Get Paid to Care for Your Spouse in New Hampshire (2026)

There is one route in New Hampshire where you can reliably get paid to care for your spouse: the VA, if the person you care for is a veteran. New Hampshire Medicaid is the less certain path, and the uncertainty is not vagueness on our part. The Choices for Independence waiver has a self-directed option that pays family and friends, but the state's adopted rule and the state's own FAQ say opposite things about a spouse, so this is one to get in writing.

This guide walks through both routes: the VA programs that pay spouses directly, and how to get a straight answer out of New Hampshire Medicaid.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in New Hampshire?
• The Medicaid Self-Directed Route: How Self-Direction Works
• When a Spouse Is Blocked: the Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance for a Veteran Spouse
• How to Get Paid to Care for Your Spouse in New Hampshire: Who to Call
• Frequently Asked Questions
• Learn More

Can You Get Paid to Care for Your Spouse in New Hampshire?

The most honest answer is: possibly through Medicaid, and yes through the VA if your spouse is a veteran. That is different from a flat yes, and it is worth understanding why before you make a single phone call.

When Medicaid pays a family member for personal care, federal rules draw a line between relatives who choose to help and relatives who are already legally expected to help. A husband or wife falls in the second group. In Medicaid's language a "legally responsible relative" is someone with a duty under state law to care for another person, state law usually puts a spouse there, and that status can block payment under the most basic Medicaid home-care benefit.2 That is the rule that turns spouses away in a lot of states.

New Hampshire runs its Medicaid long-term services and supports through the NH DHHS Division of Long Term Supports and Services, whose Choices for Independence waiver includes Participant Directed and Managed Services, the option that lets a care recipient hire family and friends as the paid worker. For a spouse, the state's own sources conflict: the adopted rule bars a "legally responsible relative," which it defines as the spouse, while the department's PDMS FAQ says spouses can become providers.1 So for the Medicaid path, the accurate posture is to ask, ask specifically, and get the answer in writing.

The path that does not carry that uncertainty is the VA. If the person you care for is a veteran, the VA is built to pay spouses directly, through more than one program, and it does not depend on Medicaid at all. The rest of this guide covers both routes so you can pursue whichever fits, or both.

The Medicaid Self-Directed Route: How Self-Direction Works

The reason a spouse can ever be paid by Medicaid comes down to one idea, called self-direction. Instead of an agency assigning a stranger to your home, self-direction lets the person receiving care, or their authorized representative, control the budget and choose, hire, train, and supervise their own attendant, with a financial management company handling payroll and taxes.6 That authority is what can let a family member become the paid worker, and it is more permissive than the standard agency-delivered benefit.

In New Hampshire, that option is Participant Directed and Managed Services under the Choices for Independence waiver, and the participant can hire family and friends.1 For a spouse, though, New Hampshire's two sources say opposite things, and that is the single most important thing on this page. The adopted rule, He-E 801.12(a), bars CFI from covering any service "provided by a legally responsible relative," and He-E 801.02(ac) defines a legally responsible relative as "the participant's spouse." NH DHHS's own PDMS and FMS Frequently Asked Questions says the opposite, that "Spouses and authorized representatives can become providers under PDMS." The rule is the binding text. So do not treat the FAQ as your answer: get the department's position in writing before anyone leaves a job.1 Self-direction is a state option under federal law, and each state decides, program by program, who may be hired, including whether a legally liable relative such as a spouse is allowed.2

Here is how to get a real answer rather than a guess. Call the New Hampshire statewide aging and long-term-care line at 1-866-634-9412 and ask two specific things: whether the self-directed attendant care option is available for the person you care for, and whether a spouse is allowed to be the paid attendant under that option.1 Naming the self-directed option matters, because a general question about "getting paid to care for my husband or wife" often gets a general no, while the self-directed path is exactly where a yes can live.

One more thing to keep in mind about any Medicaid route: the person you care for has to qualify for New Hampshire Medicaid long-term care in the first place, which has its own financial and functional eligibility tests. Self-direction is a way to deliver a benefit someone already qualifies for, not a benefit on its own.

When a Spouse Is Blocked: the Legally Responsible Relative Rule

It helps to understand the rule the state may or may not be stepping around, both so you can explain your situation clearly on the phone and so you know what to avoid.

Under the standard Medicaid state plan personal care benefit, the services must be "provided by an individual who is qualified to provide such services and who is not a member of the individual's family," and for that benefit a family member "means a legally responsible relative." Two things narrow that exclusion, both on the face of the regulation: whether a spouse is a legally responsible relative is a question of state law, and a state may define "family member" differently for its own 1915(c) waiver, so the state-plan exclusion does not carry over automatically to waiver-funded care.2 That is the rule that produces a no in many states, and it is why a general question to a caseworker can get a general no.

