Unlike many states, Maryland is one of the places where a husband or wife often can be paid to provide care at home. So if you have been asking whether you can get paid to care for your spouse in Maryland, the honest answer is more hopeful than in most states.

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 a federal rule explained below. Maryland is different. Its main Medicaid home-care program, Community First Choice, lets a participant who directs their own care choose a family member to provide it, and the program's governing rules do not carve out a spouse. And if the person you care for is a veteran, the VA pays spouses 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 Maryland is a state where a spouse often can be paid, through Medicaid's self-directed home care, and where a veteran's spouse has additional VA routes on top of that. It helps to separate the two systems from the start, because families sometimes assume a spouse is automatically excluded when in Maryland that is usually not the case.

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 does not exclude a spouse, so in practice a husband or wife can generally be the paid personal assistant. Through the VA, an eligible veteran's spouse can also be paid, either a stipend through the PCAFC program or wages through Veteran-Directed Care.,

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 Generally yes, the state plan does not exclude a spouse
Medicaid, Community Personal Assistance Services Lighter personal-care benefit that also allows self-direction Self-direction with a relative is allowed, confirm the spouse question by program
VA PCAFC Tax-free monthly stipend to a veteran's Primary Family Caregiver Yes, a spouse can be the paid caregiver
VA Veteran-Directed Care Veteran's flexible budget to hire their own workers Yes, no bar on paying 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. The sections below explain how the Medicaid route works, why the spouse block that stops other states does not stop Maryland's main program, and how the VA routes work for veteran couples.

The Medicaid Self-Directed Route: Community First Choice

The reason a spouse can be paid in Maryland starts with how the state delivers home care. Self-direction, also called consumer direction, means the person receiving care, or their representative, controls the budget and hires, trains, and supervises their own workers, with a financial management agency handling payroll and taxes. That authority is what lets a relative become the paid caregiver in the first place.

Maryland's main home-care benefit is Community First Choice. It is a Medicaid state plan benefit rather than a capped waiver, so there is no waitlist. To qualify, a person must already have full Medicaid, need a nursing-facility 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.

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: they recruit, hire, supervise, and set the pay for their own personal assistant, within Medicaid rules. This is the doorway a spouse 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 the federal rule carves out a spouse.

A note on how strong to read that: the state plan permits family members broadly and contains no spouse exclusion, which is a genuinely favorable position, but it stops short of naming a spouse in so many words. So the honest way to plan is to treat a spouse as generally hireable under self-directed CFC and to confirm your specific situation before you count on it. Two people help you do that and handle the paperwork. A Supports Planner helps you build your plan of service, and a Financial Management and Counseling Services agency handles the employer tasks, background checks, payroll, and tax withholding, so the paycheck to the caregiving spouse comes through that agency.

Maryland also runs a lighter personal-care benefit, Community Personal Assistance Services (CPAS), for people who need hands-on help but not the fuller CFC package or an institutional level of care. CPAS also allows self-direction and hiring a relative. And if you have heard of the Community Options Waiver, know that it does not pay attendants itself; a waiver participant receives personal assistance through Community First Choice, so the spouse question there folds back into the CFC answer above.

When Maryland Says No: the Legally Responsible Relative Rule

To understand why Maryland is more open than many states, it helps to know the rule that blocks spouses elsewhere. 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, a category that includes a spouse. So under that particular benefit, a spouse is excluded. Self-direction is the exception: under the self-directed personal assistance authority, a state may choose to let participants hire legally liable relatives, including a spouse. Whether a spouse can be paid therefore depends on the state and on the specific Medicaid authority the care runs through.

Maryland lands on the permissive side for its main program, because Community First Choice runs on the self-directed model and its governing state plan carries no legally-responsible-relative exclusion. But that does not mean every Maryland program treats a spouse the same way. Rules differ from one program to the next, and some are narrower niche programs with their own attendant conditions. 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.

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, there are two more doors, and both can pay a spouse. 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 tax-free monthly stipend, and a spouse is expressly eligible to serve. PCAFC is for veterans with a VA disability rating of 70 percent or higher who need at least six months of continuous, in-person personal care and are enrolled in VA health care. The stipend is not a single national dollar figure: it is calculated from the federal pay scale for the area where the veteran lives, at 62.5 percent of that local monthly rate, or the full 100 percent if the VA finds the veteran unable to self-sustain in the community. 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.

The second is Veteran-Directed Care (VDC), which is offered in Maryland through the Maryland Department of Aging in partnership with the VA, and through the VA Maryland Health Care System. VDC gives an enrolled veteran a flexible monthly budget, set by the VA care team based on assessed need, that the veteran uses to hire and pay caregivers of their choosing. Family members are allowed, including a spouse, and unlike Aid and Attendance, VDC has no prohibition on paying a spouse. A financial management agency handles the payroll. Availability varies by county, so a veteran should ask their VA social worker or Caregiver Support Coordinator.,

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 for a qualifying wartime veteran or surviving spouse who needs another person to help with daily activities such as bathing, feeding, and dressing. The extra income raises what the household has to spend on care, which a couple can then put toward the cost of care at home.

