Whether you can get paid to care for your spouse in Maryland depends on the program, and Maryland's rules say no for some programs while staying silent for its main one. Self-directed Community First Choice gives a participant the option to hire family members without naming spouses, so a husband or wife has to ask the program before counting on the pay.
In a lot of states, a spouse is the one relative who gets turned away. An adult child or a sibling can be hired and paid, but a husband or wife cannot, because of how Medicaid treats a "legally responsible relative," explained below. Maryland's picture is mixed. Its main Medicaid home-care program, Community First Choice, lets a participant who directs their own care choose a family member to provide it, but its state plan speaks of "family members" and never mentions spouses either way. Two other Maryland programs do address spouses, and both can bar them. And if the person you care for is a veteran, the VA's family caregiver program can pay a spouse directly. This guide walks through each route and how to confirm your own case.
Can a Spouse Get Paid to Care for a Husband or Wife in Maryland?
The short answer is that it depends on the program. Maryland's Medicaid rules leave the spouse question open for self-directed home care under its main program and bar a spouse in two others, while a veteran's spouse has VA routes that do pay spouses. It helps to separate the two systems from the start.
Through Maryland Medicaid, the main paid-caregiving benefit is Community First Choice (CFC), and it can be self-directed, which is the arrangement that lets a family member be hired and paid. Maryland's approved CFC state plan permits "family members, or any other individuals" and does not mention spouses, so whether a husband or wife can be the paid personal assistant is something to confirm with the program.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf Through the VA, an eligible veteran's spouse can also be paid a stipend through the PCAFC program, and Veteran-Directed Care gives the veteran a budget to hire their own workers, which can include a family member.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 Jul 13, 2026, from https://www.va.gov/GERIATRICS/pages/Veteran-Directed_Care.asp
| Route | What it is | Can a spouse be paid? |
|---|---|---|
| Medicaid, Community First Choice (self-directed) | Participant directs their own care and hires their own personal assistant | Ask the program: the state plan permits family members and does not mention spouses |
| Medicaid, Community Personal Assistance Services | Personal-care benefit with a self-directed option added in 2023 | Not as a self-directed hire if the spouse is a legally liable relative, which Maryland's self-directed option excludes |
| Medicaid, Increased Community Services | Home care for people leaving a nursing facility whose income is too high for the waiver | No. The rule allows Department exemptions but does not say the spouse bar can be lifted |
| VA PCAFC | Monthly stipend to a veteran's Primary Family Caregiver | Yes, a spouse can be the paid caregiver |
| VA Veteran-Directed Care | Veteran's budget to hire their own workers | Family members can be hired, ask the VA about a spouse |
| VA Aid and Attendance | Added pension income the household spends on care | Adds income, but is not a wage to the spouse |
That table is the whole guide in one view.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf,Centers for Medicare & Medicaid Services. (2025). Maryland HealthChoice Section 1115 Demonstration — CMS approval letter (December 16, 2025) and Special Terms and Conditions, approval period January 1, 2022 through December 31, 2026 - Centers for Medicare & Medicaid Services. medicaid.gov. Retrieved Sep 30, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/md-healthchoice-dmnstn-aprvl-rnty-dmnstn-intve-implnt-pln-pa.pdf The sections below explain how the Medicaid route works, where Maryland's rules bar a spouse and where they are silent, and how the VA routes work for veteran couples.
