, and it works differently from a caregiver stipend. It is an increased monthly pension added to a qualifying veteran's or surviving spouse's VA pension when they need another person to help with daily activities such as bathing, feeding, and dressing.4 The money goes to the veteran or survivor, not directly to the caregiver, but a spouse providing that daily help can be paid out of it, ideally under a written care agreement.

For the rating year running December 1, 2025 through November 30, 2026, VA sets the Aid and Attendance maximum for a veteran with no dependents at $29,093 per year, and for a veteran with one dependent at $34,488 per year. A surviving spouse with Aid and Attendance may receive up to $18,697 per year. VA publishes these ceilings as annual amounts, and they are maximums, not flat payments: VA pays the difference between the veteran's or survivor's countable income and the ceiling, so someone with income receives less than the maximum. Divided into twelfths, the veteran-alone ceiling works out to about $2,424 a month for someone with no countable income.11 Eligibility requires that the veteran or survivor already qualify for a VA pension, meet the functional criteria, and fall under the 2026 net-worth limit of $163,699.11 Indiana's county Veterans Service Officers can help file these claims; connect through the Indiana Department of Veterans Affairs.

One tax note that matters for spouses: IRS Notice 2014-7 treats qualified Medicaid waiver payments to a caregiver who lives in the same home as the care recipient as difficulty-of-care payments excludable from federal gross income.12 That co-residence rule is a natural fit for a spouse paid through SFC, though you should confirm your specific treatment with a tax preparer.

How to Apply and Who to Call in Indiana

The Medicaid and VA routes start in different places. Here is where to begin for each.

Learn More

Find personalized help getting paid to care for your spouse in Indiana 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.