In Louisiana, the realistic way to get paid for caring for a parent is to enroll them in a Medicaid program that pays a family member as the worker. You don't get a check from the state directly. Instead, your loved one needs long-term care Medicaid and an offer from the Community Choices Waiver (CCW).Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Under CCW self-direction, your loved one becomes the employer and hires their own worker, and a Fiscal Employer Agent runs the payroll.Centers for Medicare & Medicaid Services. (n.d.). CMS / Medicaid.gov - Louisiana Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA An adult child isn't barred from that job for being family.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA If your loved one is a veteran, VA's caregiver stipend is a separate route, covered below.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Spouses face a separate rule. Under Louisiana's CCW self-direction option, a husband or wife counts as a Legally Responsible Individual and can be the paid worker only if the spouse meets Extraordinary Care criteria and OAAS approves it.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA CCW's live-in service, Monitored In-Home Caregiving, is different: its rule names the spouse among the people allowed to be the paid principal caregiver, subject to a licensed provider's approval.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
The Short Version
If you're an adult child of someone on the Community Choices Waiver, the route is to have them self-direct their Personal Assistance Services and hire you as their Direct Service Worker, as long as you aren't also their employer of record or responsible representative. Other relatives should confirm with the support coordinator first.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
If you're a spouse, CCW gives you two routes. Self-direction opens only with OAAS approval under its Extraordinary Care criteria.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA If you live with your spouse, Monitored In-Home Caregiving allows a spouse as the live-in principal caregiver, if a licensed provider approves the home and the caregiver. LT-PCS, by contrast, bars a spouse from being paid.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf,Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf See getting paid to care for your spouse in Louisiana.
If your loved one is a veteran, check the VA programs early: PCAFC's caregiver stipend and Veteran-Directed Care's hiring budget.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf,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
If your family has private assets and wants to pay a relative directly, Louisiana Medicaid looks back 60 months at transfers, so document the care your parent received in return.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
What Makes Louisiana Different: Self-Direction Under the Community Choices Waiver
The Community Choices Waiver is Louisiana's Section 1915(c) home and community-based services waiver, run by OAAS, for people who meet a nursing facility level of care and qualify for long-term care Medicaid.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA CCW offers a self-direction option, which the OAAS handbook describes as one that "allows participants to become the employers of the people they choose to hire to provide supports for them."Centers for Medicare & Medicaid Services. (n.d.). CMS / Medicaid.gov - Louisiana Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
CCW is not available on request. LDH keeps a Request for Services Registry for people asking for CCW, offers openings first to six priority groups, and then makes offers to everyone else first-come, first-served by the date they asked for services. Get on the registry early by calling Louisiana Options in Long Term Care at 1-877-456-1146.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
By contrast, Long Term-Personal Care Services (LT-PCS), another OAAS Medicaid program, isn't on LDH's list of programs with a self-direction option.Centers for Medicare & Medicaid Services. (2022). Louisiana SPA LA-22-0014 (CMS-approved Attachment 3.1-A, Item 26, Personal Care Services, eff. July 1, 2022) - medicaid.gov. medicaid.gov. Retrieved Sep 29, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf Its rule (LAC 50:XV, Chapter 129) bars six people from being paid as the worker: the recipient's spouse, curator, tutor, legal guardian, designated responsible representative, and power of attorney. An adult child isn't on that list. LT-PCS is limited to up to 32 hours a week.Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf See LT-PCS family caregiver pay.
The Louisiana Paid Family Caregiver Pathways
1. Community Choices Waiver Self-Direction: The Main Medicaid Route
Who pays: Louisiana Medicaid through the Community Choices Waiver, administered by OAAS.
Who can be paid: The OAAS handbook says the worker can be the participant's curator, tutor, legal guardian, or power of attorney, or the participant's spouse with OAAS approval (see below), as long as they meet the worker requirements. The worker can never be the participant, the participant's employer of record, or the participant's responsible representative.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA The handbook doesn't name adult children, so an adult child isn't barred for the relationship itself, but a daughter who is Mom's employer of record or responsible representative can't also be her paid worker.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
What it is: A service-delivery option within CCW in which the participant, not an agency, directs the care. Personal Assistance Services is the only CCW service that can be self-directed.Centers for Medicare & Medicaid Services. (n.d.). CMS / Medicaid.gov - Louisiana Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA See how the Community Choices Waiver pays family caregivers.