The Medicaid Self-Directed Route: Community First Choice
Whether a spouse can be paid in Maryland starts with how the state delivers home care. Self-direction, also called participant direction, means the person receiving care, or their representative, controls the budget and recruits, hires, trains, and supervises their own workers. Self-direction alone does not make a relative payable, though: whether a family member can be the paid caregiver is an option each state chooses to allow or not. One more limit matters for couples. Under the federal Community First Choice rules, a person serving as the participant's representative may not also be their paid caregiver, so a spouse who hopes to be the paid assistant should not also be the one appointed as representative to direct the care.U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Oct 15, 2026, from https://www.ecfr.gov/current/title-42/section-441.450
Maryland's main home-care benefit is Community First Choice. It is a Medicaid state plan benefit rather than a waiver. To qualify, a person must already have full Medicaid, need an institutional level of care, and live in the community, and there is no age limit. CFC covers personal assistance with daily activities along with related supports, including supports planning.U.S. Government Publishing Office. (n.d.). 42 CFR 441.500 Basis and scope — Community First Choice (ecfr.gov). ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.500
CFC can be delivered two ways: through a licensed agency, or, for a participant in the self-directed model, from one or more people the participant employs directly. Maryland added the self-directed model to its approved CFC state plan in 2023. In that model the participant is the employer of their own personal assistant.Centers for Medicare & Medicaid Services. (n.d.). Maryland State Plan Amendment MD-23-0012, §1915(k) Community First Choice — Attachment 3.1-K, §viii.C (Qualifications of Providers of CFC Services). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf This is the doorway a family member walks through. Under the self-directed model, Maryland's CMS-approved state plan says a participant has the option to permit family members, or any other individuals, to provide their CFC services, provided the person meets the qualifications the participant sets. The state plan adopts this from the federal Community First Choice rule, and neither the state plan nor Maryland's CFC regulations name spouses, either to permit or to bar them.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf The participant's own standards are not the only ones, though. A self-directed personal assistant, including any family caregiver, must be certified in first aid and CPR, the participant must complete a background check on them before hiring, and every CFC provider must meet the state's general Medicaid provider requirements.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, §1915(k) Community First Choice — Attachment 3.1-K, §viii.B (Qualifications of Providers of CFC Services), approved by CMS with a July 1, 2023 effective date. medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf
A note on how strong to read that: the state plan permits family members broadly but never names a spouse, so the sources leave the spouse question open. The honest way to plan is to ask the program whether a spouse can be the paid self-directed assistant in your case before you count on it. You will not be doing the paperwork alone. Supports planning is one of the services CFC covers.U.S. Government Publishing Office. (n.d.). 42 CFR 441.500 Basis and scope — Community First Choice (ecfr.gov). ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.500 And federal Community First Choice rules require the state to make financial management available to everyone who self-directs with a service budget; that entity processes the assistant's timesheets and payroll and withholds and pays the employment taxes, so the paycheck to the family caregiver comes through it.U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Oct 15, 2026, from https://www.ecfr.gov/current/title-42/section-441.450
Maryland also runs a separate Medicaid personal-care benefit, Community Personal Assistance Services (CPAS), for Medicaid participants who need help with one or more activities of daily living and live at home. CPAS added a self-directed option in 2023, but under it Maryland chose not to let participants hire legally liable relatives as paid providers, a category federal rules say may include a spouse. So don't count on self-directed CPAS to pay a husband or wife unless the program confirms it for your case.Centers for Medicare & Medicaid Services. (2024). Maryland State Plan Amendment MD-23-0014 — §1915(j) Community Personal Assistance Services (CPAS) self-directed personal assistance services, CMS approval letter (March 14, 2024) and approved SPA pages - Centers for Medicare & Medicaid Services. medicaid.gov. Retrieved Sep 30, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0014.pdf,U.S. Government Publishing Office. (n.d.). 42 CFR 440.167 — Personal care services (Medicaid state plan benefit). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-440/subpart-A/section-440.167 And if you have heard of the Community Options Waiver, know that it covers no personal assistance benefit of its own; a waiver participant gets paid personal assistance through Community First Choice or CPAS, so the spouse question there turns on those two programs' rules above.Centers for Medicare & Medicaid Services. (n.d.). CMS — Maryland Waiver Factsheet, entry for MD Home and Community Based Options Waiver (0265.R06.00). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MD The waiver is not a self-direction route either: CMS's description of it lists no participant-directed service.Centers for Medicare & Medicaid Services. (1915). CMS / Medicaid.gov — Maryland 1915(c) waiver factsheet (HCBOW 0265.R06.00; Community Pathways 0023.R08.00; Family Supports and Community Supports terminated 10/5/2025). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MD
