Caregiver Programs in North Carolina: Paid & Respite (2026)

In North Carolina, Coordinated Caregiving under the CAP/DA Medicaid waiver pays a live-in caregiver a stipend through a provider agency. The CAP/DA and CAP/C waivers also fund respite and consumer direction, and a veteran's family caregiver may qualify for VA's PCAFC stipend.1,2,3

If you are caring for an aging parent, a spouse, or an adult child with a disability in North Carolina, the hardest part is rarely whether help exists. It is knowing what is there and where to start. This guide maps the major caregiver programs in the state for 2026: who qualifies, what each one offers, and the first call to make.

You do not have to figure this out alone, and you do not have to fund all of it from your own savings.

North Carolina Caregiver Programs at a Glance

Which North Carolina Caregiver Programs Pay Family Members?

For a lot of families, this is the real question: can the person already doing the caregiving get paid for it? In North Carolina, two Medicaid waiver services and one VA program can put money in a caregiver's hands.

Coordinated Caregiving

Coordinated Caregiving is a service approved under both of North Carolina's Medicaid 1915(c) waivers, the Community Alternatives Program for Disabled Adults (CAP/DA) and the Community Alternatives Program for Children (CAP/C). NC Medicaid defines it as "supportive services to a live-in caregiver that assists with the acquisition, retention or improvement of skills related to living in the community," and it is delivered by an enrolled provider agency.2

Under CAP/DA, NC Medicaid's Policy 3K-2 says Coordinated Caregiving is provided by a caregiver who resides in the home of the waiver participant or the caregiver's home. NC Medicaid pays the Coordinated Caregiving provider agency a daily rate, and the agency pays the live-in caregiver a stipend. Givers describes Coordinated Caregiving as the state's Structured Family Caregiving pathway through CAP/DA.1

Before you count on it, know who CAP/DA is for. It serves adults 18 and older who are at risk of institutionalization, are determined to require a level of institutional care, and need at least one CAP/DA service coordinated by a CAP/DA case manager. NC Medicaid says its 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."2 Since Feb. 16, 2024, people requesting CAP/DA services may be placed on a statewide waitlist.6

CAP/C is the children's waiver. NC Medicaid describes it as a cost-effective alternative to institutionalization for 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, and CMS describes that population as meeting a hospital or nursing facility level of care. Coordinated caregiving is one of the services approved under CAP/C.2

The pay is the part to pin down. The CAP/DA fee schedule last updated in February 2022 lists $63.55 a day for high-acuity and $41.93 a day for low-acuity Coordinated Caregiving, but those are the rates the agency bills Medicaid, not the caregiver's pay. Policy 3K-2 says in one place that the caregiver's stipend must be at least 50 percent of the approved utilization amount, and in another that the agency must give the caregiver up to 50 percent of the Medicaid rate. Because the policy is not consistent, ask the agency in writing what share of the daily rate it pays you.1

Provider marketing gives a rough ceiling: Careforth advertises that a qualifying caregiver could earn up to $1,100 a month, and Givers says family caregivers can earn up to $960 a month through Medicaid waiver programs. Treat both as provider estimates, not a published rate.1

CAP/DA and CAP/C Consumer Direction

Both CAP waivers also offer consumer direction, a service delivery model in which the participant or a designated representative acts as the employer of record: choosing who will provide care, then recruiting, hiring, supervising and firing that personal assistant and setting the pay rate. Under CAP/C that choice is made "within the qualifying limits," and State Plan Nursing is not a directable service.2

NC Medicaid lists care advisor, personal assistant and financial management services as "CAP/Choice only" services under CAP/DA.2

