Kansas lets a family caregiver be paid for in-home care through the self-direction option in its KanCare HCBS waivers, where the person receiving care chooses and directs their own attendant.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Kansas pays a spouse only by exception. KDADS's Frail Elderly page says a spouse or appointed representative cannot be the paid attendant, but the approved Frail Elderly waiver lets Personal Care Services pay a spouse when the needs assessment finds extraordinary care is required. Enhanced Care Services bars a legally responsible person and anyone residing in the home, with narrow exceptions.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
The Short Version
If you are an adult child, sibling, or other relative, and your loved one qualifies for KanCare HCBS waiver services, becoming their self-directed attendant is the most direct route. They enroll in the Frail Elderly or Physical Disability waiver, choose the self-direction option, and hire you.
If you live with the person you care for, that by itself does not close self-directed Attendant Care to you: KDADS's Frail Elderly page names a spouse and an appointed representative, not a housemate. Where living in the home does matter is Enhanced Care Services, which cannot be provided by anyone residing with the participant except under narrow exceptions.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
If you are a spouse, Kansas pays you only by exception (see below), so raise it with the MCO before accepting a no.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS The VA programs (if your loved one is a veteran) and a private personal services contract are the other options.
If your loved one is a veteran, check the VA programs first. The PCAFC caregiver stipend can pay a spouse outright.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
What Makes Kansas Different: Self-Direction Through KanCare Waivers
Kansas delivers its paid in-home family caregiving through the self-direction option in its KanCare HCBS waivers, overseen by the Kansas Department for Aging and Disability Services (KDADS). When a waiver participant self-directs, they take on employer responsibilities: choosing, training, monitoring, and dismissing their own workers. A Financial Management Services agent then handles payroll and tax withholding behind the scenes.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
The waivers that matter most for older adults and people with physical disabilities are the Frail Elderly (FE) waiver, which covers Kansans age 65 and older at a nursing-facility level of care, and the Physical Disability (PD) waiver, which covers Kansans ages 16 to 64 with physical disabilities.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Where Kansas is strict is the spouse. KDADS's Frail Elderly page says the Attendant Care worker cannot be the participant's spouse or appointed representative, but the approved FE waiver lets Personal Care Services pay a spouse by exception (see the FAQ below). Living in the home is a separate question for a different service: Enhanced Care Services cannot be provided by a legally responsible person or anyone residing in the home, subject to the narrow exceptions below.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
How to Enroll in Kansas Self-Directed Attendant Care
If the non-veteran Medicaid route fits your family, here is the path from application to first paycheck. Ask the case manager what to expect at each step.
Confirm KanCare financial eligibility
The KanCare Clearinghouse decides Medicaid financial eligibility, and the asset limit for one person is $2,000.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS Kansas's 2026 long-term-care income standard is $2,982 a month for one person (300 percent of the SSI rate).Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026), with the attached 2026 standards chart. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf Above it, the Medically Needy program applies: the excess becomes a monthly client obligation, and HCBS coverage holds only if that obligation does not exceed the cost of HCBS services.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Request the functional eligibility assessment
The Frail Elderly waiver requires a nursing-facility level of care, set by an FE Functional Eligibility Assessment; the Aging and Disability Resource Center (ADRC) refers applicants for it.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Enroll in the waiver and choose self-direction
Once approved, enroll in the Frail Elderly waiver (age 65 and older) or the Physical Disability waiver (ages 16 to 64), and tell the case manager you want the self-direction option so the participant can hire and direct their own attendant.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Get the care plan and authorized hours
The services to be self-directed are determined by the participant together with their MCO care coordinator.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS The participant sets the worker's pay rate within the range the state establishes, and the FMS provider is expressly prohibited from setting wages or benefits, so ask the case manager what that range is and how many weekly hours are authorized.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Set up Financial Management Services
The participant is the sole employer of the direct service worker and keeps the common-law employer responsibility, so they obtain a Federal Employer Identification Number (FEIN) in their own name for tax filing. Kansas runs a Vendor Fiscal/Employer Agent model under IRS Section 3504, which makes the FMS provider the participant's agent, never the employer: it processes payroll, withholds and files federal, state, and local taxes, and submits the worker's background-check paperwork.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS The FMS provider bills the participant's KanCare managed care organization a per-member-per-month administrative fee, so Medicaid pays for FMS, not your family, and KDADS's FMS manual bars the provider from using any part of that fee to pay the participant's client obligation or the worker's wages, taxes, or withholding, and from using any portion of the worker-pay fund for its own administration.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Hire your caregiver and start
With FMS in place, the participant formally hires the family member, and the attendant begins logging paid hours. If that worker is the participant's spouse, get the MCO's authorization first.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
If there is a waitlist: HCBS depends on services being available, and Kansas policy provides for an HCBS waiting list.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS On the PD waiting list, KDADS says your number does not decide when an offer comes; offers follow the release of funds.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
The Kansas Paid Family Caregiver Pathways
1. Frail Elderly Waiver: Self-Directed Attendant Care
Who pays: KanCare (Kansas Medicaid), through the FE waiver managed by KDADS.
