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

Minnesota is one of the few states that will pay a spouse or the parent of a minor to be a family caregiver.1 It does this through a Medicaid program most families have never heard of: Community First Services and Supports (CFSS), which began statewide in October 2024 and is replacing the old personal care assistance (PCA) and Consumer Support Grant programs.2

That is the headline: in either CFSS delivery model, the person receiving care can choose their own spouse, or the parent of a minor child, as a paid support worker. This guide covers every legitimate way to be paid as a family caregiver in Minnesota for 2026: who can be hired under each route, how the money flows, and how to pick the one that fits your family.

The Short Version

If the person you care for qualifies for Medical Assistance (Minnesota's Medicaid program) and needs help with daily activities, CFSS is the main route: they pick a delivery model and direct their own care, and you are paid as their support worker, including if you are their spouse or the parent of a minor.

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 also pays family. If they are a veteran, check the VA first: Veteran-Directed Care and the VA caregiver stipend can pay a spouse. And if the family has enough private assets, a written personal services contract can pay a caregiver now while documenting the arrangement for Minnesota's 60-month Medicaid look-back later.

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

Minnesota delivers most of its Medicaid in-home personal care through CFSS, a program built around self-direction: the person receiving care, not an agency scheduler, has the central say in who provides their care and how. CFSS replaced the older PCA program when it began rolling out on October 1, 2024, and it is also absorbing the Consumer Support Grant. Everyone still on PCA, PCA Choice, or CSG who stays eligible transitions to CFSS at their next assessment rather than on a single statewide cutoff date.2

Here is the part that surprises families: 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.1 In Washington, California, and many other states, a husband or wife generally cannot be paid through standard Medicaid personal care. Minnesota does, which changes the math for households where one spouse has left a job to provide care.

One honest caveat: the hours a spouse or parent of a minor can be paid for may be limited, and the assessment sets them. Confirm the authorized hours with Minnesota DHS or your county or tribal lead agency rather than assuming the full assessed amount can go to a spouse.1

The Minnesota Paid Family Caregiver Pathways

1. CFSS Budget Model: You Become the Employer

Who pays: Medical Assistance, administered by DHS through your county or tribal lead agency.

Who can be paid: Adult children, other relatives, friends, and notably a spouse or the parent of a minor.1

What it is: In the budget model, the person receiving care is the employer of their own support workers. Instead of a fixed block of service units, they get a budget to recruit, hire, train, and supervise the people who provide their care, and they select a financial management services (FMS) provider that runs payroll, withholds taxes, and handles the employer paperwork.2

What it covers: Help with activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental activities (meals, medication reminders, housekeeping, shopping), plus certain health-related tasks and a budget to train workers on the person's needs.2

Eligibility, recipient: Must qualify for Medical Assistance and have an assessed need for help with daily activities, determined through a MnCHOICES assessment scheduled by the county or tribal nation.5

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: Medical Assistance through DHS and the lead agency.

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 a CFSS agency that serves as the workers' employer and recruits, hires, trains, supervises, and pays the support workers. The person still has a say in who is chosen, including a spouse, adult child, or friend, but the agency carries the employer responsibilities.2

Best for: Families who want a paid family caregiver but prefer an agency to handle employment, payroll, and compliance.

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.6

What it is: CSG is a state-funded alternative to Medical Assistance home care services (home care nursing, home health aide, and personal care assistance): the person receives a budget they direct instead of those services, funded from the state share only.

The eligibility rule families miss: CSG is the mirror image of Alternative Care. AC is for people not yet financially eligible for Medical Assistance; CSG requires Medical Assistance eligibility. 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.6

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. Purchases can go beyond the usual home care categories, but each must relate to the person's functional limitations and an assessed need, help delay or prevent out-of-home placement, and not be covered by another source such as Medical Assistance or private insurance.6

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.6

Best for: People already on CSG who are enrolled in Medical Assistance and hold a PCA or home care nursing rating; 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 is a Medicaid home and community-based services waiver for people 65 or older who need a nursing-facility level of care but choose to live in the community, and it requires Medical Assistance eligibility. The senior asset limit is $3,000 for an individual and $6,000 for a couple, with the home and one vehicle generally excluded; someone whose income is too high spends down to the senior MA standard of 100 percent of the federal poverty guideline, approximately $1,300 a month, updated each July. Functional eligibility comes from a MnCHOICES assessment. 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. To qualify, a person must be 65 or older, be assessed through MnCHOICES as needing a nursing-facility level of care, have income and assets insufficient to pay for 135 days of nursing facility care, be able to pay a fee if one applies, have no other way to pay, and need services AC can deliver for less than 75 percent of what Medical Assistance would pay for someone with a similar level of need. Someone at or below 120 percent of the federal poverty guidelines with assets at or below the $3,000 MA asset limit cannot be on AC, though AC can cover them for up to 60 days while their MA application is pending. AC is funded by a Minnesota legislative appropriation plus a federal match DHS has drawn since November 1, 2013 under a CMS-approved 1115 waiver.5,7

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 support plan, then hire, train, and supervise the people they choose, including a spouse or parent.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, which can be a spouse, adult child, parent, or other family member.8

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 one of four factors. Which factor applies turns on whether the veteran qualifies under the current program or as a legacy participant or legacy applicant:

• 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 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. A legacy participant's stipend also cannot fall below what the caregiver was eligible for on September 30, 2020, as long as the veteran stays at the address VA has on record. The legacy rules end on October 1, 2028.

