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

North Carolina paid family caregiver programs center on two NC Medicaid waivers, CAP/DA for adults and CAP/C for children, and both offer a service called coordinated caregiving.1 Under CAP/DA, NC Medicaid pays a Coordinated Caregiving provider agency a daily rate, and the agency pays the live-in caregiver a stipend.2 The VA runs its own programs: PCAFC pays a monthly stipend to a Primary Family Caregiver, and Veteran-Directed Care gives a veteran a budget to hire their own workers.3,4

Under CAP/DA consumer direction the beneficiary freely chooses who will provide care.1 Relatives such as an adult child can be hired, but the CAP/DA waiver lets a spouse be paid only in one of three extraordinary circumstances, for no more than 40 hours a week.5

The Short Version

Live-in caregiver of an adult on CAP/DA: ask about coordinated caregiving, or about consumer direction, where the beneficiary chooses and hires the worker.

Caring for a medically fragile child: CAP/C offers coordinated caregiving and consumer direction, with the worker chosen within the qualifying limits.1

Caring for a veteran: check PCAFC first; if the veteran is rated 70% or higher and meets VA's other requirements, a spouse can be the Primary Family Caregiver.3

With substantial private assets: a personal services contract can pay a family caregiver, but North Carolina treats it as not an asset transfer only when it is written, dated and signed before services begin and every other condition is met.8

What Makes North Carolina Different: Coordinated Caregiving

Coordinated caregiving is supportive services to a live-in caregiver, delivered by an enrolled provider and distinct from CAP consumer direction.1 CMS lists it among the services of both NC Medicaid CAP waivers: the Community Alternatives Program for Disabled Adults (CAP/DA) for adults, and the Community Alternatives Program for Children (CAP/C) for medically fragile children.1 The caregiver-resource site Givers describes it as the state's Structured Family Caregiving pathway through the CAP/DA waiver.2

The North Carolina Paid Family Caregiver Pathways

1. Coordinated Caregiving: A Stipend for a Live-In Caregiver

Who pays: NC Medicaid, through an enrolled Coordinated Caregiving provider agency, as a service under CAP/DA (adults) or CAP/C (children).1

Who can be paid: The live-in caregiver. Under CAP/DA, Policy 3K-2 says coordinated caregiving is provided by a caregiver who resides in the home of the waiver participant or in the caregiver's own home.2 The CAP/DA waiver says relatives of all kinds can provide coordinated caregiving, but Policy 3K-2 says family, which includes a spouse or parent, shall not be the paid provider of any CAP/DA service unless exemptions are granted, so a spouse or parent should ask in writing.5

What it pays: The CAP/DA fee schedule last updated in February 2022 lists $63.55 per diem at high acuity and $41.93 at low acuity, but those are what the agency bills Medicaid, not your pay, and they exclude room and board. Policy 3K-2 says the caregiver's stipend must be at least 50 percent of the approved utilization amount in one section and up to 50 percent of the Medicaid established rate in another. Careforth, a Coordinated Caregiving provider in North Carolina, advertises that a qualifying caregiver could earn up to $1,100 each month, and Givers says family caregivers in North Carolina can earn up to $960 per month through Medicaid waiver programs; treat both as provider estimates, and ask the agency in writing what share it pays you.2

Eligibility, recipient: The participant must qualify for CAP/DA (adults 18 or older determined to require a level of institutional care, which CMS describes as a nursing-facility level of care) or CAP/C (children age 0 through 20 determined to require a level of institutional care), and need at least one waiver service based on an assessment coordinated by a CAP case manager.1

How you get paid: The provider agency bills NC Medicaid the daily rate for each day of service and pays you the stipend.2

2. CAP/DA Consumer Direction: Hiring Your Own Worker

Who pays: NC Medicaid, through CAP/DA's participant-directed track, which NC Medicaid calls CAP/Choice.1

Who can be paid: The personal assistant the beneficiary freely chooses, recruits, hires, supervises and fires (when necessary).1 Policy 3K-2 says a spouse, parent, step-parent, child, sibling or other relative can be hired if the employee is at least 18 and qualified. The CAP/DA waiver lets a spouse be paid only in one of three extraordinary circumstances, for up to 40 hours a week, and 3K-2's family definition says family shall not be the paid provider unless exemptions are granted. Not meeting the extraordinary circumstances is not appealable, so ask the case manager in writing which rule applies.5

What it is: A service delivery model in which the beneficiary (or a designated representative) acts as employer of record and independently sets a pay rate for the personal assistant. NC Medicaid lists care advisor, personal assistant and financial management services as CAP/Choice-only services.1

Eligibility, recipient: A disabled adult 18 or older who is at risk of institutionalization, is determined to require a level of institutional care under the State Medicaid Plan, and needs at least one CAP/DA service based on an assessment coordinated by a CAP/DA case manager. NC Medicaid also states that CAP/DA services are intended for situations where no household member, relative, caregiver, landlord, community, agency, volunteer agency or third party payer is able or willing to meet all medical, psychosocial and functional needs of the beneficiary.1

How you get paid: As the personal assistant the beneficiary employs. This is a consumer-directed services model.1

3. CAP/C: Coordinated Caregiving and Consumer Direction for Children

Who pays: NC Medicaid, through the Community Alternatives Program for Children (CAP/C).

