If you are caring for an aging parent, a spouse, or an adult child with a disability in Nebraska, the state may be able to pay you. Nebraska caregiver programs split along one line: Personal Assistance Services pays a family member who is not legally responsible for the person they care for, and a spouse can be paid instead through a waiver service called LRI Personal Care. LRI Personal Care can be authorized only when the person cared for meets Nebraska's Extraordinary Care test. The Aged and Disabled waiver adds respite and other supports, and for veterans, VA programs open a separate route.

Knowing that help exists is rarely the hard part. Knowing what it is and where to start is. This guide maps Nebraska's main caregiver programs for 2026, from paid-caregiver pathways to respite programs and VA benefits.

You don't have to figure this out alone, and you don't have to fund all of it from your savings.

In This Guide

Nebraska Caregiver Programs at a Glance

Program What It Offers Pay a spouse? Cost to You
Personal Assistance Services (Medicaid state plan) Pays a family member who is not legally responsible to provide in-home personal care, up to 40 hours per seven-day period No, a spouse is legally responsible Paid by Medicaid
LRI Personal Care (Medicaid waiver) Pays a legally responsible individual to provide personal care, up to 40 hours a week Only if the participant meets Extraordinary Care Paid by Medicaid
NFCSP caregiver support Counseling, support groups, caregiver training; respite only when caring for a frail older adult N/A Ask your Area Agency on Aging
VA PCAFC Monthly stipend; pays spouses Yes Paid by VA
VA Aid and Attendance Pension up to $29,093/yr to a veteran with no dependents, less countable income Pension to veteran Free application help from NDVA service officers

Who Pays Family Caregivers in Nebraska?

If you are already doing the hands-on work of bathing, dressing, or supervising a loved one, Nebraska Medicaid may be able to pay you for it. In-home care runs through the Nebraska Department of Health and Human Services (DHHS), which funds personal care through two main pathways.

  • Personal Assistance Services (PAS) is the Medicaid state plan benefit: help with activities of daily living such as bathing or dressing, for a person of any age who receives Medicaid, lives in their own home rather than an institution, and has an assessed need for the service in order to live in the community. DHHS says a participant has the right to choose their provider and direct their own care. Under 471 NAC 15, PAS is limited to a maximum of 40 hours per seven-day period, any services above 40 hours in a seven-day period must receive the Department's prior authorization, and the Department makes the final determination of units authorized.
  • LRI Personal Care is a waiver service, and it is the route for a spouse. DHHS defines a Legally Responsible Individual as a spouse or the natural or adoptive parent of a minor child, and offers LRI Personal Care on the Aged and Disabled waiver, all three Developmental Disabilities waivers, and, as of July 1, 2026, the Traumatic Brain Injury waiver. It can only be authorized if the participant meets Nebraska's definition of Extraordinary Care on the DD-26 tool, a "yes" in at least three areas of need, and it cannot exceed 40 hours a week across all LRI providers. The LRI must be employed by an agency except in limited circumstances, the service may not be self-directed, and it cannot be billed while the LRI is engaged in other employment.
  • The Aged and Disabled (AD) waiver pays for home and community-based services for a person who receives Nebraska Medicaid, has a disability or is over 65, meets Nursing Facility Level of Care, and needs waiver services. Its services include adult day health, chore, companion, home-delivered meals, personal care, LRI Personal Care and respite, and a Service Coordinator must determine that a service is needed. DHHS says the choice of Service Coordination provider can depend on age: DHHS Local Offices serve all ages, and for a participant 65 or older the option is the local Area Agency on Aging, unless the participant already has a DHHS service coordinator and wants to keep them.

The question most Nebraska families are really asking is whether a relative can actually be the paid worker, and Nebraska publishes the answer. Under Personal Assistance Services, a family member may be a paid provider as long as that family member is not legally responsible for the participant; a spouse, or the parent or guardian of a minor child, cannot. On the Aged and Disabled waiver the pattern reverses: a relative may be paid for Personal Care, Respite and Chore but not for LRI Personal Care, while a Legally Responsible Individual may be paid for LRI Personal Care and none of the others. So a spouse can be paid, through LRI Personal Care, on a waiver, when the conditions above are met. Whoever is paid must be able to meet the qualifications to become a provider.