So a legacy household whose 2019 ratings totaled 21 or more reaches the full 1.00 factor on the rating sum alone, without any self-sustain finding. The dollar figure depends on the Minnesota locality, so confirm your factor and your exact stipend with your VA Caregiver Support Coordinator. The veteran needs a service-connected rating of 70 percent or higher, a six-month need for in-person personal care, and enrollment in VA health care. The stipend is federal tax-free, allows paid spouses, and can combine with Aid and Attendance and Medicaid.8

Best for: Families of an eligible veteran where one person provides substantial daily care.

6. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse.4

Veteran-Directed Care gives the veteran a flexible monthly budget, managed by the veteran or their representative with a counselor's help, to hire and pay their own workers, including family members; a fiscal agent runs payroll. In Minnesota, VDC is offered through the Minneapolis VA Health Care System caregiver support program. Availability is set by the local VA facility, so veterans elsewhere in the state should ask their VA social worker whether their facility offers it.4

Best for: A Minnesota veteran who wants to pay a spouse or set their caregiver's schedule and rate directly.

7. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension directly, and a family caregiver is typically paid out of it under a private arrangement.9

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. The monthly payment is the yearly award divided by 12. The net worth limit is $163,699. The benefit goes to a wartime veteran (90 days of active duty including one wartime day) or surviving spouse who meets the functional criteria and the income and asset limits. Minnesota's county Veterans Service Officers and the Minnesota Department of Veterans Affairs help file at no cost; avoid for-profit pension consultants who charge a fee.9

Best for: A wartime veteran or surviving spouse under the income and asset limits who needs help with daily activities.

8. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, since transfers between spouses are treated differently.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income.

Why the format matters: Minnesota enforces a 60-month Medicaid look-back under Minnesota Statutes 256B.0595. Without a written contract, money that flows from an aging parent to an adult child for care is presumed to be a gift and can create a penalty period when the parent later applies for long-term care. The penalty is the uncompensated amount divided by the statewide average nursing-facility payment rate in effect on the application date, a figure DHS adjusts each July 1, so confirm the current rate with DHS or a Minnesota elder-law attorney rather than relying on a fixed number.10

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

Start with the care recipient's situation:

Start any Medicaid route by contacting your county or tribal nation to schedule a MnCHOICES assessment.

Tax Considerations

Most Minnesota caregiver pay is reportable income, with one valuable federal exception.

• CFSS, CSG, the Elderly Waiver, and CDCS generally pay wages reported for tax purposes, with withholding handled by the agency or your FMS provider.
• VA PCAFC is a federal tax-free stipend. VA Aid and Attendance is tax-free to the veteran, but a caregiver the veteran then pays out of it receives ordinary taxable income.
• Personal services contracts pay W-2 or 1099 income depending on how the caregiver is classified.

IRS Notice 2014-7: If you live in the same home as the person you care for and you are paid through a Medicaid program, your wages may be excluded from federal gross income. This applies to many Minnesota self-directed arrangements.11

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. A full-year Minnesota resident pays Minnesota tax on all of their income, and the federal Notice 2014-7 exclusion does not automatically carry over to your Minnesota return, so confirm state treatment with a Minnesota tax preparer before you file.12

Common Misconceptions

"A spouse can never be paid as a Medicaid caregiver." True in many states, but not Minnesota. Under CFSS, a spouse or the parent of a minor child can be a paid support worker in either delivery model.

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It covers short-term skilled home health through certified agencies only. Paid family caregiving in Minnesota comes through Medical Assistance, the VA, or a private contract.

"I can just start getting paid out of Dad's bank account." Not without a written personal services contract. An informal transfer of a parent's money to a child for care is treated as a gift under Minnesota's 60-month look-back and can delay the parent's Medicaid eligibility later.

"The state mails me a paycheck." No. The state authorizes the budget; your FMS provider (budget model) or the CFSS agency (agency model) is what pays you.

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs like Minnesota's CFSS budget model and CDCS, where the care recipient directs their own worker.
• HCBS waiver: The federal authority behind the Elderly Waiver and the CDCS option that pays family.
• Activities of Daily Living (ADLs): The functional basis for authorizing personal care hours across Minnesota's programs.
• 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.