You can get paid as a family caregiver in Nebraska, and which door you use turns on one question: whether you are legally responsible for the person you care for.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
On the Medicaid side there are two named services with opposite rules. Personal Assistance Services, the state plan benefit, pays a family member as long as that family member is not legally responsible for the participant, which covers an adult child or a sibling but not a spouse. LRI Personal Care, a waiver service, pays exactly the people Personal Assistance Services will not: a spouse, or the parent of a minor child.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE If your loved one is a veteran with a VA disability rating of 70% or higher who meets VA's other requirements, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) can pay a monthly stipend to you as the veteran's designated Primary Family Caregiver, and Veteran-Directed Care and Aid and Attendance add two more veteran-based routes.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,U.S. Department of Veterans Affairs. (2022). Veteran-Directed Care (VA Geriatrics and Extended Care fact sheet, revised February 2022). va.gov. Retrieved Sep 26, 2026, from https://www.va.gov/geriatrics/docs/Veteran-Directed_Care.pdf
The Short Version
If the person you care for is not a veteran, your Medicaid route depends on who you are to them. Not legally responsible for them? Personal Assistance Services can pay you. Their spouse? Your route is LRI Personal Care, which exists only on a waiver, so they have to qualify for a waiver first. Ask Nebraska DHHS for whichever fits, by name.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
If your loved one is a veteran, the VA programs below follow national rules, though Veteran-Directed Care is only offered in certain locations.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,U.S. Department of Veterans Affairs. (2022). Veteran-Directed Care (VA Geriatrics and Extended Care fact sheet, revised February 2022). va.gov. Retrieved Sep 26, 2026, from https://www.va.gov/geriatrics/docs/Veteran-Directed_Care.pdf
If you have private assets and may need Medicaid later, a written caregiver agreement at a fair market rate, signed before care begins, is your record for the look-back's exception for transfers at fair market value.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
How to Get Paid as a Family Caregiver in Nebraska Through Medicaid
Nebraska's Two Medicaid Routes to Family Caregiver Pay
Personal Assistance Services (PAS): the State Plan Route
Personal Assistance Services is Nebraska Medicaid's state plan help with activities of daily living, such as bathing or dressing. You may qualify if you are a person of any age who receives Medicaid, lives in your own home rather than an institution, and has an assessed need for the service in order to live in the community.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Can a family member be the paid provider? Yes, unless that family member is legally responsible for the participant. A spouse, or the parent or guardian of a minor child, cannot, and whoever does the work must meet the provider qualifications. DHHS also says a participant has the right to choose their provider and direct their own care.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
What to ask DHHS: what the provider qualifications and enrollment steps are for a family member on Personal Assistance Services, and how many hours the assessment authorizes.
LRI Personal Care and the HCBS Waivers
Nebraska has five active home and community-based waivers. Two serve adults at a nursing facility level of care: the Aged and Disabled (AD) waiver, for individuals ages 65 or older and individuals with physical disabilities ages 0 to 64, and the Traumatic Brain Injury (TBI) waiver, for individuals with brain injury ages 18 or older. The other three, for people with autism, intellectual disabilities or developmental disabilities, use an ICF/IID level of care instead.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Who may be paid depends on the service. On the AD waiver a relative may be paid to provide Personal Care, Respite and Chore, while a Legally Responsible Individual may not. LRI Personal Care is the one AD waiver service an LRI may be paid for, and a relative who is not an LRI may not be paid for that one. The TBI waiver follows the same pattern. LRI Personal Care is offered on the AD waiver, all three Developmental Disabilities waivers, and, as of July 1, 2026, the TBI waiver.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
To be eligible for AD waiver services a person must already receive Nebraska Medicaid, have a disability or be over the age of 65, meet nursing facility level of care, and have a need for waiver services, so Medicaid financial eligibility is a separate determination that comes first.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Lifespan Respite: Support Without a Wage
Nebraska DHHS runs the Lifespan Respite program for eligible people across the lifespan with medical, mental or behavioral special needs. It provides up to $125 per month for planned respite per client, plus an additional $2,000 per eligibility period for qualified Exceptional Circumstances including crisis respite. It will only serve people who are not receiving and not eligible for respite services from another government program, and a waiver participant can receive respite from only one source, so a family already getting AD waiver respite cannot also draw Lifespan Respite.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
It also funds only unpaid primary family caregivers, who must give care without reimbursement or payment, live with the person or give at least 4 hours of care a day in their home, and not use respite while working. A family member paid through Personal Assistance Services, LRI Personal Care or waiver Personal Care does not qualify, so treat paid care and Lifespan Respite as alternatives.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
How a Family Provider Enrolls and Is Paid
Each step gates the next. Confirm the specifics with a DHHS caseworker or your service coordinator as you go.