Two more Aged and Disabled waiver rules matter for relatives. Personal Care does not cover the help a relative living in the home would give as part of a normal household routine, unless the support is clearly above and beyond what is typically expected for someone without a disability; DHHS uses a separate Personal Care Live-in service code when the provider lives with the participant. And after July 1, 2025, a legal guardian seeking to become an AD waiver provider for their ward must be related to the ward and serve as an agency employee, except in limited circumstances, while current guardian-providers may continue. Waiver Personal Care and Medicaid state plan personal care cannot be authorized at the same time.

For the full walkthrough of who can be paid and how the paychecks work, see How to Get Paid as a Family Caregiver in Nebraska.

How to Start Paid Caregiver Support

Getting paid feels bureaucratic from the outside, but it comes down to a few steps.

1
Step 1

Contact Nebraska DHHS

Ask about Medicaid home and community-based services. DHHS runs both Personal Assistance Services and the Aged and Disabled waiver.

2
Step 2

Complete the eligibility determination

For Personal Assistance Services, the person must be receiving Medicaid, live in their own home rather than an institution, and have an assessed need for the service in order to live in the community. For the Aged and Disabled waiver, the person must receive Nebraska Medicaid, have a disability or be over 65, meet Nursing Facility Level of Care, and have a need for waiver services.

3
Step 3

Ask for the service that matches your relationship, by name

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, ask about LRI Personal Care on a waiver. Asking the general question, "can a family member be paid," gets the general answer, which is the wrong one for a spouse.

4
Step 4

Confirm the services and start

On the waiver, a Service Coordinator must determine that a service is needed. See the Nebraska paid family caregiver guide for the full walkthrough.

Respite Care Programs

Caregiving without a break is how burnout starts, and respite exists precisely because no one can be on call around the clock indefinitely. Nebraska has respite routes both inside and outside Medicaid.

The National Family Caregiver Support Program (NFCSP), funded by Title III-E of the Older Americans Act, flows through Nebraska's Area Agencies on Aging. Services include information, help getting access to services, individual counseling, support groups, caregiver training, respite care, and limited supplemental services. Eligibility is defined by the caregiving relationship (caring for an adult 60 or older, or a person of any age with Alzheimer's or a related dementia). Respite and supplemental services carry one more condition: under federal law, a family caregiver receives them only when caring for an older individual who is frail, meaning unable to perform at least two activities of daily living without substantial help, or needing substantial supervision because of a cognitive or other mental impairment that makes their behavior a serious health or safety hazard. If the person you care for is younger than 60, ask your Area Agency on Aging how this condition applies to your family. Reach your regional agency through the Eldercare Locator.

The Aged and Disabled waiver also covers respite, which pays someone to come into the home and give the primary caregiver a temporary break. It is capped at 360 hours per annual eligibility period, and the caregiver being relieved must be the usual unpaid caregiver, meaning someone who meets most of the participant's unpaid care needs and lives at the same address. Respite cannot be used to let the caregiver go to work, except while the participant attends an approved camp. Separately, Nebraska DHHS runs Lifespan Respite, which 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, which needs a separate funding application that must be approved. It serves only people who are not receiving and not eligible for respite from another government program, and a waiver participant can receive respite from only one source, so a family already drawing waiver respite cannot also draw Lifespan Respite. It also funds only unpaid primary family caregivers, so a family member being paid to provide the care, through Personal Assistance Services, LRI Personal Care or waiver Personal Care, does not qualify; treat paid care and Lifespan Respite as alternatives. The caregiver must also live in the same home as the person or provide care in that person's home for at least 4 hours a day, every day of the week, and may not use the respite while working. For the full respite guide, see Respite Care in Nebraska.

Where to Get Help

You do not need to know which program you qualify for before you reach out. These are the places to start.