The way past it, where a state allows it, is self-direction. Federal rules give each state the option, under self-directed personal assistance authority, to let participants hire "any individual capable of providing the assigned tasks, including legally liable relatives," and the definition of legally liable relatives expressly includes a spouse.2 That option is what makes a spouse potentially payable through New Hampshire's self-directed attendant care, and it is why the follow-up question is always: "What about the self-directed option, and can a spouse be the attendant under it?" The answer for a given program is set by the state, which is why confirming with NH DLTSS is not optional here.1

The VA Route: PCAFC and Veteran-Directed Care

If the person you care for is a veteran, you have a second, entirely separate path, and the VA is the one system built to pay spouses directly. It applies anywhere in New Hampshire and does not depend on Medicaid. Three VA routes come up most often, and they work very differently:

The centerpiece is the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which pays an eligible veteran's approved Primary Family Caregiver a tax-free monthly stipend, and a spouse is expressly allowed to be that caregiver. To qualify, the veteran generally needs a VA disability rating of 70 percent or higher, must need at least six months of continuous in-person personal care, and must be enrolled in VA health care.3

The stipend is not a single national figure, and it is not an hourly wage. It starts from the Office of Personnel Management (OPM) General Schedule grade 4, step 1 annual rate for the locality where the veteran lives, divided by 12, so the exact amount depends on where in New Hampshire you live. That monthly figure is then multiplied by a factor, and the regulation at 38 CFR 71.40(c)(4)(i) sets four of them:3

• Current program (the veteran meets the requirements of 38 CFR 71.20(a)): the multiplier is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the multiplier comes from the sum of the veteran's 2019 clinical ratings instead, with no self-sustain determination required. A sum of 21 or higher pays 1.00, a sum of 13 through 20 pays 0.625, and a sum of 1 through 12 pays 0.25.
• A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher.
• A legacy participant also has a floor: the stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, as long as the veteran stays at the address the VA has on record. The legacy schedule is time-boxed and lapses on October 1, 2028.3

If your household is a legacy one, that second point is worth reading twice: your 2019 ratings alone can carry you to the full 1.00 multiplier, so do not assume an "unable to self-sustain" finding is the only route to the top amount. Confirm the figure that applies to you with your VA Caregiver Support Coordinator.3

The second VA route is Veteran-Directed Care (VDC), which works on the same self-direction principle as Medicaid. The veteran receives a flexible monthly budget, managed by the veteran or their representative, and uses it to hire and supervise their own workers, and enrolled veterans may hire family, friends, or neighbors. Unlike the VA pension and Aid and Attendance benefit, VDC buys care rather than topping up an income check, so ask the options counselor to confirm your spouse can be the paid worker.4 The veteran works with an options counselor at an Aging and Disability Network Agency, such as an Area Agency on Aging, and a financial management service helps handle the employer responsibilities.4 To find out whether VDC is available in your part of New Hampshire, ask the VA Caregiver Support Line or your local Area Agency on Aging.

Aid and Attendance for a Veteran Spouse

Aid and Attendance comes up often in the same searches, so it is worth being clear about what it is and is not. It is not a wage paid to you as the spouse. It is an increase to a veteran's or surviving spouse's VA pension for someone who needs another person's help with daily activities such as bathing, dressing, and eating.3

What it does is add household income a couple can put toward care however they choose, including making up for income a spouse gave up to provide that care. The VA publishes these limits as annual Maximum Annual Pension Rates (MAPR), ceilings, not flat payments, and pays the difference between the claimant's countable income and the MAPR, so someone with income receives less than the ceiling. For 2026, the MAPR ceiling is $29,093 a year (about $2,424 a month at that ceiling) for a single veteran with no dependents who qualifies for Aid and Attendance, and $18,697 a year (about $1,558 a month at that ceiling) for a surviving spouse.7 Aid and Attendance requires that the veteran or survivor already qualify for a VA pension, which has income and net-worth tests (the 2026 net-worth limit is $163,699), so it reaches lower-income households.7 If your spouse is a veteran, it is worth checking whether PCAFC, Veteran-Directed Care, or Aid and Attendance fits your situation, since they serve different needs and can sometimes work together.

How to Get Paid to Care for Your Spouse in New Hampshire: Who to Call

Because the Medicaid path is not a settled yes, the order below is built to get you a clear answer quickly and to line up the VA route in parallel. It usually takes a few weeks rather than a single call.

One caution before you set anything up informally: care paid for privately, without a formal agreement, can raise questions later when Medicaid reviews the care recipient's finances for long-term-care eligibility. Setting the arrangement up formally through the Medicaid program (a genuine employment arrangement with a financial management company handling payroll and taxes) is how you keep the pay clean and avoid that risk. And on taxes: when you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excludable from federal gross income as "qualified Medicaid waiver payments" under the IRS Notice 2014-7, an exclusion that reaches Medicaid waiver payments but not money paid from your own funds.9 Because spouses so often share a home, this frequently applies. State income-tax treatment varies, so ask a tax preparer familiar with Medicaid caregiver pay before you file.

Learn More

Find personalized help getting paid to care for your spouse in New Hampshire 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.