Utah pays family members to provide in-home care, but the route depends on whether the person receiving care is employed or not. Adults with disabilities who work can use EPAS, Utah's self-directed personal assistant program, where the participant hires their own attendant.
The rule that surprises most families is the same across both EPAS and Utah's other Medicaid programs: a spouse cannot be the paid caregiver, and a parent cannot be paid for a minor child. Adult children, siblings, other relatives, and friends can be hired.
This guide lays out every legitimate way to be paid as a family caregiver in Utah for 2026: who can be hired under each program, how the pay works, and how to choose the route that fits your family.
The Short Version
If your loved one is a working adult with a disability, EPAS is the most direct route. The participant enrolls in EPAS, becomes the employer, and hires you as their personal assistant. You must be at least 16, have a valid driver's license, and carry automobile insurance.
If your loved one is not employed but needs in-home personal care, the Physical Disabilities Waiver (personal care assistance) or the Aging Waiver (age 65+, institutional level of care) are the Medicaid routes. Ask the DHHS case manager whether self-directed personal care is available within the specific waiver.
If your loved one is a veteran, check the VA programs first. The VA caregiver stipend and Veteran-Directed Care can pay a spouse, an option Medicaid does not offer in Utah.
If your family has enough private assets, a written personal services contract can pay a caregiver now while documenting the arrangement for later Medicaid planning.
What Makes Utah Different: EPAS Self-Direction
Most states put their self-directed personal care inside an HCBS waiver. Utah's primary self-direction program, Employment-related Personal Assistant Services (EPAS), is different: it is a standalone Medicaid state plan benefit specifically designed for adults with disabilities who are employed and need personal assistance to keep working. The participant is the employer who selects, hires, trains, and directs their personal assistant.
Because EPAS is a state plan service rather than a waiver, it is not subject to enrollment caps. But it also cannot be layered on top of a 1915(c) waiver: a participant enrolled in the Physical Disabilities Waiver or Aging Waiver cannot simultaneously receive EPAS. Families need to choose the right program for their loved one's situation.
The Utah Paid Family Caregiver Pathways
1. EPAS: Self-Directed Personal Care for Working Adults
Who pays: Utah Medicaid (state plan benefit).
Who can be paid: An adult child (once the participant turns 18), sibling, other relative, or friend age 16 or older. The assistant must have a valid driver's license and automobile liability insurance. Cannot be paid: the participant's spouse or a parent who is the participant's legal guardian (which includes parents of minor children).
What it covers: Assistance with ADLs and IADLs directly related to maintaining the participant's employment.
Eligibility, recipient: A Utah Medicaid-eligible adult with a disability who is employed and needs personal assistance to remain working. Not available to people simultaneously enrolled in a 1915(c) HCBS waiver.
How you get paid: Through Utah Medicaid's EPAS payroll system. The participant is the employer of record.
Best for: A family member caring for a working adult with a disability who needs help with daily activities to stay employed.
2. Physical Disabilities Waiver and Aging Waiver Personal Care
Who pays: Utah Medicaid, through 1915(c) HCBS waivers administered by the Utah Division of Aging and Adult Services and the Department of Health and Human Services.
What they are: The Physical Disabilities Waiver covers people with physical disabilities and explicitly includes personal care assistance and consumer training among its covered services. The Aging Waiver serves people age 65 or older who meet a nursing-facility level of care.
Paying a family member: Whether a specific waiver participant can hire a family member as their personal care worker depends on the waiver's self-direction option and the case manager's authorization. Contact the DHHS case manager to confirm whether self-directed personal care is available and who can serve as the paid worker.
Important: EPAS is not available to people enrolled in these waivers.
Best for: An older adult or person with a physical disability who is not employed or who needs a broader package of services beyond what EPAS covers.
3. New Choices Waiver
Who pays: Utah Medicaid, through this 1915(c) waiver.
What it is: The New Choices Waiver serves people age 65 or older, or adults ages 21 to 64 who meet SSA disability criteria, and is designed to transition people from institutional settings into the community. Ask a DHHS case manager whether personal care services through a family member are available under this waiver.
Best for: Someone transitioning out of a nursing facility who needs in-home support to live in the community.
4. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Who can be paid: A designated Primary Family Caregiver of an eligible veteran, including a spouse, adult child, parent, or other family member.
2026 stipend: The PCAFC stipend is calculated from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a level factor (0.625 for Level 1; higher for Level 2). Confirm your exact amount with the VA Caregiver Support Coordinator.
Veteran eligibility: Service-connected disability rating of 70 percent or higher, needs personal care for at least six continuous months, enrolled in VA health care.
Why it stands out: Tax-free stipend, pays spouses, can stack with Medicaid.
Best for: Families of eligible veterans where one person provides substantial daily care.
5. VA Veteran-Directed Care (VDC)
Who can be paid: Almost any caregiver the veteran chooses, including a spouse, the most permissive hiring rule in this guide.
How it works: The veteran receives a flexible monthly budget from their VA care team and hires caregivers directly at a rate they set within that budget. Ask your VA social worker whether VDC is available at your VA medical center.
Best for: Utah veterans with daily-living needs who want to pay a spouse or choose their own caregiver.
6. VA Aid and Attendance Pension
2026 maximums: Single veteran receives up to $2,424 per month ($29,093/year); veteran with one dependent up to $2,874 per month ($34,488/year). Confirm current rates at the VA pension rate page before applying.
Eligibility: Wartime veteran or surviving spouse who meets the Aid and Attendance functional criteria and whose countable income and assets fall under the net-worth limit ($163,699 in 2026).