Who can be paid: A family member. KDADS's Frail Elderly page excludes the spouse and the person appointed to represent them (Acting on Behalf, activated durable power of attorney, or guardian/conservator), but the approved FE waiver allows a spouse by exception, as above, and a guardian or A-DPOA if the conflict of interest is mitigated.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
What it covers: One self-directable service: KDADS's FE page calls it Attendant Care Services, and the approved FE waiver calls it Level I Personal Care Services. What those services include is set by the participant together with their MCO care coordinator. KDADS's PCS policy, effective October 1, 2026, replaces the term Attendant Care Services with PCS.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Eligibility, recipient: Age 65 or older, nursing-facility level of care, KanCare financial eligibility.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
How you get paid: Through the FMS agent's payroll, with taxes withheld. The participant is the employer; you are the worker.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Best for: An adult child or other relative caring for an older Kansan on the FE waiver.
2. Physical Disability Waiver: Broader Self-Direction Options
Who pays: KanCare, through the PD waiver.
Who can be paid: For Personal Care Services, family members, plus a spouse by the same extraordinary-care exception. Enhanced Care Services is stricter rather than looser: it cannot be provided by a legally responsible person (a spouse, or the parent of a minor child) or by any individual residing in the home with the participant, except as below.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
What it covers: The PD waiver lets participants self-direct Personal Care Services (PCS), Enhanced Care Services (ECS), and Financial Management Services (FMS).Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Eligibility, recipient: Ages 16 to 64, a nursing-facility level of care, determined disabled by Social Security standards, and KanCare financial eligibility.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
The ECS exceptions: The KMAP provider manual allows exceptions under one or more of three conditions: the participant lives in a rural area where a provider is beyond a 50-mile radius of the residence and the relative is the only provider available to meet their needs; or the participant lives alone and has a severe cognitive impairment, physical disability, or intellectual disability; or the individual has exhausted other support options through the MCO and without ECS would be at significant risk of institutionalization. The approved PD waiver (effective July 1, 2026) is narrower: its exception reaches only a legally responsible person, when the participant lives alone with a severe cognitive impairment and/or physical disability or has exhausted other MCO support options and faces significant risk of institutionalization. It has no rural ground. Ask the MCO which test it applies. The KMAP manual also provides that a guardian or an individual authorized as an A-DPOA may be paid if the potential conflict of interest is mitigated.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Best for: A Kansan ages 16 to 64 with a physical disability who wants a relative paid for personal care under PCS.
3. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated Primary Family Caregiver of an eligible veteran, age 18 or older, who is a family member (including a spouse) or lives full time with the veteran, or is willing to.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
2026 stipend: The PCAFC stipend starts from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12. That monthly figure is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i). The factor is 0.25, 0.625 or 1.00, not a single figure, and which one applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant:U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
- 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."
- 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, at 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. No self-sustain determination is required on this route, so a legacy household rated 21 or higher reaches the full 1.00 on the rating schedule alone.