When Maryland Says No: the Legally Responsible Relative Rule
To see where Maryland's programs stand, it helps to know the rule that blocks spouses in many states. Under Medicaid's basic state plan personal care benefit, the paid worker must be someone "who is not a member of the individual's family," and for that benefit a family member means a legally responsible relative. Self-direction uses a related term: the federal self-direction rule defines legally liable relatives as people with a state-law duty to care for another person and says they may include a spouse. A state can also define "family member" differently for its 1915(c) home and community-based services waiver, so that exclusion does not automatically carry over to waiver-funded care. Self-direction also has its own payment rule: under the self-directed personal assistance authority, a state may elect to let participants hire legally liable relatives as paid providers. Whether a spouse can be paid therefore depends on the state and on the specific Medicaid authority the care runs through, not on a single federal yes or no.U.S. Government Publishing Office. (n.d.). 42 CFR 440.167 — Personal care services (Medicaid state plan benefit). ecfr.gov. Retrieved Aug 3, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-440/subpart-A/section-440.167
For its main program, Maryland's sources are silent rather than permissive: the Community First Choice state plan carries no legally-responsible-relative exclusion, but it does not name spouses either.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf Other Maryland programs do say no. Self-directed CPAS does not let participants hire legally liable relatives.Centers for Medicare & Medicaid Services. (2024). Maryland State Plan Amendment MD-23-0014 — §1915(j) Community Personal Assistance Services (CPAS) self-directed personal assistance services, CMS approval letter (March 14, 2024) and approved SPA pages - Centers for Medicare & Medicaid Services. medicaid.gov. Retrieved Sep 30, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0014.pdf Under Increased Community Services (ICS), COMAR 10.09.81.13 says that unless the Department grants an exemption, an attendant may not be a spouse, and the rule does not say whether that bar can be exempted.Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf That is exactly why the safe move is to ask about your own program by name rather than assume the CFC answer applies everywhere. When in doubt, ask your Supports Planner or call Maryland Access Point and ask specifically whether a spouse can be your paid, self-directed assistant under the program you are enrolled in.aging.maryland.gov. (n.d.). Maryland Access Point — Maryland Department of Aging (aging.maryland.gov). Retrieved Jul 16, 2026, from https://aging.maryland.gov/programs-and-services/maryland-access-point
The VA Route: PCAFC and Veteran-Directed Care
If the person you care for is a veteran, there are two more doors: one pays a spouse outright, and the other lets the veteran hire family members. These sit on top of the Medicaid routes above, so a veteran couple may have several options to compare.
The first is PCAFC. It pays an eligible veteran's approved Primary Family Caregiver a monthly stipend, and a spouse is expressly eligible to serve. VA's first screen is four requirements for the veteran, and all four must be true: a VA disability rating 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, and enrollment in VA health care. Meeting those four is necessary but not the whole test. The couple applies together, and under the regulation VA also decides whether participating is in the veteran's best interest, whether the veteran gets care at home and from a primary care team, and whether the same personal care is already being regularly provided by another person or program, which on its own can rule a household out. Once approved, the caregiver must enroll in direct deposit through VA's customer engagement portal before the stipend is paid. PCAFC also provides caregiver training, mental health counseling, at least 30 days of respite care a year, and, if not otherwise covered, CHAMPVA health coverage.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
The stipend is not a single national dollar figure: it is calculated from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by a factor of 0.625, 1.00, or 0.25. Which factor applies depends on whether the veteran qualifies under the current program or as a legacy participant or legacy applicant: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
- Current program: 0.625 (VA's Level 1), or 1.00 (Level 2) when VA determines the veteran is unable to self-sustain in the community.
- Legacy participant or legacy applicant: the factor is set by the sum of the veteran's 2019 clinical ratings, and no self-sustain determination is required. That sum pays 1.00 at 21 or higher, 0.625 at 13 to 20, and 0.25 at 1 to 12.