Eligibility, recipient: Must be 21 or older, qualify for long-term care Medicaid, and meet a nursing facility level of care.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA For long-term care Medicaid, a single applicant is limited to $2,000 in countable assets, and the 2026 Special Income Limit is $2,982 a month. A person on a waiver like CCW counts as institutionalized under the spousal impoverishment rules, so a spouse at home can keep up to $162,660 of the couple's countable resources in 2026. Apply online through the Medicaid Self-Service Portal, by mail or fax, at 1-888-342-6207, or at a local Medicaid office; see Louisiana Medicaid eligibility and income limits.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf CMS's approved waiver describes the population served as people 65 or older and people 21 to 64 with physical disabilities, so an applicant under 65 should expect to need a physical disability.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Self-direction then has its own test: the participant must be able to self-direct without a decline in care or added risk and complete the support coordinator's mandatory overview. A participant who can't make decisions independently needs a responsible representative to act as the employer.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Eligibility, caregiver: Be at least 18, be able to do the Plan of Care tasks, have a valid Social Security Number, and pass background, adverse actions list, and exclusion database checks, which the employer repeats monthly.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
How you get paid: You choose a Fiscal Employer Agent, Acumen Fiscal Agent or Morning Sun Financial Services, which pays you at least every two weeks with the required taxes withheld and runs your background checks. No work before the FEA issues your "Good to Go" date is paid.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA The employer must follow wage and overtime law; ask the support coordinator what the participant's budget allows.Centers for Medicare & Medicaid Services. (n.d.). CMS / Medicaid.gov - Louisiana Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Best for: An adult child, or a curator, tutor, legal guardian, or power of attorney, caring for someone on CCW who wants to direct their own care, where someone else acts as employer of record.
2. The Spouse Rule and the Legally Responsible Individual Exception
Under CCW self-direction, your husband or wife is a Legally Responsible Individual (LRI), and the spouse can be the paid Direct Service Worker only if the spouse meets Extraordinary Care criteria and OAAS approves it.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
The process: the participant tells the employer of record they want their spouse as the worker, and the employer emails the LRI/Spouse Request Form to the OAAS Regional Office, which sends its decision to the employer, the FEA, and the support coordinator. If OAAS approves, the approval goes in the Plan of Care and the spouse is hired. If not, another worker must be found.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
The Extraordinary Care criteria themselves aren't in the handbook. They're in the LDH Medicaid CCW Provider Manual, Section 7.1.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
If you live with your spouse, Monitored In-Home Caregiving (below) also allows a spouse as the principal caregiver.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
3. Monitored In-Home Caregiving (MIHC): Live-In Care Under CCW
What it is: MIHC is one of the services covered under the Community Choices Waiver. LDH describes it as a principal caregiver who lives with you and helps with basic self-care, such as dressing and bathing.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Who pays: Louisiana Medicaid through the Community Choices Waiver, via a licensed HCBS provider with a monitored in-home caregiving module.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
Who can be paid: Louisiana's CCW rule, LAC 50:XXI.8329, allows the participant's spouse, curator, tutor, legal guardian, or the person holding power of attorney to be the MIHC principal caregiver. The participant's responsible representative can't be. Being allowed isn't being hired: the provider must approve the home and contracts only with caregivers it has approved and trained.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf An adult child isn't named in the rule and isn't on its prohibited list, and the rule doesn't say whether OAAS treats an adult child differently, so confirm with your support coordinator.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
How you get paid: The provider pays the principal caregiver a per diem stipend, not hourly wages through a Fiscal Employer Agent. The rule text cited here sets no stipend amount, so ask the provider.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
The tradeoff: A participant receiving MIHC can't also receive Personal Assistance Services or home-delivered meals during that time, so a family chooses between self-directed PAS and MIHC.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf
Access: MIHC uses the same CCW registry and offer order. CCW does not provide help 24 hours a day.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Best for: A spouse, guardian, curator, tutor, or POA living with the participant.
4. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated Primary Family Caregiver who is at least 18 and a spouse, son, daughter, parent, stepfamily or extended family member of the veteran, or someone who lives full time with the veteran. A veteran may have one Primary and up to two Secondary Family Caregivers.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 is the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, times a factor set by 38 CFR 71.40(c)(4)(i). For the current program that factor is 0.625, or 1.00 if VA finds the veteran "unable to self-sustain in the community." Legacy participants and applicants have a separate schedule based on their 2019 clinical ratings, which lapses October 1, 2028. The monthly rate varies by the veteran's locality pay area, so confirm your amount with VA. The stipend is paid only once you enroll in direct deposit through the VA customer engagement portal.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Veteran eligibility: The veteran must meet all four of VA's published conditions: a VA disability rating, individual or combined, of 70 percent or higher; 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.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Those four are necessary, not sufficient. 38 CFR 71.20(a) adds four more that VA assesses during the application, including that participating is in the veteran's best interest and that the same care isn't regularly provided by someone else.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Best for: Families of an eligible veteran where one person provides substantial daily care.