If the veteran meets both sets of requirements, VA pays 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, as long as the veteran remains at the address on record. The legacy schedule is time-limited: it runs for eight years from October 1, 2020 and lapses October 1, 2028. If your household joined PCAFC before October 2020, ask which paragraph VA is paying you under. Confirm your exact amount with the VA Caregiver Support Coordinator.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
Veteran eligibility: VA's first screen is a disability rating of 70 percent or higher, a discharge or medical discharge date, a need for at least six months of continuous in-person personal care, and enrollment in VA health care. Passing it is not approval: you and the veteran apply together, and VA decides.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
Why it stands out: VA treats the stipend as a non-taxable benefit,U.S. Department of Veterans Affairs. (n.d.). VA Community Care — Information for Caregivers (VHA Office of Finance, Payment Operations). va.gov. Retrieved Oct 1, 2026, from https://www.va.gov/COMMUNITYCARE/programs/caregiver/index.asp and a spouse can be the paid caregiver.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp
Best for: Families of eligible veterans where one person provides substantial daily care.
4. VA Veteran-Directed Care (VDC)
Who can be paid: Caregivers the veteran chooses and hires. ACL says enrolled veterans may hire family, friends and neighbors, and VA says the workers might include their own family member or neighbor; neither page says whether a spouse can be one, so put that question to the medical center.U.S. Department of Veterans Affairs. (n.d.). Veteran-Directed Care - Geriatrics and Extended Care. va.gov. Retrieved Jun 3, 2026, from https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp
How it works: The veteran or their representative manages a budget for services and, with a counselor's help, hires their own workers. For Kansas, ACL lists the VA Eastern Kansas and VA Wichita health care systems, but a listing does not guarantee local referrals, so ask your VA social worker whether it is available where you live.U.S. Department of Veterans Affairs. (n.d.). Veteran-Directed Care - Geriatrics and Extended Care. va.gov. Retrieved Jun 3, 2026, from https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp
Best for: Kansas veterans with daily-living needs who want to choose their own caregiver.
5. VA Aid and Attendance Pension
2026 maximums: Single veteran up to $29,093 a year; veteran with one dependent up to $34,488 a year. VA publishes these as annual maximums, not guaranteed payments: it pays the ceiling minus the claimant's countable income. Confirm current figures at the VA pension rate page before applying.U.S. Department of Veterans Affairs. (n.d.). Current Pension Rates For Veterans. va.gov. Retrieved Sep 3, 2026, from https://www.va.gov/pension/veterans-pension-rates/
Eligibility: A wartime veteran or surviving spouse who needs help with everyday activities, is largely confined to bed, is in a nursing home because of incapacity, or is severely sight-impaired.U.S. Department of Veterans Affairs. (n.d.). Aid And Attendance Benefits And Housebound Allowance. va.gov. Retrieved Jun 24, 2026, from https://www.va.gov/pension/aid-attendance-housebound/ Net worth (assets plus income) must be under $163,699.U.S. Department of Veterans Affairs. (n.d.). Current Pension Rates For Veterans. va.gov. Retrieved Sep 3, 2026, from https://www.va.gov/pension/veterans-pension-rates/
How caregivers get paid: VA pays the pension to the veteran or surviving spouse, not a caregiver; paying a relative from it is private.U.S. Department of Veterans Affairs. (n.d.). Aid And Attendance Benefits And Housebound Allowance. va.gov. Retrieved Jun 24, 2026, from https://www.va.gov/pension/aid-attendance-housebound/ The Kansas Office of Veterans Services (KOVS) has accredited Veteran Service Representatives who help file pension claims at no cost.U.S. Department of Veterans Affairs. (n.d.). Aid And Attendance Benefits And Housebound Allowance. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/aid-attendance-housebound/
Best for: Wartime veterans or surviving spouses under the limits.