Population: Medically fragile and medically complex children age 0 through 20 who are determined to require a level of institutional care under the North Carolina Medicaid State Plan. CMS describes them as meeting a hospital or nursing facility level of care.1

Two routes a family can ask about:

• Coordinated caregiving, one of the services approved under the CAP/C waiver, is supportive services to a live-in caregiver.1
• Consumer direction lets the CAP/C beneficiary or a designated representative act as employer of record and, within the qualifying limits, freely choose who will provide care, then recruit, hire, supervise and set a pay rate for that personal assistant. State Plan Nursing is not a directable service.1

4. NC Medicaid Personal Care Services (PCS)

Who pays: NC Medicaid, as a State Plan service.9

Who can be paid: An unrelated agency aide who does not live with the beneficiary. NC Medicaid Policy 3L (amended January 1, 2026) says Medicaid shall not cover PCS performed by the beneficiary's legally responsible person, spouse, child, parent, sibling, grandparent, grandchild, or equivalent step or in-law relative, or by anyone whose primary private residence is the same as the beneficiary's, regardless of relationship. The policy adds that spouses are expected to care for each other unless medical documentation, work verification or other information indicates otherwise. For a beneficiary under 21, 3L points to its EPSDT exception, under which policy criteria may not apply when the service is medically necessary; 3L does not say whether that reaches the family or live-in exclusions.6 See who NC Medicaid PCS will and won't pay.

What it is: Help with the five activities of daily living NC Medicaid lists (eating, dressing, bathing, toileting and mobility) for people living in a private home, a licensed adult care home, a combination home, or certain licensed group homes. To qualify, a person must have a medical condition, disability or cognitive impairment and unmet needs for one of: three of the five ADLs with limited hands-on assistance; two ADLs, one of which requires extensive assistance; or two ADLs, one of which requires full dependence. Eligibility is determined by an independent assessment conducted by NC Medicaid or its designee.9

5. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver of an eligible veteran. VA requires the caregiver to be at least 18 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). VA also says you must be enrolled in direct deposit through the VA customer engagement portal to get the monthly stipend.3

2026 stipend: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12. That monthly figure is then multiplied by a factor, and there is no single factor: 38 CFR 71.40(c)(4)(i) sets the factors on two schedules, and which one applies depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant.3

• Current program (a veteran meeting 38 CFR 71.20(a)): the multiplier is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community."3
• Legacy participant or legacy applicant (a veteran meeting 38 CFR 71.20(b) or (c)): the multiplier comes instead from the sum of the veteran's 2019 clinical ratings, at 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12. The legacy schedule runs for eight years beginning October 1, 2020, so it lapses October 1, 2028.3
• A veteran who meets both sets of 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, so long as the veteran still resides at the address on record with PCAFC on that date.3

Ask VA which multiplier it has applied to your case and confirm your exact stipend.3

Veteran eligibility: VA lists four requirements that must all be true: 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; and enrollment in VA health care. Those are a first screen, not a decision: you and the veteran apply together to determine eligibility.3

Other benefits: Primary Family Caregivers may also receive access to CHAMPVA health care benefits if they don't already qualify for care under another health care plan, and at least 30 days of respite care per year.3

6. VA Veteran-Directed Care (VDC)

Who can be paid: A worker the veteran hires. ACL's model VDC Veteran Handbook, a template local agencies modify, says the veteran may hire their own service workers, a family member, or a friend, once the spending plan and budget are approved and background checks are complete.10

How it works: Veteran-Directed Care gives the veteran a budget for services, managed by the veteran or the veteran's representative, and with the help of a counselor the veteran hires their own workers. Through an options counselor, the Aging and Disability Network Agency arranges fiscal management services.4

North Carolina availability: ACL's list of approved VDC providers names four North Carolina VA medical centers: the Durham VA Medical Center (with the Triangle J Council of Governments Area Agency on Aging beneath it), the Fayetteville VA Medical Center, the Charles George VA Medical Center and VA Salisbury Health Care. Being listed is not the same as being reachable, so talk with your VA social worker and find out if it is available in your location.4

7. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse who qualifies receives the pension.7