For 2026, effective December 1, 2025 through November 30, 2026, Aid and Attendance can bring a single veteran's pension to as much as $2,424 a month, or $2,874 a month for a veteran with one dependent. A surviving spouse can receive up to $1,558 a month. To qualify, a veteran generally needs qualifying wartime service, an age of 65 or older or a permanent and total disability, net worth under $163,699, and a documented need for aid and attendance. Aid and Attendance and pension are also subject to a 36-month look-back on asset transfers, so plan ahead before moving money.,

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 a nursing-facility level of care. If your spouse already has full Medicaid, CFC is the most direct path to being paid, and there is no waitlist.
  • 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 that lets a spouse be the paid assistant.
  • Confirm the spouse question for your specific program. The main CFC rules do not exclude a spouse, but confirm your own case, especially if you are enrolled in a narrower program, before you count on the pay.
  • If your spouse is a veteran, call the VA in parallel. PCAFC and Veteran-Directed Care can pay a spouse, and Aid and Attendance can add pension income, so a veteran couple should compare all three.,
  • Ask about taxes. Wages paid to a caregiver who lives in the same home as the person they care for, under a Medicaid program, may be excludable from federal income as "qualified Medicaid waiver payments" under IRS Notice 2014-7. That rule reaches Medicaid payments, not private-pay money, and state tax treatment varies, so check with a tax preparer.

Who to Call

Frequently Asked Questions

Can my spouse be paid if we are on the Community Options Waiver?

The Community Options Waiver does not pay personal-care attendants on its own. A waiver participant receives that personal assistance through Community First Choice, so the spouse question folds back into the CFC rules: under self-directed CFC, a husband or wife can generally be the paid assistant. Ask your Supports Planner to set up self-directed Community First Choice alongside the waiver.,

How much does a self-directed spouse caregiver get paid in Maryland?

There is no single set hourly wage. Under self-directed Community First Choice, the participant is the employer and sets the pay for their own personal assistant within Medicaid rules, and a Financial Management and Counseling Services agency processes the paycheck. Ask your Supports Planner what rates your plan of service allows.,

How does a spouse actually get on payroll in Maryland?

Through self-directed Community First Choice, the person receiving care is the employer, and a Financial Management and Counseling Services agency handles background checks, hiring paperwork, payroll, and tax withholding. A Supports Planner helps build the plan of service. The caregiving spouse's paycheck comes through that financial management agency, not directly from the state.

Does the VA pay a spouse to be a caregiver in Maryland?

Yes. The PCAFC program pays an approved Primary Family Caregiver a tax-free monthly stipend, and a spouse is eligible, provided the veteran meets the 70 percent disability-rating, six-month care-need, and VA health care enrollment requirements. Veteran-Directed Care, offered in Maryland, can also pay a spouse from the veteran's flexible budget.

Is the money taxable?

The VA PCAFC stipend is a tax-free benefit. If a spouse is paid through a Medicaid program and lives in the same home as the person they care for, those wages may be excludable from federal income as "qualified Medicaid waiver payments" under IRS Notice 2014-7, though that rule reaches Medicaid payments, not private-pay money. State tax treatment varies, so ask a tax preparer familiar with caregiver pay.

What is the difference between Aid and Attendance and being paid as a caregiver?

Aid and Attendance is added pension income for a qualifying veteran or surviving spouse who needs help with daily activities. 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, PCAFC, or Veteran-Directed Care, means the spouse is actually hired and paid for the care they provide.

Learn More

CaregiverHow to Get Paid to Care for a Family Member in MarylandGet paid to care for a family member in Maryland: self-directed Community First Choice, the VA caregiver programs, and when a spouse can be hired. CaregiverHow to Get Paid to Care for Your Spouse: the national guideCan you get paid to care for your spouse? Spouses are often excluded from Medicaid pay, but some states, the VA PCAFC program, and Aid and Attendance do. CaregiverHow to Get Paid as a Family Caregiver: The 50-State GuideHow to get paid to care for a family member in 2026: Medicaid self-direction, VA caregiver programs, personal care agreements, plus all 50 state guides. CaregiverMaryland Caregiver Support ProgramsThe Maryland programs that support family caregivers, which ones pay you through Medicaid self-direction, how to get a respite break, and where to get help. VA BenefitsVA Aid and Attendance in MarylandVA Aid and Attendance in Maryland for 2026: who qualifies, monthly rates up to $2,874, how to apply, and free claims help from the MDVMF Service Program.

Find personalized help figuring out how to get paid to care for your spouse in Maryland 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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