Confirm the care recipient's Medicaid eligibility
The person receiving care must qualify for Nebraska Medicaid first. Nebraska uses an AABD/MA resource limit of $4,000 for a single applicant. Someone over the income limit with costly medical bills can qualify through the Medically Needy program by putting monthly income above the Medically Needy Income Level toward those bills (the share of cost). Apply online at iServe Nebraska, by phone, or on paper mailed to a DHHS office.U.S. Government Publishing Office. (n.d.). ecfr.gov. Retrieved Aug 8, 2026, from https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-435/subpart-H/section-435.725
Request an assessment
DHHS determines whether the person has an assessed need for Personal Assistance Services in order to live in the community, or meets the nursing facility level of care a waiver requires. That finding sets which route is open to you.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Name the service that matches your relationship
If you are not legally responsible for the person you care for, ask about becoming their Personal Assistance Services provider. If you are their spouse, or the parent of a minor child, ask about LRI Personal Care on a waiver, by name.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Complete provider enrollment
Whoever is paid must be able to meet the qualifications to become a provider, and LRI Personal Care in particular cannot be authorized until the provider is fully enrolled, so finish this before you count on any hours.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Understand how you are paid and tracked
People delivering LRI Personal Care are W-2 employees, and the service is tracked with an Extraordinary Care Tool and Electronic Visit Verification.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
What if you are told a spouse cannot be paid? That answer is correct about Personal Assistance Services and wrong about the waivers, so ask the follow-up in these words: is LRI Personal Care available on the waiver my spouse qualifies for, and what does provider enrollment require? If they do not meet nursing facility level of care and no waiver is open to them, Personal Assistance Services can still pay a family member who is not legally responsible for them, as long as they have an assessed need for the service.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE If your loved one is also a veteran, PCAFC, below, can pay a spouse as the Primary Family Caregiver under VA's own eligibility rules rather than a Medicaid waiver's.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
How to Get Paid as a Family Caregiver in Nebraska Through the VA
VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated Primary Family Caregiver, who must be at least 18 years old and either a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or someone who lives full time with the veteran (or is willing to if VA designates them as a family caregiver). A veteran may also appoint 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 monthly base is the OPM GS-4 Step 1 annual rate for the veteran's locality, divided by 12; it is not an hourly wage. 38 CFR 71.40(c)(4)(i) then multiplies that base by a factor, which depends first on whether the veteran is in the current program under 38 CFR 71.20(a) or is a legacy participant or legacy applicant under 38 CFR 71.20(b) or (c).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
| Route | What sets the factor | Multiplier |
|---|---|---|
| Current program, 38 CFR 71.20(a) | Default | 0.625 |
| Current program, 38 CFR 71.20(a) | VA determines the veteran is "unable to self-sustain in the community" | 1.00 |
| Legacy participant or applicant, 38 CFR 71.20(b) or (c) | Sum of the veteran's 2019 clinical ratings is 21 or higher | 1.00 |
| Legacy participant or applicant, 38 CFR 71.20(b) or (c) | 2019 rating sum is 13 to 20 | 0.625 |
| Legacy participant or applicant, 38 CFR 71.20(b) or (c) | 2019 rating sum is 1 to 12 | 0.25 |
Three rules sit on top of that grid. First, the legacy schedule reaches 1.00 on the rating sum alone, with no self-sustain determination. Second, a veteran who meets both the current-program and the legacy criteria is paid whichever of the two amounts is higher. Third, a legacy participant's stipend is held at not less than what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran still resides at the address on record with PCAFC on that date. That schedule runs eight years from October 1, 2020 and lapses October 1, 2028.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
Confirm your locality's GS-4 Step 1 figure and your row in the grid with your VA Caregiver Support Coordinator.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
Veteran eligibility: VA disability rating of 70% or higher (individual or combined); discharged from the U.S. military or has a date of medical discharge; enrolled in VA health care; needs at least 6 months of continuous, in-person personal care services. These are a first screen: you and the veteran apply together, and VA's application process decides eligibility.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
