How to Get Paid as a Family Caregiver in Minnesota (2026)

In Minnesota, a spouse or the parent of a minor can be paid as a family caregiver.1 The route is Community First Services and Supports (CFSS), a Minnesota health care program open to people enrolled in Medical Assistance (Minnesota's Medicaid program) and a few other state health care programs. DHS began implementing CFSS on October 1, 2024, and it replaces the old personal care assistance (PCA) and Consumer Support Grant programs.2

The Short Version

If the person you care for is enrolled in Medical Assistance or one of the other qualifying Minnesota health care programs, and an assessment finds them eligible, CFSS is the main route: they pick a delivery model, direct their care, and can choose you as their paid support worker, including if you are their spouse or the parent of a minor.1

If they are 65 or older and need a nursing-home level of care, look at the Elderly Waiver or Alternative Care with the consumer-directed community supports (CDCS) option, which lets them hire family.3 Veterans should check the VA pathways first, and families paying a relative privately must meet Minnesota's look-back rules: a notarized, written agreement or payment within 60 days after the care.6

What Makes Minnesota Different: CFSS and the Spouse-Pay Rule

CFSS replaces Minnesota's PCA program and the Consumer Support Grant. In both of its delivery models, the person receiving care directs their care and has a say in selecting their worker. DHS began implementing CFSS on October 1, 2024, and counties, tribal nations and managed care organizations move people over at their yearly reassessment so services are not disrupted.2

Under CFSS, the person receiving services can select their own spouse, or the parent of a minor child, as a paid support worker, in either delivery model. DHS puts it in one sentence: "In CFSS, a person’s spouse or the parent of a minor may serve as that person’s support worker."1

Hiring a spouse or parent does not by itself make anyone eligible. And in the budget model, the person receiving care, as the employer, takes on employer duties, including confirming worker competency, determining the workers' pay rate, and complying with the SEIU Healthcare Minnesota and Iowa collective bargaining agreement. Confirm the remaining worker rules with your lead agency or FMS provider.1

The Minnesota Paid Family Caregiver Pathways

1. CFSS Budget Model: You Become the Employer

Who pays: CFSS, a Minnesota health care program run by the Department of Human Services (DHS).2

Who can be paid: The support worker the person selects. DHS specifically names their spouse, the parent of a minor, and another person who uses CFSS services as options.2

What it is: In the budget model, the person receiving care is the employer of their support workers. They have a budget rather than service units, they recruit, hire, train, and supervise their own support workers, and they select a financial management services (FMS) provider to help with payroll.2

What it covers: The same main services as PCA: activities of daily living such as eating, bathing, grooming, and transferring; health-related tasks; instrumental activities such as shopping, cooking, laundry, and help with self-administered medications; and observation and redirection of behavior.2

Eligibility, recipient: Must live in the community rather than a facility such as a skilled nursing home, be able to direct care or have a representative who can, be enrolled in one of Minnesota's health care programs (Medical Assistance, an MA waiver, the Alternative Care program, or, for some people, MinnesotaCare), have an assessment that determines they are eligible, and not be using the Family Support Grant.1

Best for: Families who want the most control, including those where a spouse or parent of a minor wants to be the paid caregiver and the family is comfortable acting as the employer.

2. CFSS Agency-Provider Model: An Agency Is the Employer

Who pays: CFSS, the same DHS program.

Who can be paid: The same workers, including a spouse or parent of a minor, but hired and employed by an agency rather than by the family.1

What it is: In the agency-provider model, the person selects an agency that serves as their workers' employer, and the agency recruits, hires, trains, supervises, and pays the support workers. The person still has a say in selecting their worker, including a spouse or the parent of a minor, and reviews and approves the worker's documentation of time worked. In the agency model, the person has the same number of units they would have had if they had selected PCA.2

Best for: Families who want an agency to recruit, hire, and pay the family caregiver.

3. Consumer Support Grant (CSG): The Cash-Grant Predecessor

Who pays: The state, through the Consumer Support Grant program.

Who can be paid: Support workers the grant recipient hires and employs, including a spouse or, for a minor, a parent.7

What it is: CSG is a state-funded alternative to Medical Assistance home care services: the person directs a budget instead of those services, funded from the state share only.