6. Private Personal Services Contract
Who can be paid: Any family member, under a fair-market contract entered into before the care begins.Office of the Law Revision Counsel, U.S. House of Representatives. (n.d.). 42 U.S.C. 1396p — Liens, adjustments and recoveries, and transfers of assets (Office of the Law Revision Counsel, U.S. Code prelim edition). uscode.house.gov. Retrieved Jul 13, 2026, from https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396p&num=0&edition=prelim (A spouse can be paid this way too, but a transfer to a spouse is already exempt from the federal look-back penalty, so the contract adds no protection there.)U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
Why the format matters: Kansas enforces a 60-month Medicaid look-back. Kansas presumes a transfer for less than fair market value inside the look-back was made to qualify for Medicaid, and the family must disprove that by clear and convincing evidence. Payments to family carry that presumption unless shown to be for a listed reason, such as a debt under a fair-market contract entered into before the services.Office of the Law Revision Counsel, U.S. House of Representatives. (n.d.). 42 U.S.C. 1396p — Liens, adjustments and recoveries, and transfers of assets (Office of the Law Revision Counsel, U.S. Code prelim edition). uscode.house.gov. Retrieved Jul 13, 2026, from https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396p&num=0&edition=prelim Kansas's penalty divisor is an average daily nursing facility rate of $308.25 (July 2026).Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026), with the attached 2026 standards chart. medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.
Comparing Kansas Paid Family Caregiver Pathways
| Pathway | Pay a spouse? | Pay a co-resident relative? | Who pays | Best fit |
|---|---|---|---|---|
| FE Waiver self-directed Attendant Care | Only by exception (extraordinary care, MCO-authorized) | Yes; the FE page's bar names a spouse and representative, not a housemate | KanCare via FMS | Adult child or relative providing attendant care |
| PD Waiver self-directed PCS/ECS | PCS only by exception (extraordinary care); ECS only by narrow exception | PCS yes; ECS only by narrow exception | KanCare via FMS | Ages 16 to 64 with a physical disability |
| VA PCAFC | Yes | Yes | VA (stipend VA treats as non-taxable) | Eligible veteran's primary caregiver |
| VA Veteran-Directed Care | Ask the VA medical center | Yes | VA (veteran-set budget) | Veteran choosing their own worker |
| VA Aid and Attendance | Pension to veteran | Pension to veteran | VA (pension) | Wartime veteran under limits |
| Personal services contract | Yes, but no look-back benefit | Yes | Private funds | Family with assets, planning ahead |
How to Choose a Kansas Paid Caregiver Program
- Is your loved one a veteran? VA programs are the highest priority. PCAFC can pay a spouse outright, and a senior can receive Aid and Attendance and KanCare at the same time, though the two programs interact.U.S. Department of Veterans Affairs. (n.d.). Aid And Attendance Benefits And Housebound Allowance. va.gov. Retrieved Jun 24, 2026, from https://www.va.gov/pension/aid-attendance-housebound/ A KOVS Veteran Service Representative helps at no cost.U.S. Department of Veterans Affairs. (n.d.). Aid And Attendance Benefits And Housebound Allowance. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/aid-attendance-housebound/
- Do you live with the person you care for? That alone does not disqualify you from self-directed Attendant Care, whose rule names a spouse and an appointed representative rather than a housemate. It does bar you from Enhanced Care Services unless a narrow exception applies. Ask the case manager which service is being authorized.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
- Are you neither the spouse nor the appointed representative? If your loved one qualifies for the FE or PD waiver, becoming their self-directed attendant is the most direct path. For FE, the ADRC makes the assessment referral and the Clearinghouse decides financial eligibility.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
- Are you a spouse? Ask the MCO about the approved FE waiver's spouse provision rather than stopping at the FE page's no.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS If it is refused, VA PCAFC or a private personal services contract are the alternatives (a contract does not help with Medicaid planning for spousal transfers).U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
- Private assets, planning ahead? Work with a Kansas elder-law attorney on a personal services contract before payments start.
Not sure which Kansas program fits your family? Chat with Brevy's care navigator for a side-by-side comparison based on your situation: whether you live with the person, the care recipient's veteran status, and their KanCare eligibility.