Other benefits: Primary and Secondary Family Caregivers can get caregiver education and training and certain travel benefits when traveling with the veteran to receive care. The primary caregiver can also get CHAMPVA health care benefits if you don't already qualify for care under another health care plan, at least 30 days of respite care per year, and free legal and financial planning assistance related to the veteran's needs.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
How the caregiver is paid: By direct deposit; you must enroll in direct deposit through the VA customer engagement portal to get the stipend.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
Apply: Through the VA Program of Comprehensive Assistance for Family Caregivers portal, or work with your VA Caregiver Support Coordinator at the VA Nebraska-Western Iowa Health Care System.
VA Veteran-Directed Care
Who can be paid: Workers the veteran chooses and hires, which VA says might include a family member or neighbor, and ACL says can include family, friends and neighbors. If you are the veteran's spouse, ask the VAMC directly whether a spouse can be the paid worker.U.S. Department of Veterans Affairs. (2022). Veteran-Directed Care (VA Geriatrics and Extended Care fact sheet, revised February 2022). va.gov. Retrieved Sep 26, 2026, from https://www.va.gov/geriatrics/docs/Veteran-Directed_Care.pdf
How it works: The veteran receives a flexible monthly budget based on their need for help with activities of daily living, managed by the veteran or a representative with a counselor's help. A financial management services provider handles payroll and taxes.Administration for Community Living. (n.d.). Veteran Directed Care — ACL No Wrong Door. acl.gov. Retrieved Sep 26, 2026, from https://acl.gov/nwd/veteran-directed-care
Veteran eligibility: Enrolled in VA health care and meets the clinical need for the service, such as needing help with bathing or getting dressed. VDC is only available in certain locations, so ask your VA social worker whether it is offered near you.U.S. Department of Veterans Affairs. (2022). Veteran-Directed Care (VA Geriatrics and Extended Care fact sheet, revised February 2022). va.gov. Retrieved Sep 26, 2026, from https://www.va.gov/geriatrics/docs/Veteran-Directed_Care.pdf
VA Aid and Attendance Pension
Who is paid: The pension goes to the veteran or surviving spouse, not to the caregiver. Care given by a relative or another member of the household does not prevent VA from granting the Aid and Attendance allowance.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 benefit maximums (Maximum Annual Pension Rate, effective Dec 1, 2025 through Nov 30, 2026). These are ceilings, not guaranteed payments: VA pays the difference between the claimant's countable income and the applicable MAPR, so a veteran or surviving spouse who has other income receives less than the maximum shown here. VA publishes these as yearly amounts, not monthly ones.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/
- Veteran with no dependents, with Aid and Attendance: up to $29,093/year
- Veteran with one dependent, with Aid and Attendance: up to $34,488/year
- Two veterans married to each other who both qualify for Aid and Attendance: up to $46,143/year
- Surviving spouse with no dependents, with Aid and Attendance: up to $18,697/year
- Each additional dependent adds $2,984/year
Net worth limit (2026): $163,699. The calculation counts the claimant's and dependents' assets and income for VA purposes; assets exclude the primary residence, the car, and basic home items.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 must qualify for VA pension (wartime service, age 65 or another listed condition, and income and net worth limits, among other rules) and have at least 1 aid-and-attendance need, such as help with bathing, feeding and dressing, being confined to bed by illness, nursing home care due to a disability, or severely limited eyesight. A surviving spouse has a separate Survivors Pension Aid and Attendance rate.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/,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/
36-month look-back: VA pension is subject to a 36-month look-back on asset transfers for less than fair market value made on or after October 18, 2018, under 38 CFR 3.276.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/
Apply: Through va.gov/pension/aid-attendance-housebound or free of charge through an accredited veterans service officer at the Nebraska Department of Veterans' Affairs State Service Office.nebraskalegislature.gov. (n.d.). Neb. Rev. Stat. 80-407 — County veterans service committee; duties; appointment of county veterans service officer. Retrieved Aug 25, 2026, from https://nebraskalegislature.gov/laws/statutes.php?statute=80-407
Private Caregiver Agreement (Personal Services Contract)
A written caregiver agreement can formalize the payment of a family member from private funds.