Nebraska Department of Health and Human Services (DHHS) Handles intake and assessment for Nebraska Medicaid home and community-based care, including Personal Assistance Services, the Aged and Disabled waiver, and LRI Personal Care, the waiver service that can pay a spouse. Its Lifespan Respite program is at https://dhhs.ne.gov/Pages/Respite.aspx. dhhs.ne.gov/Pages/Medicaid-Home-and-Community-Based-Programs.aspx
Nebraska 2-1-1 The statewide social-services helpline for the broader network of local resources beyond aging and Medicaid programs. 211 www.211.org
VA Caregiver Support Line For caregivers of veterans: help, support, and referrals, including on the PCAFC stipend., 1-855-260-3274 www.caregiver.va.gov

VA Caregiver Programs in Nebraska

If the person you care for is a veteran enrolled in VA health care, a separate set of VA benefits opens up. PCAFC can be combined with other in-home care programs, but not to cover the same care twice: the personal care the family caregiver would provide cannot be simultaneously and regularly provided by or through another individual or entity, and VA can revoke the caregiver's designation if the veteran stops meeting that requirement. Before a Medicaid paid-caregiver program pays for that same personal care, ask your local VA Caregiver Support Program team.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran.

Veteran eligibility: VA lists four conditions, and all of them must be true for the veteran:

  • A VA disability rating, individual or combined, 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 services.
  • Enrollment in VA health care.

The regulation, 38 CFR 71.20(a), also lists these requirements:

  • Participating in the program is in the veteran's best interest.
  • The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.
  • The veteran receives care at home, or will do so if VA designates a family caregiver.
  • The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.

The caregiver and the veteran apply together and take part in an application process that determines whether they are eligible.

The stipend starts from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, so the dollar amount varies by where the veteran lives and is not an hourly wage. 38 CFR 71.40(c)(4)(i) then multiplies that monthly base by a factor, and there are five rungs, using three distinct multipliers, across two schedules. It allows a spouse to serve as the paid caregiver.

Which schedule applies turns 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), meaning a household whose connection to PCAFC predates the program's October 1, 2020 restructuring. In the current program the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community." On the legacy route the factor comes instead from the sum of the veteran's 2019 clinical ratings: 1.00 at a sum of 21 or higher, 0.625 at 13 to 20, and 0.25 at 1 to 12, with no self-sustain determination required. A veteran who meets both sets of criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below 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. The legacy schedule lapses October 1, 2028.

VA Aid and Attendance Pension

Aid and Attendance is an increased VA pension: monthly payments added to a monthly VA pension for qualified veterans and survivors, so the veteran or survivor must already qualify for a VA pension. Veterans Pension requires wartime service, no dishonorable discharge, age 65 or older or another listed condition such as a permanent and total disability, and income and net worth within limits (net worth limit $163,699 through November 30, 2026); Aid and Attendance then requires at least one need, such as help with bathing, feeding, and dressing. The VA publishes these rates as annual maximums: a veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year, and a veteran with one dependent up to $34,488 a year. These are ceilings, not flat payments: VA pays the difference between the veteran's or survivor's countable income and the applicable maximum, so someone with other income receives less than the amount shown here. Pension is paid monthly, and the monthly rate is that difference divided by 12 and rounded down to the whole dollar.

The Nebraska Department of Veterans' Affairs State Service Office helps veterans and families apply for benefits at no cost, and County Veterans Service Officers also help file claims. For caregiver-specific questions, the VA Caregiver Support Line is listed under Where to Get Help above.

Taxes for Nebraska Caregivers

Once you are being paid to provide care, the natural next question is how that income is taxed.

IRS Notice 2014-7

If you are paid through a state Medicaid Home and Community-Based Services waiver program described in section 1915(c) for care in your own home, where the person you care for lives under their plan of care, those payments may be excluded from federal gross income under IRS Notice 2014-7. The exclusion does not apply if you have a separate home where you reside. Talk to a tax preparer familiar with the rule before filing.

Nebraska State Income Tax

State income tax treatment of caregiver wages varies. Confirm the current rate and how it applies to Medicaid waiver payments with the Nebraska Department of Revenue or a tax preparer.

VA PCAFC Stipend

In the preamble to its March 2020 proposed PCAFC rule, VA described the monthly caregiver stipend as a nontaxable benefit. Confirm how it applies to your return with a tax preparer.

Not sure which Nebraska caregiver program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's Medicaid enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.