5. VA Veteran-Directed Care (VDC)
Who can be paid: Workers the veteran hires. ACL's VDC page says enrolled veterans "may also hire family, friends, and/or neighbors to provide services." Neither VA's nor ACL's VDC page permits or bars paying a spouse, so confirm that with the VA medical center serving you.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: Veteran-Directed Care is for veterans who need help with daily activities like bathing, dressing, or fixing meals. The veteran uses a flexible service budget to choose which goods and services to purchase, through local aging and disability network agencies.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
Availability: VDC runs only through local agencies with a VA provider agreement that serve veterans their VA medical center refers. Ask your VA social worker whether VDC is offered where you live, or contact VA caregiver support in Louisiana.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: A Louisiana veteran with daily-living needs who wants to hire family and direct a service budget.
6. VA Aid and Attendance Pension
Who is paid: Aid and Attendance is a monthly payment added to a VA pension, paid to the qualified veteran or survivor, not to the caregiver.U.S. Department of Veterans Affairs. (n.d.). Eligibility For Veterans Pension. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/eligibility/ VA's rule says a relative or household member providing the needed help does not prevent the allowance from being granted.U.S. Department of Veterans Affairs. (n.d.). Eligibility For Veterans Pension. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/eligibility/
2026 maximums (effective December 1, 2025 through November 30, 2026): the maximum annual pension rate with Aid and Attendance is $29,093 for a single veteran and $18,697 for a surviving spouse with no dependents. It is a ceiling VA reduces by countable income, not a flat award, and VA pays the result monthly.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: The veteran or survivor must qualify for a VA pension and need another person's help with daily activities, or meet another listed condition.U.S. Department of Veterans Affairs. (n.d.). Eligibility For Veterans Pension. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/eligibility/ Income and net worth must fall within the limits.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/ See Louisiana Aid and Attendance for the full rules.
Getting help applying: The Louisiana Department of Veterans Affairs has VA-accredited veterans assistance counselors in 74 service offices who file pension claims free of charge.U.S. Government Publishing Office. (n.d.). 38 CFR 14.636 — Payment of fees for representation by agents and attorneys in proceedings before Agencies of Original Jurisdiction and before the Board of Veterans' Appeals. ecfr.gov. Retrieved Aug 1, 2026, from https://www.ecfr.gov/current/title-38/chapter-I/part-14/subject-group-ECFR6d0a8c39a3b0d19/section-14.636 Under federal rules, only accredited agents and attorneys may charge a fee, and with narrow exceptions only after VA's initial decision on the claim.U.S. Government Publishing Office. (n.d.). 38 CFR 14.636 — Payment of fees for representation by agents and attorneys in proceedings before Agencies of Original Jurisdiction and before the Board of Veterans' Appeals. ecfr.gov. Retrieved Aug 1, 2026, from https://www.ecfr.gov/current/title-38/chapter-I/part-14/subject-group-ECFR6d0a8c39a3b0d19/section-14.636
Best for: A wartime veteran or surviving spouse with income and net worth under the limit who needs help with daily activities.
7. Paying a Relative From Private Funds
What matters: Louisiana Medicaid looks at any transfer of resources the applicant or spouse made in the 60 months before applying, or after. A transfer for less than fair market value is presumed to have been made to qualify for Medicaid, but that presumption can be rebutted with convincing evidence the transfer was made exclusively for another purpose.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
Why the format matters: Paying a family member for care is not automatically a penalized transfer. What counts is whether your parent received value in return and whether the family can show it, so keep records of the care and the payments. If Louisiana finds a transfer was made to qualify, it sets a period of ineligibility for facility or waiver services from the uncompensated value, and the cost figure it uses must come from Louisiana Medicaid.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
The home exemption: Federal law exempts transferring the home to a son or daughter who lived there for at least two years right before the parent entered an institution and whose care let the parent stay home, as Louisiana determines.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
Best for: Families with assets who want to pay a relative and can show the care the parent received in return.