- Both routes: a veteran who qualifies under each is paid at whichever factor is higher. A legacy participant's stipend also cannot fall below what the caregiver was eligible for on September 30, 2020, while the veteran remains at the address VA has on record. The legacy rules end on October 1, 2028.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
A legacy household whose 2019 ratings totaled 21 or more therefore reaches the full 1.00 factor on that sum alone, with no self-sustain finding involved, so ask your VA Caregiver Support Coordinator which factor VA has applied to your case.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
The second is Veteran-Directed Care (VDC), a VA program for veterans of all ages who are at risk of nursing home placement. In Maryland, the federal Administration for Community Living lists the VA Maryland Health Care System at Perry Point as a VDC program, with Bay Aging and the Maryland Department of Aging as the approved local agencies. The veteran, or a representative, manages a budget for services based on assessed needs and hires their own workers, which can include family members, friends, or neighbors. If you are the veteran's spouse, ask whether you can be the paid worker before you count on it. Through an options counselor, the local agency arranges fiscal management services. Services vary by location, so a veteran should ask their local VA medical center about availability and eligibility.U.S. Department of Veterans Affairs. (n.d.). Veteran-Directed Care - Geriatrics and Extended Care. va.gov. Retrieved Jul 13, 2026, from https://www.va.gov/GERIATRICS/pages/Veteran-Directed_Care.asp,U.S. Department of Veterans Affairs. (n.d.). Veteran-Directed Care - Geriatrics and Extended Care. va.gov. Retrieved Jun 24, 2026, from https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp
Aid and Attendance
A third VA benefit, Aid and Attendance, works differently from the two above. It does not pay a spouse a wage. It is an increased monthly pension, and VA says a veteran or survivor may be eligible if they get a VA pension and meet at least one of VA's listed requirements, such as needing another person to help with daily activities like bathing, feeding, and dressing. The payments are added to the monthly pension rather than paid to a caregiver.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.). Eligibility For Veterans Pension. va.gov. Retrieved Jul 31, 2026, from https://www.va.gov/pension/eligibility/ The Veterans Pension itself is for wartime veterans who meet age-or-disability requirements and have income and net worth within VA's limits.U.S. Department of Veterans Affairs. (n.d.). Current Pension Rates For Veterans. va.gov. Retrieved Sep 29, 2026, from https://www.va.gov/pension/veterans-pension-rates/
For 2026, effective December 1, 2025 through November 30, 2026, Aid and Attendance can bring the pension of a veteran with no dependents to as much as $29,093 a year, or $34,488 a year for a veteran with one dependent. A surviving spouse with no dependents can receive up to $18,697 a year. These are ceilings, not payments: VA pays the maximum minus your countable income, divided into monthly payments. To qualify, a veteran needs qualifying wartime service; no dishonorable discharge plus age 65 or older, a permanent and total disability, nursing-home care for a disability, or SSDI or SSI; net worth (VA counts income as well as assets) under $163,699; and a documented need for aid and attendance. Aid and Attendance is also subject to a 36-month look-back on asset transfers.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/,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/
How to Get Paid to Care for Your Spouse in Maryland: What to Do Next
Here is a practical order of operations for a Maryland couple.