Can a relative be the paid worker? Under CAP/DA, usually yes. The CMS-approved CAP/DA waiver says relatives of all kinds and a court-appointed guardian can provide CAP In-Home Aide, coordinated caregiving and personal assistant services, though NC Medicaid Policy 3K-2 lets a legal guardian or power of attorney be hired only when one of its special circumstances or extraordinary conditions is met, and a relative or guardian cannot provide non-institutional respite, and a relative living in the same home may not be assigned more than 40 hours a week as the direct care worker. NC Medicaid Policy 3K-2 says an adult child or other relative can be hired as the employee when the CAP/DA beneficiary is 18 or older and the employee is at least 18 and meets the qualifications based on the need-based assessment. 3K-2's own definition of family (which includes a parent, grandparent, sibling and spouse, but not an adult child) also says family shall not be the paid provider unless exemptions are granted, so if you are one of those relatives, ask the CAP/DA case manager in writing which rule applies. A spouse can be paid only in one of three extraordinary circumstances, which our guide to getting paid to care for a spouse in North Carolina walks through.7 North Carolina's separate Medicaid Personal Care Services (PCS) benefit is stricter: 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.8

For a side-by-side of every paid pathway, see How to Get Paid as a Family Caregiver in North Carolina.

How Do I Get a Break? Respite Options in North Carolina

Every caregiver needs to step away sometimes, and needing a break does not make you any less devoted. The exhaustion of never being off the clock is real, and respite in North Carolina comes through a few different doors, one of which does not depend on Medicaid.

Medicaid Respite (CAP Waivers)

CAP/DA covers institutional respite and in-home aide respite for an approved adult participant. CAP/C covers respite care, institutional and in-home, as "temporary relief to the primary unpaid caregiver(s) by taking over the care needs of the waiver participant for a limited time," but only for medically fragile and medically complex children age 0 through 20. NC Medicaid describes CAP/DA as "supplementing, rather than replacing, the formal and informal services and supports already available" to an approved beneficiary.2

NC Medicaid's bulletin announcing the renewed CAP/DA waiver states that it "applies to NC Medicaid Direct."9 To request a CAP/DA referral, contact the local CAP/DA case management entity in the applicant's county, or NC LIFTSS, which manages CAP/DA referrals and assessments, at 833-522-5429.6 For CAP/C, contact the local CAP/C case management entity in your county.2

Respite Without Medicaid: NFCSP

The National Family Caregiver Support Program (NFCSP), authorized under Title III-E of the Older Americans Act, funds five kinds of service delivered by an Area Agency on Aging or an entity it contracts with: information, help getting services, counseling and training, respite, and limited supplemental services. Eligible caregivers include adult family members or other informal caregivers of someone 60 or older, or of someone of any age with Alzheimer's disease or a related disorder.4

One condition matters for respite in particular. For a family caregiver of an older person, respite and supplemental services are available only when that person is "frail": unable to perform at least two activities of daily living without substantial human assistance, or, because of a cognitive or other mental impairment, needing substantial supervision because their behavior poses a serious health or safety hazard.4

The NC Division of Aging lists Family Caregiver Support, the NC Lifespan Respite Program and Project CARE Caregiver Support among its programs. Project CARE is aimed at people caring for a family member or friend with Alzheimer's disease or a related dementia.6,2

For the full breakdown, see Respite Care in North Carolina.

Where to Get Help in North Carolina

When you are ready to make calls, these are the front doors.

VA Caregiver Benefits in North Carolina

If your loved one served, do not skip this section. VA's PCAFC stipend can go to a family caregiver, including a spouse.3 For the state benefits a veteran's own disability rating unlocks, see North Carolina benefits for disabled veterans by VA rating.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran, and VA has stated the stipend is a nontaxable benefit. The caregiver must be at least 18 and either a family member, including a spouse, or someone who lives full time with the veteran or is willing to. To receive the stipend, the caregiver must be enrolled in direct deposit through the VA customer engagement portal.3,13

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:3

• A VA disability rating, individual or combined, of 70 percent or higher.3
• Discharge from the U.S. military, or a date of medical discharge.3
• A need for at least six months of continuous, in-person personal care services.3
• Enrollment in VA health care.3