The look-back issue: Federal Medicaid law sets a 60-month (5-year) look-back that runs back from the Medicaid application. Transfers for less than fair market value inside that window trigger a penalty period during which Medicaid will not pay for long-term care. Federal law excuses the penalty on a satisfactory showing to the state that the assets were meant to be transferred at fair market value or for other valuable consideration. A written contract at a fair market rate is the record you would offer; the state decides whether it is enough.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
What to put in writing, with an elder-law attorney's help:
- Sign the agreement before care begins, with a start date
- The specific services and a weekly schedule
- An hourly rate you can show matches local market rates
- Payment terms and method
- Daily logs of hours and tasks performed
- Ask a tax preparer how the caregiver should report the pay
Not for spouses: Federal law already exempts assets transferred to a person's spouse from the transfer penalty, so the Medicaid look-back protection that a contract provides for adult children does not apply the same way for spouses.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
Comparison Table
| Pathway | Pay spouses? | Pay non-spouse family? | 2026 pay | Waitlist? | Key step |
|---|---|---|---|---|---|
| PAS personal care (Medicaid state plan) | No | Yes, if not legally responsible | Confirm with DHHS | Confirm with DHHS | Ask DHHS for a PAS assessment |
| LRI Personal Care (HCBS waiver) | Yes | No | Confirm with DHHS | Confirm with DHHS | Ask for LRI Personal Care by name |
| VA PCAFC | Yes | Yes | GS-4 Step 1 locality annual rate ÷ 12, times 0.25, 0.625 or 1.00 | Confirm with VA | Apply jointly with the veteran; a 70%+ VA disability rating is one of four VA requirements |
| VA Veteran-Directed Care | Ask the VAMC | Yes | Paid from the veteran's VA budget | Only in certain locations | Enrolled in VA health care |
| VA Aid and Attendance | Paid to veteran | Paid to veteran | Up to $29,093/yr (veteran, no dependents) | Confirm with VA | Wartime service, A&A criteria |
| Private Caregiver Agreement | Not for look-back purposes | Yes (with written contract) | Fair market rate | Not applicable | Have an elder-law attorney draft it |
How to Choose
Caring for a veteran? Start with VA programs, beginning with your VA Caregiver Support Coordinator.
Medicaid-eligible, not a veteran? Ask Nebraska DHHS about Personal Assistance Services if you are not legally responsible for the person you care for, or about LRI Personal Care on a waiver if you are their spouse.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Want maximum flexibility in who you hire? Veteran-Directed Care, where offered, lets the veteran hire their own workers. Ask the VAMC social work team about it.U.S. Department of Veterans Affairs. (2022). Veteran-Directed Care (VA Geriatrics and Extended Care fact sheet, revised February 2022). va.gov. Retrieved Sep 26, 2026, from https://www.va.gov/geriatrics/docs/Veteran-Directed_Care.pdf
Have private assets and concerned about Medicaid later? Have an elder-law attorney draft a personal services contract before payments start. The federal 60-month look-back applies.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
Unpaid caregiver needing a break? Ask Nebraska DHHS about Lifespan Respite, described above; it is only for caregivers not being paid for the care.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Not sure where to start in Nebraska? Chat with Brevy's care navigator for a personalized look at veteran status, Medicaid eligibility, and which pathway fits your family's situation.