- Check whether your spouse has full Medicaid, or could qualify. Community First Choice requires full Medicaid and an institutional level of care. If your spouse already has full Medicaid, CFC is the program to ask about first, but confirm a spouse can be the paid self-directed assistant.U.S. Government Publishing Office. (n.d.). 42 CFR 441.500 Basis and scope — Community First Choice (ecfr.gov). ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.500
- Ask for self-directed Community First Choice by name. When you contact Maryland Access Point or a Supports Planner, say you want to self-direct CFC and hire a family member. Self-direction is the setting under which a family member can be hired.Centers for Medicare & Medicaid Services. (n.d.). Maryland State Plan Amendment MD-23-0012, §1915(k) Community First Choice — Attachment 3.1-K, §viii.C (Qualifications of Providers of CFC Services). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf
- Confirm the spouse question for your specific program. The CFC rules do not mention spouses, and CPAS and ICS can bar a spouse, so confirm your own case before you count on the pay.aging.maryland.gov. (n.d.). Maryland Access Point — Maryland Department of Aging (aging.maryland.gov). Retrieved Jul 16, 2026, from https://aging.maryland.gov/programs-and-services/maryland-access-point
- If your spouse is a veteran, call the VA in parallel. PCAFC can pay a spouse, Veteran-Directed Care lets a veteran hire family members, and Aid and Attendance can add pension income, so a veteran couple should compare all three.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 Jul 13, 2026, from https://www.va.gov/GERIATRICS/pages/Veteran-Directed_Care.asp
- Ask about taxes. Under IRS Notice 2014-7, "qualified Medicaid waiver payments" for care given in the caregiver's own home, where the person cared for also lives, can be excluded from federal income. Community First Choice is a state plan benefit rather than a waiver, and for a Medicaid program that is not a waiver the IRS says the answer depends on the nature of the payments and the program's design. The rule never reaches private-pay money. Confirm your program's treatment with a tax professional before you report the pay.U.S. Government Publishing Office. (2024). 26 U.S.C. §131, Certain foster care payments (govinfo.gov, United States Code 2024 Edition). govinfo.gov. Retrieved Oct 13, 2026, from https://www.govinfo.gov/content/pkg/USCODE-2024-title26/html/USCODE-2024-title26-subtitleA-chap1-subchapB-partIII-sec131.htm,U.S. Government Publishing Office. (n.d.). 42 CFR 441.500 Basis and scope — Community First Choice (ecfr.gov). ecfr.gov. Retrieved Sep 2, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-441/subpart-K/section-441.500
Who to Call
- Maryland Access Point (MAP): 1-844-627-5465. Maryland's single entry point for long-term services and supports; ask about self-directed Community First Choice and paying a spouse.aging.maryland.gov. (n.d.). Maryland Access Point — Maryland Department of Aging (aging.maryland.gov). Retrieved Jul 16, 2026, from https://aging.maryland.gov/programs-and-services/maryland-access-point
- VA Caregiver Support Line: 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. Eastern. Ask about PCAFC and Veteran-Directed Care.U.S. Department of Veterans Affairs. (n.d.). VA's National Caregiver Support Line (CSL) - VA Caregiver Support Program. caregiver.va.gov. Retrieved Aug 1, 2026, from https://www.caregiver.va.gov/help_landing.asp
- Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov, the national way to reach your local Area Agency on Aging.Administration for Community Living. (n.d.). Area Agencies on Aging. acl.gov. Retrieved Jul 13, 2026, from https://acl.gov/programs/aging-and-disability-networks/area-agencies-aging
Frequently Asked Questions
Can my spouse be paid if we are on the Community Options Waiver?
The Community Options Waiver covers no personal assistance benefit of its own. A waiver participant gets paid personal assistance through Community First Choice or CPAS instead, so the spouse question turns on those programs' rules: self-directed CFC permits family members but does not mention spouses, so ask the program, while self-directed CPAS does not let participants hire legally liable relatives. Ask your Supports Planner about self-directed Community First Choice alongside the waiver.Centers for Medicare & Medicaid Services. (n.d.). CMS — Maryland Waiver Factsheet, entry for MD Home and Community Based Options Waiver (0265.R06.00). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MD,Centers for Medicare & Medicaid Services. (2023). Maryland State Plan Amendment MD-23-0012, Section 1915(k) Community First Choice, Attachment 3.1-K (effective July 1, 2023) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf,Centers for Medicare & Medicaid Services. (2024). Maryland State Plan Amendment MD-23-0014 — §1915(j) Community Personal Assistance Services (CPAS) self-directed personal assistance services, CMS approval letter (March 14, 2024) and approved SPA pages - Centers for Medicare & Medicaid Services. medicaid.gov. Retrieved Sep 30, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0014.pdf
How much does a self-directed spouse caregiver get paid in Maryland?