Frequently Asked Questions

Can I get paid to care for my spouse in Nebraska?

Yes, through a waiver service named LRI Personal Care, if your spouse qualifies for it. DHHS defines a Legally Responsible Individual as a spouse or the parent of a minor child, and LRI Personal Care is the one Aged and Disabled waiver service an LRI may be paid to provide; it is also offered on all three Developmental Disabilities waivers and, as of July 1, 2026, the Traumatic Brain Injury waiver. What will not work is Personal Assistance Services, the state plan benefit, where a family member may be paid only if they are not legally responsible for the participant. Ask for LRI Personal Care by name. DHHS can authorize it only if your spouse meets Nebraska's Extraordinary Care test, for up to 40 hours a week, and the spouse providing it must be employed by an agency except in limited circumstances. If your loved one is a veteran, the VA PCAFC program can also pay a spouse, provided the veteran meets all of VA's PCAFC conditions. A 70 percent rating is the first of the four VA publishes, and those four are the screen rather than the whole test: 38 CFR 71.20(a) adds four more, including that the same personal care is not already being provided regularly by another individual or entity.

Do I have to qualify for Medicaid to be paid as a caregiver in Nebraska?

On the Medicaid routes, it is the person receiving care who must be on Nebraska Medicaid. Personal Assistance Services is for someone receiving Medicaid, living at home rather than in an institution, with an assessed need for the service in order to live in the community. The Aged and Disabled waiver, which carries LRI Personal Care, also requires that your loved one receive Nebraska Medicaid. The VA's PCAFC stipend is a separate route with its own VA conditions, described in the PCAFC section above. See the Nebraska paid family caregiver guide for the details.

Can I get respite in Nebraska without Medicaid?

Yes. Outside Medicaid, Nebraska DHHS runs the Lifespan Respite program, though only for people who are not receiving and not eligible for respite from another government program, and only for unpaid primary family caregivers. The National Family Caregiver Support Program also provides respite through Nebraska's Area Agencies on Aging. Its eligibility is defined by the caregiving relationship, and federal law limits respite to caregivers of an older individual who is frail. Reach your regional agency through the Eldercare Locator.

Which VA programs help family caregivers in Nebraska?

The PCAFC stipend is paid to the caregiver: a monthly stipend to the approved Primary Family Caregiver, who can be a spouse, when the veteran meets all of VA's PCAFC conditions, not only the 70%+ disability rating. Aid and Attendance is different: it provides monthly payments added to the amount of a monthly VA pension for qualified veterans and survivors, and the pension has a net worth limit ($163,699 from December 1, 2025, to November 30, 2026). Call the VA Caregiver Support Line at 1-855-260-3274.,,

How do I reach my Area Agency on Aging in Nebraska?

Reach your regional agency through the Eldercare Locator. They handle NFCSP caregiver services, including respite, counseling, and caregiver training. On the Aged and Disabled waiver, DHHS lists both its Local Offices, for all ages, and the local Area Agency on Aging, for a participant 65 or older, as service coordination options; someone 65 or older who already has a DHHS service coordinator can keep them.

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverHow to Get Paid as a Family Caregiver in NebraskaHow to get paid as a family caregiver in Nebraska in 2026: VA programs, Medicaid personal care, and private caregiver agreements, and how to apply. CaregiverNebraska Aged and Disabled Waiver: Who in the Family Can Be PaidNebraska's AD waiver can pay an adult child or other relative for personal care, and a spouse only through LRI Personal Care. Who qualifies, pay, steps. CaregiverNebraska Personal Assistance Services: How a Family Caregiver Gets PaidAn adult child or other relative who isn't legally responsible can be paid through Nebraska's PAS; a spouse can't. Hours cap, pay, and how to start. CaregiverRespite Care in NebraskaA 2026 guide to respite care in Nebraska: Medicaid LTSS respite, NFCSP grants through AAAs, VA options, and how to start as a family caregiver. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Benefits for Seniors in NebraskaVA Aid and Attendance in Nebraska for 2026: who qualifies, the $34,488 yearly ceiling for a veteran with a spouse, how to apply, and free NDVA and county help. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

Find personalized help navigating Nebraska caregiver programs 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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