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

There is one route in New Hampshire that reliably pays a spouse to provide care: the VA, if the person you care for is a veteran. New Hampshire Medicaid is the less certain path. Its long-term care benefits include a self-directed option that can let a family member be hired as the paid caregiver, but whether a husband or wife specifically qualifies is not guaranteed and has to be confirmed with the state.

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 spouse is a "legally responsible relative," one of the people who have a duty under state law to care for another person, 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 in-home personal care benefit serves eligible adults and includes a self-directed attendant care option, which is the kind of arrangement that can let a care recipient hire a family member as the paid worker. But whether a spouse specifically is permitted under that option is not something we can promise you here, because it varies by program component and has to be confirmed with the state.1 So for the Medicaid path, the accurate posture is: ask, and ask specifically.

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, the Medicaid in-home personal care benefit includes a self-directed attendant care option. Under that option, the care recipient may be able to hire a family member as a paid personal care worker.1 The open question, the one you must resolve directly with the state, is whether a spouse counts as an allowable family member for the specific program the care recipient qualifies for. 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." A spouse fits that description, so under the plain personal care benefit a spouse cannot be the paid worker.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, including a spouse. Unlike the VA pension and Aid and Attendance benefit, VDC has no prohibition on paying a spouse to provide the care.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 maximums, and the monthly payment is the yearly figure divided by 12. For 2026, a single veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year (about $2,424 per month), and a surviving spouse can receive up to $18,697 a year (about $1,558 per month).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.