How caregivers get paid: The pension goes to the veteran; caregivers are paid from it under a private agreement. Utah's county Veterans Service Officers and the Utah Department of Veterans and Military Affairs help file at no cost.
Best for: Wartime veterans or surviving spouses under the income and asset limits.
7. Private Personal Services Contract
Who can be paid: An adult child, sibling, other relative, or friend under a written contract, signed before care begins.
Why the format matters: Utah enforces a 60-month Medicaid look-back. Informal payments to a family member for care are presumed to be gifts and can trigger a penalty period when Medicaid is later needed. A properly drafted contract at fair-market rates converts the payment into a documented exchange. The transfer-penalty divisor changes periodically; confirm the current figure with Utah Medicaid or an elder-law attorney.
Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.
Comparing the Utah Pathways
| Pathway | Pay a spouse? | Who pays | Self-directed? | Best fit |
|---|---|---|---|---|
| EPAS | No | Utah Medicaid | Yes | Working adult with disability |
| Physical Disabilities / Aging Waiver | Varies (ask case manager) | Utah Medicaid (waiver) | Varies | Non-employed adults needing personal care |
| New Choices Waiver | Varies (ask case manager) | Utah Medicaid (waiver) | Varies | Transitioning from a nursing facility |
| VA PCAFC | Yes | VA (tax-free stipend) | N/A | Eligible veteran's primary caregiver |
| VA Veteran-Directed Care | Yes | VA (veteran-set budget) | Yes | Veteran wanting to pay a spouse |
| VA Aid and Attendance | Pension to veteran | VA (pension) | N/A | Wartime veteran under limits |
| Personal services contract | No | Private funds | N/A | Family with assets, planning ahead |
How to Choose
- Is your loved one a veteran? Check VA programs first. PCAFC and Veteran-Directed Care pay spouses and are often competitive with Medicaid rates. Contact your county Veterans Service Officer to apply.
- Is your loved one a working adult with a disability? EPAS is the most direct self-directed route.
- Is your loved one 65+ or has a physical disability but isn't employed? Ask a Utah DHHS case manager about the Aging Waiver or Physical Disabilities Waiver and whether self-directed personal care is available.
- Are you a spouse? Medicaid routes generally exclude spouses. VA programs are the Medicaid-side alternative.
- Does your family have private assets and want to plan ahead? Work with a Utah elder-law attorney to draft a personal services contract before payments start.
Not sure which Utah program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's employment status, veteran status, and Medicaid eligibility.
Tax Considerations
- EPAS and waiver personal care pay W-2 wages through Utah Medicaid's payroll system.
- VA PCAFC is a federal tax-free stipend.
- VA Aid and Attendance is tax-free to the veteran; caregivers pay ordinary income tax on what they receive.
- Personal services contracts pay W-2 or 1099 income.
IRS Notice 2014-7: If you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excluded from federal gross income. Utah's income tax starts from federal AGI, so the exclusion generally flows through to your Utah return.
Utah state income tax: Utah levies a flat income tax of approximately 4.5 percent. Confirm the current year's rate at incometax.utah.gov.
Common Misconceptions
"EPAS will pay me to care for my husband." No. A spouse cannot be the paid EPAS personal assistant. If your husband is a veteran, Veteran-Directed Care or the PCAFC stipend are the pathways that allow paid spousal caregiving.
"Medicare will pay me to be Mom's caregiver." Medicare does not pay family caregivers. It covers short-term skilled home health through certified agencies only.
"EPAS and waiver services can stack." No. A person enrolled in a 1915(c) HCBS waiver cannot also receive EPAS services. Families need to choose the right program for their situation.
"I can informally get paid out of Dad's savings." Not without a written personal services contract. Utah's 60-month look-back treats informal payments as gifts and can delay Medicaid eligibility later.
Frequently Asked Questions
Not through EPAS or standard Medicaid personal care. Both exclude a spouse from being the paid caregiver. If your spouse is a veteran enrolled in VA care, Veteran-Directed Care and the PCAFC stipend allow paid spousal caregiving. A private personal services contract is not effective for Medicaid planning purposes between spouses.
An adult child (the participant must be at least 18 to hire a parent), sibling, other relative, friend, neighbor, or coworker who is at least 16 years old, holds a valid driver's license, and carries automobile liability insurance. A spouse or a parent serving as the participant's legal guardian cannot be hired.
EPAS is a standalone Medicaid state plan benefit for working adults with disabilities. The 1915(c) HCBS waivers (Physical Disabilities, Aging, New Choices, Community Supports) serve people not limited to those who are employed. Someone in a waiver cannot use EPAS at the same time.
EPAS, as a state plan benefit, does not have an enrollment cap or waitlist for eligible participants. Some 1915(c) waivers may have waitlists; confirm with your DHHS case manager.
Related Terms
- Consumer Directed Services (CDS): The national term for self-directed programs like EPAS, where the participant controls who provides their care.
- HCBS waiver: The federal authority behind Utah's Physical Disabilities, Aging, New Choices, and Community Supports waivers.
- Activities of Daily Living (ADLs): The functional basis for personal care hours under EPAS and Utah's waiver programs.
- Nursing Facility Level of Care: The clinical threshold for the Aging Waiver.
Learn More
- How to Get Paid as a Family Caregiver in Washington
- How to Get Paid as a Family Caregiver in Colorado
- Caregiver Burnout: Signs, Stages, and How to Get Support
- VA Aid and Attendance in Utah
- Medicaid Planning Strategies
Find personalized help getting paid as a family caregiver in Utah 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.