The eligibility rules families miss: CSG requires Medical Assistance eligibility, and a person cannot use CSG while participating in any of these: Alternative Care, a home and community-based services waiver, Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+), PCA, home health aide or home care nursing services, or the Family Support Grant. The person must also meet the requirements for home care nursing, a home health aide, and/or PCA: able to direct and purchase their own care (or have a family member, legal representative, or other authorized representative do it), a functional limitation that requires ongoing support to live in the community, and living in their own or a family home rather than an institution, plus a PCA and/or home care nursing rating.7

How the budget is set: A CSG budget replacing PCA is roughly the PCA units the person is eligible for, multiplied by the current PCA rate, divided by two.7

CSG is being phased out under the CFSS transition: as of October 1 the state began moving current CSG users to CFSS at their next assessment, with the county or tribal nation authorizing six months of CSG during the changeover. People new to personal care assistance or CSG may not select CSG, so families starting fresh in 2026 will be directed to CFSS. DHS states: "All people must transition to CFSS by Sept. 30, 2027."7

Best for: People already on CSG; confirm your CFSS transition timeline with your lead agency.

4. Elderly Waiver and Alternative Care with CDCS

Who pays: Medical Assistance for the Elderly Waiver; a state legislative appropriation plus a federal match for Alternative Care.

Who can be paid: Under the consumer-directed community supports (CDCS) option, the person can hire family, friends, neighbors, a spouse, or the parent of a minor.3

What they are: The Elderly Waiver provides home and community-based services in place of a nursing home. DHS lists four conditions, and a person must meet all of them: be 65 or older, be eligible for Medical Assistance, meet nursing home level of care as determined by a MnCHOICES assessment, and need services the Elderly Waiver can provide for less than the cost of care in a nursing home. The asset limit is $3,000 for a single person and $6,000 for a household of two, and in most cases the home and one car do not count; someone whose income is too high can still get MA through a spenddown that deducts certain medical expenses from income; DHS puts the MA Elderly, Blind, Disabled figure at $1,330 a month for a household of one for July 1, 2026 through June 30, 2027, an approximation for general reference. DHS also warns that the state may make a claim against the person's estate, or their spouse's estate, if the person received MA on or after age 55. Alternative Care is the bridge for adults 65 and older who need that same level of care but are not yet financially eligible for Medical Assistance. A person must meet all of DHS's criteria, among them being 65 or older, being assessed through MnCHOICES as needing a nursing-facility level of care, having income and assets insufficient to pay for 135 days of nursing facility care, being able to pay a fee if one applies, having no other payer for the services, and needing services AC can deliver for less than 75 percent of what Medical Assistance would pay for someone with a similar level of need. Being on MA already bars a person from AC, and so does being at or below 120 percent of the federal poverty guidelines with assets at or below the $3,000 MA asset limit, though AC can cover such a person for up to 60 days while their MA application is pending.8,9

How family gets paid: Choose the CDCS option. CDCS gives the participant an individual budget and makes them the employer of their workers with help from an FMS provider. They develop a community support plan, then hire, train, supervise, and monitor the people they choose, including a spouse or the parent of a minor. CDCS is not a way onto a waiver: the person must already qualify for the Elderly Waiver or Alternative Care.3

Best for: An older adult who needs a nursing-home level of care, wants to stay home, and wants to pay a family member.

5. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran. VA requires the caregiver to be at least 18 and either be the veteran's spouse, son, daughter, parent, stepfamily member, or extended family member, or live full time with the veteran (or be willing to if VA designates them).5

The PCAFC stipend is built from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a factor of 0.25, 0.625, or 1.00. The factor depends on the veteran's track:

• Current program: 0.625, or 1.00 when VA determines the veteran is unable to self-sustain in the community.
• Legacy participant or legacy applicant: the factor comes from the sum of the veteran's 2019 clinical ratings instead, with no self-sustain determination required. That sum is 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. The legacy rules end on October 1, 2028.

The dollar figure depends on the locality pay area where the veteran lives, so confirm your factor and your exact stipend with your VA Caregiver Support Coordinator. VA lists four things that must all be true for the veteran: a VA disability rating (individual or combined) of 70 percent or higher; a discharge, 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. Those four are a first screen, not the decision: the veteran and caregiver apply together, and VA's application process determines eligibility. The stipend is paid monthly, and VA requires the caregiver to be enrolled in direct deposit through the VA customer engagement portal to get it.5

Best for: A family where one person gives an eligible veteran substantial daily care.

6. VA Veteran-Directed Care (VDC)

Who can be paid: Workers the veteran hires, who VA says might include their own family member or neighbor.4

Veteran-Directed Care is for veterans who need personal care services and help with daily activities: the veteran gets a budget for services, managed by the veteran or their representative, and with a counselor's help hires their own workers. In Minnesota, the Administration for Community Living (ACL) lists the Minneapolis VA Health Care System, the St. Cloud VA Medical Center, and the Fargo VA Medical Center as approved VDC providers, each working with the Minnesota River Area Agency on Aging. Availability is still a local question, so confirm with your VA social worker or Caregiver Support Coordinator.4

Best for: A Minnesota veteran who wants to hire their own workers, possibly a family member.