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:3

• Participating in the program is in the veteran's best interest.3
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.3
• The veteran receives care at home, or will do so if VA designates a family caregiver.3
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.3

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.3

The amount starts from the federal General Schedule GS-4, Step 1 annual rate for the veteran's locality, divided by 12. That monthly base is then multiplied by a factor, and there is no single factor: 38 CFR 71.40(c)(4)(i) sets five rungs using three distinct multipliers (0.625, 1.00 and 0.25) across 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 (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. No self-sustain determination is required on this route, so a legacy household with a high enough rating sum reaches the full 1.00 on the rating schedule alone. 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 is held at no less than what it was the day before October 1, 2020, so long as the veteran remains at the same address on record.3

Because the monthly base depends on the locality pay area where the veteran lives, ask your VA Caregiver Support Coordinator which rate and multiplier VA applied and confirm your exact stipend before planning around it.3

VA's Veteran-Directed Care program is another option to ask about: an eligible veteran gets a budget and, with a counselor's help, hires their own workers. ACL's list of approved VDC providers names four North Carolina VA medical centers: Durham (with the Triangle J Council of Governments Area Agency on Aging in Durham listed beneath it), Fayetteville, Charles George and VA Salisbury Health Care. Being listed is not the same as being reachable, because ACL marks the VA medical centers that have not yet referred a veteran to VDC, so ask your VA social worker whether it is available where you live.14

VA Aid and Attendance (A&A) Pension

Aid and Attendance (A&A) adds monthly payments to a VA pension for qualified veterans and survivors: someone who gets a VA pension may be eligible if they meet at least one of VA's care-need criteria, such as needing another person's help with daily activities like bathing, feeding and dressing.3 The Veterans Pension requires wartime service, among other conditions.5 The net worth limit for December 1, 2025, to November 30, 2026, is $163,699. A single veteran's maximum annual pension rate with A&A is $29,093; with one dependent it is $34,488. VA pays the difference between that rate and the veteran's income for VA purposes, so someone with income receives less than the maximum. Non-reimbursable medical expenses may reduce income for VA purposes, but only the amount above 5% of the basic pension rate for your household can be deducted, not 5% of the higher A&A rate: VA prints that threshold as $872 for a veteran with no spouse or child and $1,141 for a veteran with one dependent.15

The Veterans Affairs division of the North Carolina Department of Military and Veterans Affairs has accredited Veteran Service Officers who help with VA claims. Asked whether veterans must pay for that help, DMVA answers: "Never. All services are 100% free."12

Will I Owe Taxes on Caregiver Pay in North Carolina?

Getting paid to care for someone you love raises a practical worry: will a tax bill eat into it? Here is the short version, though a tax preparer familiar with caregiver pay is worth a call before you file.

IRS Notice 2014-7 (Federal Exclusion)

Under IRS Notice 2014-7, payments to an individual care provider for the care of an eligible individual under a state Medicaid 1915(c) waiver can be excluded from federal gross income when the care is given in the provider's own home, where the person cared for lives under their plan of care. The IRS treats the provider's home as the place where the provider resides and regularly performs the routines of private life, and the exclusion does not apply if the caregiver has a separate home where they reside. CAP/DA and CAP/C are both 1915(c) waivers, so raise this with your preparer.16,2

North Carolina State Income Tax

North Carolina levies a flat individual income tax. The rate is 4.25% for 2025 and falls to 3.99% for 2026. Confirm the current rules with the North Carolina Department of Revenue.17

The Coordinated Caregiving and PCAFC Stipends

Careforth and Givers both describe the Coordinated Caregiving stipend as tax-free, but confirm its tax treatment with your provider agency and NC Medicaid.1 VA has stated the PCAFC monthly stipend is a nontaxable benefit.3

Learn More

Find personalized help navigating North Carolina 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.