Tax Considerations
- KanCare HCBS self-directed Attendant Care pays wages through the FMS agent, which withholds and files the taxes.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
- VA PCAFC: VA treats the monthly stipend as a non-taxable benefit.U.S. Department of Veterans Affairs. (n.d.). VA Community Care — Information for Caregivers (VHA Office of Finance, Payment Operations). va.gov. Retrieved Oct 1, 2026, from https://www.va.gov/COMMUNITYCARE/programs/caregiver/index.asp
- VA Aid and Attendance is exempt from taxation under federal law.U.S. Government Publishing Office. (2024). 38 U.S.C. §5301. Nonassignability and exempt status of benefits — United States Code, 2024 Edition, U.S. Government Publishing Office (govinfo). govinfo.gov. Retrieved Oct 4, 2026, from https://www.govinfo.gov/content/pkg/USCODE-2024-title38/html/USCODE-2024-title38-partIV-chap53-sec5301.htm
- Personal services contracts: the IRS Notice 2014-7 exclusion below does not reach payments a care recipient makes from their own private funds.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Jun 3, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
IRS Notice 2014-7: If you are paid through a Medicaid HCBS waiver to care for someone who lives in your home, those payments may be excluded from federal gross income.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Jun 3, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income Kansas taxes caregiver wages only to the extent they are in federal adjusted gross income, so the exclusion generally carries through. Talk to a tax preparer before filing.ksrevisor.gov. (n.d.). K.S.A. 79-32,110 — Tax imposed; classes of taxpayers; schedules of tax rates - Kansas Office of Revisor of Statutes. Retrieved Aug 13, 2026, from https://www.ksrevisor.gov/statutes/chapters/ch79/079_032_0110.html
Kansas state income tax: The Department of Revenue's 2025 booklet applies 5.2% to taxable income up to $23,000 for a single filer ($46,000 married filing jointly) and 5.58% above that. Confirm the rates for your filing year.Office of the Law Revision Counsel, U.S. House of Representatives. (n.d.). 42 U.S.C. 1396p — Liens, adjustments and recoveries, and transfers of assets (Office of the Law Revision Counsel, U.S. Code prelim edition). uscode.house.gov. Retrieved Jul 13, 2026, from https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396p&num=0&edition=prelim
Common Misconceptions
"Medicare will pay me to be Dad's caregiver." Original Medicare does not pay family members a wage for personal care. Its home health benefit pays a Medicare-certified agency, never a relative, for part-time or intermittent care.Centers for Medicare & Medicaid Services. (n.d.). Home Health Services Coverage. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/coverage/home-health-services
"I can informally get paid from Dad's savings." Not safely. Kansas presumes payments to family aim to qualify for Medicaid unless they settle a debt under a fair-market contract made before the care, so informal payments can delay coverage.Office of the Law Revision Counsel, U.S. House of Representatives. (n.d.). 42 U.S.C. 1396p — Liens, adjustments and recoveries, and transfers of assets (Office of the Law Revision Counsel, U.S. Code prelim edition). uscode.house.gov. Retrieved Jul 13, 2026, from https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1396p&num=0&edition=prelim
Frequently Asked Questions
Can I get paid to care for my spouse in Kansas?
Only by exception, so do not stop at the first no. KDADS's Frail Elderly page says a spouse cannot be the paid attendant, and KDADS's 2015 manual allows a spousal exception approved in writing by the MCO.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS The approved Frail Elderly waiver, effective July 1, 2026, goes further: Personal Care Services may pay a spouse who meets the provider qualifications when the needs assessment finds extraordinary care is required, documented in the Person-Centered Service Plan. Raise it with the MCO.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe If your spouse is a veteran, the PCAFC stipend can pay a spouse outright.U.S. Department of Veterans Affairs. (n.d.). Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Jun 24, 2026, from https://www.caregiver.va.gov/support/PCAFC-Stipend.asp A private contract adds no look-back protection between spouses, because a transfer to a spouse is already exempt.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
Does Kansas have CDPAP?