Under self-directed Community First Choice, the participant is the employer of their own personal assistant, and the financial management entity processes the payroll.Centers for Medicare & Medicaid Services. (n.d.). Maryland State Plan Amendment MD-23-0012, §1915(k) Community First Choice — Attachment 3.1-K, §viii.C (Qualifications of Providers of CFC Services). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf,U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Oct 15, 2026, from https://www.ecfr.gov/current/title-42/section-441.450 Ask your Supports Planner what rate your plan of service allows, since Brevy has not verified a single statewide figure to quote.
How does a spouse actually get on payroll in Maryland?
Through self-directed Community First Choice, the person receiving care is the employer, but the CFC sources do not say whether a spouse can be hired, so confirm that with the program first. If the program allows a spouse to be hired, the person receiving care must complete a background check on their spouse before hiring, and the spouse must be certified in first aid and CPR.Centers for Medicare & Medicaid Services. (n.d.). Maryland State Plan Amendment MD-23-0012, §1915(k) Community First Choice — Attachment 3.1-K, §viii.C (Qualifications of Providers of CFC Services). medicaid.gov. Retrieved Jul 15, 2026, from https://www.medicaid.gov/medicaid/spa/downloads/MD-23-0012.pdf Federal CFC rules require a financial management entity for anyone self-directing with a service budget; it processes timesheets and payroll and withholds and pays employment taxes, so a hired caregiver's paycheck comes through it.U.S. Government Publishing Office. (1915). 42 CFR 441.450 — Basis, scope, and definitions (Self-Directed PAS, 1915(j)) — eCFR current edition. ecfr.gov. Retrieved Oct 15, 2026, from https://www.ecfr.gov/current/title-42/section-441.450
Does the VA pay a spouse to be a caregiver in Maryland?
Yes, through PCAFC. The program pays an approved Primary Family Caregiver a monthly stipend, and a spouse can be that caregiver. VA's first screen is four requirements for the veteran: a 70 percent or higher disability rating, discharge from the U.S. military or a date of medical discharge, a six-month care need, and enrollment in VA health care. Those four are necessary but not sufficient, because VA also weighs further conditions during the application, such as whether the same care is already being regularly provided through another person or program.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-Directed Care, offered in Maryland, lets the veteran hire family members from their budget, so ask the VA whether that can include you.U.S. Department of Veterans Affairs. (n.d.). Veteran-Directed Care - Geriatrics and Extended Care. va.gov. Retrieved Jul 13, 2026, from https://www.va.gov/GERIATRICS/pages/Veteran-Directed_Care.asp
Is the money taxable?
VA has described the PCAFC monthly 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 For Medicaid pay, IRS Notice 2014-7 lets a caregiver exclude "qualified Medicaid waiver payments" for care given in their own home, where the person cared for also lives. Community First Choice is a state plan benefit rather than a waiver, and for a non-waiver Medicaid program the IRS says the answer depends on the nature of the payments and the program's design. Private-pay money is never covered. Ask a tax professional how your program's pay is treated.U.S. Government Publishing Office. (2024). 26 U.S.C. §131, Certain foster care payments (govinfo.gov, United States Code 2024 Edition). govinfo.gov. Retrieved Oct 13, 2026, from https://www.govinfo.gov/content/pkg/USCODE-2024-title26/html/USCODE-2024-title26-subtitleA-chap1-subchapB-partIII-sec131.htm
What is the difference between Aid and Attendance and being paid as a caregiver?
Aid and Attendance is added pension income that a veteran or surviving spouse who gets a VA pension may be eligible for by meeting at least one of VA's listed needs, such as help with daily activities.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 It raises what the household has to spend on care, but it is not a wage paid to the spouse. Being paid as a caregiver, through Medicaid self-direction or PCAFC, means the spouse is actually hired or approved and paid for the care they provide.
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