Comparing Louisiana Paid Family Caregiver Pathways
| Pathway | Pay a spouse? | Who pays | Main gate | Best fit |
|---|---|---|---|---|
| CCW self-direction | Only with OAAS approval | Medicaid via a Fiscal Employer Agent | Request for Services Registry | Adult child, guardian, or POA of a CCW participant who isn't the employer |
| Monitored In-Home Caregiving | Allowed, if the provider approves the home and caregiver | Medicaid (CCW service), paid by a licensed provider as a per diem stipend | Request for Services Registry | Spouse, guardian, or POA who lives with the participant |
| LT-PCS | No (spouse is on the prohibited list) | Medicaid (OAAS program), up to 32 hours a week | Medicaid, nursing-home-level need, and one of three listed situations | Adult child or other relative with no legal role over the recipient |
| VA PCAFC | Yes | VA (monthly stipend) | Joint application and VA assessment | Eligible veteran's primary caregiver |
| VA Veteran-Directed Care | Not addressed; ask VA | VA (veteran-managed budget) | Offered through VA-approved local agencies | Veteran wanting to hire family |
| VA Aid and Attendance | Pension paid to veteran | VA (pension) | Pension, income, and net worth rules | Wartime veteran needing daily help |
| Private funds | Ask an elder-law attorney | Private funds | 60-month Medicaid look-back | Family with assets, planning ahead |
How to Choose a Louisiana Pathway
Start with the care recipient's situation:
Is your loved one a veteran?
Check PCAFC and Veteran-Directed Care first; the Louisiana Department of Veterans Affairs files pension claims free.U.S. Government Publishing Office. (n.d.). 38 CFR 14.636 — Payment of fees for representation by agents and attorneys in proceedings before Agencies of Original Jurisdiction and before the Board of Veterans' Appeals. ecfr.gov. Retrieved Aug 1, 2026, from https://www.ecfr.gov/current/title-38/chapter-I/part-14/subject-group-ECFR6d0a8c39a3b0d19/section-14.636
Are you a spouse?
Under CCW self-direction, ask the employer of record to file the LRI/Spouse Request Form for OAAS review.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA If you live with your spouse, also ask about Monitored In-Home Caregiving, which allows a spouse as the principal caregiver. Skip LT-PCS, which bars spouses.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf,Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf If your spouse is a veteran, also check PCAFC.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Are you an adult child, legal guardian, or power of attorney, and is your loved one likely eligible for the Community Choices Waiver?
Have them self-direct Personal Assistance Services and hire you, with someone other than you acting as employer of record. Start by calling Louisiana Options in Long Term Care at 1-877-456-1146 to get on the Request for Services Registry, then choose a Fiscal Employer Agent.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Waiting on CCW?
If your loved one has Medicaid, ask Louisiana Options in Long Term Care at 1-877-456-1146 about LT-PCS, an OAAS program that helps with activities of daily living. It also requires one of three situations: living in a nursing facility and able to be discharged with community services, likely nursing facility admission within 120 days, or a primary caregiver who has a disability or is at least 70.Centers for Medicare & Medicaid Services. (2022). Louisiana SPA LA-22-0014 (CMS-approved Attachment 3.1-A, Item 26, Personal Care Services, eff. July 1, 2022) - medicaid.gov. medicaid.gov. Retrieved Sep 29, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf Ask too how starting it would affect their CCW registry priority, since two of CCW's six priority groups depend on a person's LT-PCS status.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Its rule doesn't bar an adult child who isn't also the recipient's curator, tutor, legal guardian, responsible representative, or power of attorney, and services are capped at 32 hours a week.Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf
Do you have substantial private assets and want to plan ahead?
Talk to a Louisiana elder-law attorney about how Medicaid's 60-month look-back treats paying a relative for care, and keep a written record of the care given and every payment.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
Not sure which Louisiana pathway fits your family? Chat with Brevy's care navigator for a side-by-side comparison based on your situation: whether you're a spouse or another relative, the care recipient's veteran status, and whether they're likely eligible for the Community Choices Waiver.
Tax Considerations
- CCW self-direction pays wages through your Fiscal Employer Agent, which withholds and deposits the required taxes.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
- VA PCAFC: VA's 2020 proposed PCAFC rule described the stipend as "a nontaxable benefit."U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
IRS Notice 2014-7: The IRS treats qualified Medicaid waiver payments under a Section 1915(c) waiver as excludable from the caregiver's federal gross income, but only for care in the provider's own home, where the care recipient also lives.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 1, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income The Community Choices Waiver is a 1915(c) waiver, so a live-in CCW worker should ask a tax preparer whether the exclusion applies.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Louisiana state income tax: For taxable periods beginning on or after January 1, 2025, Louisiana levies a flat 3 percent individual income tax. The standard deduction is $12,500 for single filers and $25,000 for married couples filing jointly, with annual inflation adjustments starting January 1, 2026, so check the amount for the year you file.revenue.louisiana.gov. (n.d.). What are the individual income tax rates and brackets?, Louisiana Department of Revenue. Retrieved Aug 1, 2026, from https://revenue.louisiana.gov/tax-education-and-faqs/faqs/income-tax-reform/what-are-the-individual-income-tax-rates-and-brackets/
Frequently Asked Questions
Can I get paid to care for my spouse in Louisiana?