Not by that name: CDPAP is New York's Consumer Directed Personal Assistance Program.Office of the Federal Register. (2008). CMS Final Rule — Self-Directed Personal Assistance Services Program State Plan Option (Cash and Counseling), 73 FR 57854 (Oct. 3, 2008). federalregister.gov. Retrieved Sep 2, 2026, from https://www.federalregister.gov/documents/full_text/text/2008/10/03/E8-23102.txt Kansas's equivalent is the self-direction option in its KanCare HCBS waivers, where the participant directs their own workers and a Financial Management Services agent handles payroll.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Can I be paid if I live with the person I care for?
Living in the home is not a bar under the FE waiver's self-directed Attendant Care, where KDADS's FE page excludes a spouse and an appointed representative rather than a housemate, and KDADS's toolkit says most self-directed services can be provided by a family member or other person living in the house.Kansas Department for Aging and Disability Services. (1915). Application for 1915(c) HCBS Waiver: KS.0303.R06.01 (Frail Elderly), approved effective 07/01/26 — the current approved FE waiver as posted by KDADS (HCBS Programs page, "FE Waiver"). kdads.ks.gov. Retrieved Oct 14, 2026, from https://www.kdads.ks.gov/home/showpublisheddocument/3318/639219432424300000 It is a bar under Enhanced Care Services, which cannot be provided by any individual residing in the home with the participant, though narrow exceptions exist. Ask the KanCare case manager which service is being authorized.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Which waivers allow self-direction in Kansas?
The Frail Elderly waiver allows self-direction of one service: KDADS's FE page calls it Attendant Care, and the approved FE waiver limits self-direction to Level I Personal Care Services.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS The Physical Disability waiver allows self-direction of Personal Care Services, Enhanced Care Services, and FMS. KDADS also offers self-direction in its Intellectual/Developmental Disability, Brain Injury, and Technology Assisted programs.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
Who can be paid as a self-directed attendant in Kansas?
A family member; a spouse, guardian, or A-DPOA only by exception: the approved FE waiver requires extraordinary care for a spouse and a mitigated conflict of interest for a representative.Kansas Department for Aging and Disability Services. (n.d.). Frail Elderly (FE). kdads.ks.gov. Retrieved Sep 4, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs/hcbs-programs/frail-elderly-fe,Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
How does my loved one start the process?
The ADRC refers applicants for the FE waiver's functional assessment; the KanCare Clearinghouse decides financial eligibility.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Kansas Waiver Factsheet (1915(c) waivers, incl. HCBS for the Frail Elderly 0303.R06.00). medicaid.gov. Retrieved Oct 16, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS Services on the FE and PD waivers are authorized through the member's MCO care coordinator.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS Once approved for self-direction, the participant sets up FMS and hires their attendant.Centers for Medicare & Medicaid Services. (n.d.). Kansas Waiver Fact Sheet — Medicaid.gov. medicaid.gov. Retrieved Aug 7, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Where to Get Help in Kansas
Related Terms
- Consumer Directed Services (CDS): Self-directed care of the kind Kansas offers through its HCBS waivers, where the participant chooses and directs their own worker.Kansas Department for Aging and Disability Services. (n.d.). Self-Direction. kdads.ks.gov. Retrieved Aug 1, 2026, from https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-direction
- HCBS waiver: The kind of Medicaid waiver behind Kansas's Frail Elderly and Physical Disability programs.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
- Activities of Daily Living (ADLs): Everyday self-care such as bathing, dressing and using the bathroom; help with them is personal care.Centers for Medicare & Medicaid Services. (n.d.). Home Health Services Coverage. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/coverage/home-health-services
- Nursing Facility Level of Care: The clinical threshold for Kansas's Frail Elderly and Physical Disability waivers.Centers for Medicare & Medicaid Services. (1915). Kansas 1915(c) Waiver Descriptions Factsheet - Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/KS
Learn More
Find personalized help getting paid as a family caregiver in Kansas 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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