2026 maximums (effective December 1, 2025 through November 30, 2026): VA sets these as maximum annual pension rates (MAPR), not guaranteed payments: it pays the difference between the claimant's income for VA purposes and the MAPR. Income for VA purposes is not gross income: non-reimbursable medical expenses can reduce it, though only the amount above 5% of the MAPR counts (VA prints that threshold as $872 for a veteran with no spouse or child).7 A single veteran with Aid and Attendance receives up to $29,093 per year; a veteran with one dependent up to $34,488 per year; and a surviving spouse with no dependents and Aid and Attendance up to $18,697 per year. The 2026 net worth limit is $163,699.7

Eligibility: A veteran or surviving spouse who qualifies for VA pension and for the Aid and Attendance benefit, with income for VA purposes and net worth within VA's limits.7 A North Carolina Veteran Service Officer can help you determine eligibility.11 VA pension also carries a 36-month look-back on asset transfers for less than fair market value, separate from the Medicaid look-back.7

How caregivers get paid: VA pays the pension to the veteran or survivor, not to the caregiver.7 Put any payment from it to a family caregiver in a written agreement. Veteran Service Officers at the NC Department of Military and Veterans Affairs help file VA claims, and DMVA says their services are 100% free.11

8. Private Personal Services Contract

Who can be paid: A caregiver, including a family member, under a written personal services contract. Paying family is not automatically a penalized transfer; North Carolina's conditions decide.8

What it is: Under NC Medicaid's rules, a written contract with the provider is not an asset transfer only when the value of what is paid is at least equal to the value of the services and all of the conditions are met, including: the contract is dated and signed before services are delivered and payment made; the person is not living in a nursing facility or intermediate care facility while receiving services; and, at signing, a physician has recommended the services in writing as necessary to prevent entry to a nursing facility. The services may not include companionship, visits or spiritual wellbeing. The applicant, spouse or a legal representative (power of attorney or guardian) signs it; the local agency reviews it, and it must state the services' type, frequency, duration and amount transferred.8

Why the format matters: North Carolina applies a 60-month Medicaid look-back. Paying more than the services' current market value is a transfer for less than current market value, producing a sanction period: the uncompensated value divided by the average monthly private nursing-facility rate, which policy MA-2240 gives as $11,904 a month as of January 1, 2025. Talk to a North Carolina elder-law attorney about Medicaid planning before any money changes hands.8

Comparing the North Carolina Pathways

How to Choose a North Carolina Paid Family Caregiver Pathway

Start with the care recipient's situation:

Tax Considerations

Don't assume caregiver pay is tax-free. Careforth and Givers both describe the Coordinated Caregiving stipend as tax-free, but that is their description, not a ruling, so confirm it with the provider agency and a tax preparer.2

IRS Notice 2014-7: Payments to a care provider under a Medicaid 1915(c) waiver may be excludable from federal gross income when the person you care for lives in your home, but not if you live in a separate home.12 CAP/DA and CAP/C are both 1915(c) waivers.1 Talk to a tax preparer familiar with the rule before filing.

North Carolina state income tax: North Carolina taxes wage income. The state uses a flat individual income tax rate, 3.99 percent for 2026, down from 4.25 percent in 2025. So even where the federal IRS Notice 2014-7 exclusion applies, confirm how a caregiver wage is treated for North Carolina purposes with a tax preparer.13

Common Misconceptions

"A spouse can never be paid to care for a husband or wife." Not across the board. For an eligible veteran, VA's PCAFC lists a spouse among the family members who can be a Primary Family Caregiver.3 The CAP/DA waiver also lets a spouse be paid, but only in one of three extraordinary circumstances.5

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay for custodial or personal care when that is the only care a person needs. Its home health benefit covers part-time or intermittent skilled services for a homebound beneficiary, through Medicare-certified home health agencies.14

"I can use Medicaid Personal Care Services to pay myself." Not as a family member. NC Medicaid Policy 3L does not cover PCS performed by a spouse, child, parent, sibling, grandparent, grandchild or step or in-law relative, or by anyone who lives with the beneficiary.6 For a paid family role, ask about CAP/DA, CAP/C or the VA programs instead.

"I can just start getting paid out of Dad's bank account." Not safely. North Carolina treats a personal services arrangement as outside the transfer rules only with a written, dated contract signed before services are delivered and payment made, and every other condition met; a transfer for less than current market value within the 60-month look-back produces a sanction period.8

Related Terms

• Consumer Directed Services (CDS): Self-directed care, as in CAP/DA and CAP/C consumer direction.
• HCBS waiver: The federal home and community-based services authority behind CAP/DA and CAP/C.
• Activities of Daily Living (ADLs): The daily tasks personal care programs assess.
• Nursing Facility Level of Care (NFLOC): The clinical threshold for CAP/DA eligibility.1

Learn More

Find personalized help getting paid as a family caregiver in North Carolina 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.