Tax Considerations
- Medicaid personal care wages (Personal Assistance Services, or a waiver service such as LRI Personal Care): confirm tax treatment with DHHS and a tax preparer.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
- VA PCAFC stipend: ask a tax preparer how it is taxed, and VA how it affects other benefits.
- VA Veteran-Directed Care wages run through a financial management services provider, which handles payroll taxes and issues W-2 forms to workers.Administration for Community Living. (n.d.). Veteran Directed Care — ACL No Wrong Door. acl.gov. Retrieved Sep 26, 2026, from https://acl.gov/nwd/veteran-directed-care
- VA Aid and Attendance is paid to the veteran or surviving spouse; ask a tax preparer how caregiver payments from it are taxed.
- Private caregiver agreement pay: ask a tax preparer how to report it and whether the caregiver is an employee.
IRS Notice 2014-7: qualified Medicaid waiver payments for care given in the caregiver's own home, where the person receiving care also lives, may be excluded from the caregiver's federal gross income; the exclusion does not apply if the caregiver has a separate home. LRI Personal Care is a waiver service, so if you live with the person you care for, ask a tax preparer familiar with the rule.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
Common Misconceptions
"Nebraska will not pay a spouse." True of Personal Assistance Services, the state plan benefit. On the waiver side, LRI Personal Care exists to pay a Legally Responsible Individual: a spouse or the parent of a minor child.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
"Medicare pays family caregivers." Original Medicare does not pay family members a wage to provide care. Its home health benefit pays a Medicare-certified agency for part-time or intermittent skilled care for people who are homebound.Centers for Medicare & Medicaid Services. (n.d.). Home Health Services Coverage. medicare.gov. Retrieved Jul 17, 2026, from https://www.medicare.gov/coverage/home-health-services
"I can start paying myself from my parent's savings and document it later." Risky. Inside the 60-month look-back, transfers for less than fair market value draw a penalty unless an exception applies, such as a satisfactory showing that the assets were transferred at fair market value or for other valuable consideration. A written agreement signed before care begins is your record for that showing.U.S. Social Security Administration. (n.d.). Social Security Act sec. 1917(c) [42 U.S.C. 1396p(c)] - Taking into account certain transfers of assets: look-back date, penalty period, start date, divisor, and the (c)(2) exceptions (SSA Compilation of the Social Security Laws). ssa.gov. Retrieved Oct 8, 2026, from https://www.ssa.gov/OP_Home/ssact/title19/1917.htm
Frequently Asked Questions
Can a family member get paid to care for a Nebraska Medicaid recipient?
Yes. Personal Assistance Services, the state plan benefit, can pay a family member who is not legally responsible for the participant; a spouse, or the parent or guardian of a minor child, cannot be paid that way. A spouse is paid instead through LRI Personal Care on a waiver. Whoever is paid must meet the provider qualifications.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
How much does the VA PCAFC pay in Nebraska?
The PCAFC stipend is the OPM GS-4 Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a factor set in 38 CFR 71.40(c)(4)(i): 0.625 in the current program, or 1.00 if VA determines the veteran is unable to self-sustain in the community, and 0.25, 0.625 or 1.00 for a legacy participant until October 1, 2028. Confirm your figure with your VA Caregiver Support Coordinator.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
Can I get paid through both VA PCAFC and Nebraska Medicaid at the same time?
They are separate programs: PCAFC is run by the VA, while Personal Assistance Services and LRI Personal Care are Nebraska Medicaid services, so each is applied for on its own. Before counting on both, ask your VA Caregiver Support Coordinator and Nebraska DHHS how one affects the other.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,Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Does Nebraska help unpaid caregivers get a break?
Yes, through Lifespan Respite, which provides up to $125 per month for planned respite per client, plus up to $2,000 per eligibility period for qualified Exceptional Circumstances. It serves only people not receiving or eligible for respite from another government program, and funds only a caregiver who is not paid for the care.Centers for Medicare & Medicaid Services. (n.d.). Nebraska Waiver Factsheet - CMS State Waivers List, Medicaid.gov. medicaid.gov. Retrieved Sep 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE
Where to Get Help in Nebraska
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Find personalized help navigating Nebraska paid family caregiver options 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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