Possibly, through two CCW routes. Under Community Choices Waiver self-direction, only if you meet Extraordinary Care criteria and OAAS approves you as a Legally Responsible Individual.Centers for Medicare & Medicaid Services. (1915). CMS Medicaid.gov — Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver, 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Under Monitored In-Home Caregiving, CCW's live-in service, the rule names a spouse among the people allowed to be the paid principal caregiver, subject to the provider's approval. LT-PCS bars a spouse from being paid.Louisiana Department of Health. (2024). Final Rule - Home and Community-Based Services Waivers, Community Choices Waiver (LAC 50:XXI.Chapters 81-95), LDH Bureau of Health Services Financing and OAAS (June 2024) - ldh.la.gov. ldh.la.gov. Retrieved Oct 14, 2026, from https://www.ldh.la.gov/assets/medicaid/Rulemaking/FinalRules/June2024FinalRules.pdf,Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf If your spouse is a veteran, VA's caregiver program (PCAFC) lists spouses among eligible caregivers, though the veteran must still pass VA's eligibility test.U.S. Government Publishing Office. (2018). Program of Comprehensive Assistance for Family Caregivers Improvements and Amendments Under the VA MISSION Act of 2018 — Proposed Rule, 85 FR 13356 (March 6, 2020) (govinfo.gov / Federal Register). govinfo.gov. Retrieved Sep 2, 2026, from https://www.govinfo.gov/content/pkg/FR-2020-03-06/pdf/2020-04464.pdf
Can a family member be paid under LT-PCS?
It depends on your role. LT-PCS isn't on LDH's list of programs with a self-direction option.Centers for Medicare & Medicaid Services. (2022). Louisiana SPA LA-22-0014 (CMS-approved Attachment 3.1-A, Item 26, Personal Care Services, eff. July 1, 2022) - medicaid.gov. medicaid.gov. Retrieved Sep 29, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf Its rule bars the recipient's spouse, curator, tutor, legal guardian, designated responsible representative, and power of attorney from being paid. An adult child who holds none of those roles isn't on that list, and family members must meet the same employment standards as unrelated caregivers. LT-PCS is capped at 32 hours a week.Centers for Medicare & Medicaid Services. (2022). Louisiana State Plan Amendment TN 22-0014 - Attachment 3.1-A, Item 26 (Personal Care Services), effective July 1, 2022 - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/LA-22-0014.pdf
Can I just pay myself out of Dad's bank account?
Not without planning. Louisiana presumes a transfer for less than fair market value in the 60-month look-back was made to qualify for Medicaid, so an undocumented payment can delay his eligibility later. Keep records of the care and the payments.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
Is there a waitlist to get paid as a caregiver in Louisiana?
For the Community Choices Waiver, effectively yes. LDH keeps a Request for Services Registry, offers openings first to six priority groups, and then goes first-come, first-served by the date people asked for services.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
What if Medicaid or CCW services are denied?
Ask for a state fair hearing with the Division of Administrative Law: online, by mail to P.O. Box 4189, Baton Rouge, LA 70821-4189, or by fax to 225-219-9823. File by the date on your denial notice. Appeal within 10 days to keep current services during review; a decision is due within 30 days unless more time is agreed.U.S. Government Publishing Office. (n.d.). 42 CFR 431.221 — Request for hearing (eCFR, current). ecfr.gov. Retrieved Jul 31, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E/section-431.221
How does my loved one start the process?
Call Louisiana Options in Long Term Care at 1-877-456-1146 to get on the Community Choices Waiver Request for Services Registry.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov - Louisiana 1915(c) Waiver Factsheet (LA Community Choices (CC) Waiver 0866.R02.00). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA Once your loved one is offered CCW and chooses self-direction, they pick a Fiscal Employer Agent and can hire you, but you're paid only for work after the FEA issues your "Good to Go" date.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/LA
Learn More
Find personalized help getting paid as a family caregiver in Louisiana 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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