7. VA Aid and Attendance Pension

Who is paid: Aid and Attendance is an increased pension paid to the veteran or surviving spouse who needs help with daily activities, so any pay to a family caregiver comes from them under a private arrangement.10

VA publishes these as maximum annual rates. For 2026 (effective December 1, 2025 through November 30, 2026), a single veteran with Aid and Attendance receives up to $29,093 a year; a veteran with one dependent up to $34,488; a surviving spouse with Aid and Attendance up to $18,697. They are ceilings: VA pays the maximum rate less the claimant's countable income, and the monthly rate is that yearly remainder divided by 12, rounded down to the whole dollar. The net worth limit is $163,699.11 For help filing, Minnesota law bars a County Veterans Service Officer from taking any fee for helping secure veterans' benefits, and the Minnesota Department of Veterans Affairs claims divisions also represent pension claimants. An accredited attorney or claims agent, by contrast, can charge fees.12 If the veteran also needs Medical Assistance, Minnesota counts Aid and Attendance as income: its eligibility manual says VA Aid and Attendance benefits "are not excluded, even if the person is receiving SSI."10

Best for: A veteran or surviving spouse on VA pension who needs help with daily activities.

8. Private Personal Services Contract

Who can be paid: A relative, such as an adult child or sibling, paid from the care recipient's own funds. A transfer to a spouse falls under a separate exception in Minnesota's look-back law.6

What it is: A notarized, written agreement between the care recipient (or their legal representative) and the relative, in place before the care is provided, setting the pay for the care or personal services.

Why the format matters: Minnesota applies a 60-month look-back under Minnesota Statutes 256B.0595 when a person asks Medical Assistance to pay for long-term care. The statute covers payments to a relative for care or personal services unless the pay was stipulated in a notarized, written agreement that existed when the service was performed, the care directly benefited the person, and the payments were reasonable compensation. A notarized agreement is not required if each payment was made within 60 days after the service. Pay that meets neither route can be treated as an uncompensated transfer, which creates a period of ineligibility for long-term care services: the uncompensated amount divided by the statewide average monthly payment rate for skilled nursing facility care. That rate is recalculated each July 1, so get the current figure from your county or tribal agency rather than relying on a published number.6

Best for: Families with enough assets to private-pay a caregiver who also want to preserve future Medicaid eligibility. Work with a Minnesota elder-law attorney to draft the contract.

Comparing the Minnesota Pathways

How to Choose a Minnesota Pathway

Tax Considerations

A full-year Minnesota resident pays Minnesota tax on all of their income, so wages you are paid as a family caregiver, including through a Medicaid program, count unless a specific provision excludes them.13

• CFSS and CDCS: wages run through the agency's payroll or with an FMS provider's help; ask them how your wages are reported.2
• VA PCAFC and Aid and Attendance: ask a tax preparer how these payments, and wages paid from them, are treated.
• Personal services contracts: ask a tax preparer how the pay should be reported.

IRS Notice 2014-7: If you live in the same home as the person you care for and are paid under a state Medicaid home and community-based services waiver program (a section 1915(c) waiver), those payments may be excluded from your federal gross income. For a Medicaid program that is not an HCBS waiver, the IRS says the treatment "will depend on the nature of the payments and the purpose and design of the program," so confirm how your own program is treated with a tax professional. The same-home condition is strict: if you have a separate home where you live and carry on your private life, you cannot exclude the payments.14

Minnesota state income tax: Minnesota taxes wage income on a progressive scale, at rates of 5.35, 6.8, 7.85, and 9.85 percent that are set in state law; only the dollar amounts of the brackets change from year to year, adjusted for inflation. Notice 2014-7 addresses federal income tax, so confirm state treatment with a Minnesota tax preparer before you file.13

Common Misconceptions

"If Mom has Medicare, I can get paid through Medicare." Original Medicare does not pay family members or friends a wage to provide personal or custodial care. Its home health benefit pays a Medicare-certified agency, never a relative, and it does not cover 24-hour-a-day care at home.15

Related Terms

• HCBS waiver: The federal authority for home and community-based waivers like the Elderly Waiver, one of the programs that offer the CDCS option.
• Activities of Daily Living (ADLs): Everyday tasks such as eating, bathing, grooming, and transferring, which CFSS support workers help with.
• Nursing Facility Level of Care: The clinical threshold for Elderly Waiver and Alternative Care eligibility.

Learn More

Find personalized help getting paid as a family caregiver in Minnesota 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.