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

Utah pays family members to provide in-home care, but the route a paid family caregiver takes depends on whether the person receiving care is employed. Adults with disabilities who work can use EPAS, Utah's self-directed personal assistant program, where the participant hires their own attendant.1

The rule that surprises most families is EPAS's: a spouse cannot be the paid personal assistant, and a parent cannot be paid for a minor child. Family, friends, neighbors and co-workers can be hired, and so can a parent who is not the participant's legal guardian once the participant is at least 18.1 Utah's Aging, Physical Disabilities and New Choices waivers can pay relatives, and they can pay a spouse only under added conditions, such as approval as extraordinary care.2,3

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 and hires you as their personal assistant. You must be at least 16, have a valid driver's license, and have automobile liability insurance.1

If your loved one is not employed but needs in-home personal care, the Physical Disabilities Waiver or the Aging Waiver (age 65+, nursing-facility level of care) are the Medicaid routes.2 Both can pay relatives, and a spouse only under added conditions.2

If your loved one is a veteran, check the VA programs first. The VA caregiver stipend can pay a spouse.4 Veteran-Directed Care lets the veteran hire family members, though VA doesn't say whether a spouse can be the paid worker.6

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

Utah's self-direction program for working adults, Employment-related Personal Assistant Services (EPAS), is not a waiver: it is a standalone Medicaid state plan benefit for employed adults with disabilities who need personal assistance to keep working.1

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: Utah Medicaid's examples are family, friends, neighbors, co-workers and someone hired through an ad; a parent who is not the participant's legal guardian can be hired once the participant is at least 18. The assistant must be at least 16, have a valid driver's license and have automobile liability insurance. Cannot be paid: a legal guardian, which Utah Medicaid's EPAS page names as a parent to a minor child or a spouse. Utah's Medicaid State Plan also says these services are not covered when provided by a legally responsible family member or guardian.1

What it covers: Personal assistants may only help with ADLs and IADLs in support of the participant keeping their job; the State Plan's list also includes transportation to and from the worksite.1

Eligibility, recipient: Utah Medicaid lists five conditions: a disability determined by the Social Security Administration or the State Medical Review Board; currently receiving Utah Medicaid (which may mean paying a spenddown or Medicaid Work Incentive premium); currently employed in an integrated community setting making at least minimum wage; currently working at least 40 hours per month or self-employed; and needing personal assistance to keep that job. Not available to someone in a 1915(c) HCBS waiver when personal care is provided as part of their covered waiver services, or to someone residing in a hospital, nursing facility or ICF/MR who is employed by that facility.1

How you get paid: The participant employs the personal assistant, and Utah's Medicaid State Plan requires a Department-approved fiscal intermediary to coordinate the Medicaid claims and payment and the employer-based taxes.1

How to apply: Utah Medicaid's EPAS page links to the EPAS application, and the EPAS Program Coordinator answers questions at (801) 538-6955 or epas@utah.gov. If your loved one isn't on Medicaid yet, the EPAS fact sheet says to apply through the Department of Workforce Services at jobs.utah.gov.1

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. The Utah Division of Aging and Adult Services administers the Aging Waiver.7

What they are: The Physical Disabilities Waiver serves people 65 or older and people ages 18 to 64 with physical disabilities who meet a nursing-facility level of care; Utah lists personal care assistance, consumer training and personal emergency response services among the additional services it may provide. The Aging Waiver serves people age 65 or older who meet a nursing-facility level of care.2

Paying a family member: Both waivers pay for Personal Attendant Services. Aging Waiver participants can self-direct, controlling who is hired and supervising the attendant. The Aging Waiver's text lets relatives other than a legal guardian or spouse provide specified waiver services.2 The Physical Disabilities Waiver's text requires self-direction for Personal Attendant Services and lets relatives be paid, except that the participant's own parents, step-parents and legal guardians are paid only for extraordinary care in four circumstances: a rural home within five miles of a town under 2,500 people with no other help within 15 miles, while still recruiting others; specialized training to run health technology, such as a ventilator, when no other qualified person is available; a functionally quadriplegic participant; or critical health-and-safety support during non-traditional hours, such as at night.2

If you are the spouse: both waivers pay a spouse only for extraordinary care, beyond the daily-living help a spouse would ordinarily give. On the Aging Waiver, the participant must choose you with the care team's support, you can't also direct their services, and you must be able to meet their needs (the waiver text says a unique ability such as nursing licensure; Utah's rule also accepts a Department determination). You can work at most 40 hours a week, or 25 if the participant self-directs and employs you; the case manager reviews it, and a denial can be appealed.2 The Physical Disabilities Waiver's extraordinary-care test also covers parents and guardians: the participant must choose you with the team's support, and you must have the unique ability to meet their needs and be a primary caregiver. DSPD's billing rules add a best-interest and burnout review and a 40-hour weekly cap.2 These conditions come from older editions of the waiver text, and the current waivers may add requirements, so confirm them with the case manager.2

How to start: For the Aging Waiver, the referral begins with the Area Agency on Aging, and a case manager from the AAA must complete an evaluation of whether the waiver is appropriate for your loved one. Applications for the Physical Disabilities Waiver are taken through the Division of Services for People with Disabilities (DSPD).2

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 is mostly a route out of a facility, not a way to start care at home. Utah says people not living long term in a nursing facility, licensed assisted living, a licensed small health care (Type N) facility or another Utah licensed medical institution can't apply, and each setting has a minimum stay. Its fact sheet adds one exception: a transfer for someone on another Utah home and community-based services waiver with an immediate or impending need for nursing facility care.8 An applicant must be age 65 or older, or a younger adult who meets Social Security Administration (SSA) disability criteria, and must meet a nursing-facility level of care at application and throughout participation.8,2

Income: An applicant must also fit one of the eligibility coverage groups Utah lists. In the Special Income Group, income can be up to 300 percent of the Supplemental Security Income (SSI) federal benefit rate ($2,982 per month in 2026); income is not deemed from a spouse, and resources follow institutional resource rules. That $2,982 is the Special Income Group's ceiling, not a limit for every coverage group, so ask a DHHS case manager which group fits your loved one.8 Space in Utah's waivers is limited and may not be available in all areas, so ask a DHHS case manager about openings.2

Paying a family member: A participant living in a private residence (not adult residential services) can hire relatives who aren't legally responsible for them through Self-Administered Services, for attendant care, homemaker services and respite care. Those services are also available through agency-based providers, so ask the case manager whether an agency can employ your relative. A spouse can be paid for attendant care only as approved extraordinary care: the participant must choose the spouse with the team's support, and the spouse can't also direct services, must stay within the care plan's hours, and must be able to meet the participant's needs through training such as nursing licensure or a Department determination. These conditions come from state rule and 2021 waiver text, which capped a self-directing spouse at 40 hours a week; the current waiver may add requirements, so confirm with your New Choices Waiver case manager.3

Best for: A long-term facility resident ready to move into the community.

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

Who can be paid: The designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either be the veteran's spouse, son, daughter, parent, stepfamily member or extended family member, or live full time with the veteran (or be willing to if VA designates them). Those are alternatives, so a person who lives full time with the veteran meets the caregiver requirement without being related. The stipend is paid only by direct deposit set up through the VA customer engagement portal.4

2026 stipend: The PCAFC stipend is the federal GS-4, Step 1 annual rate for the veteran's locality pay area, divided by 12, then multiplied by a factor. Under the current program (38 CFR 71.20(a)) the factor is 0.625, or 1.00 if VA determines the veteran is "unable to self-sustain in the community." Legacy participants and applicants (38 CFR 71.20(b) or (c)) are tiered instead by the sum of the veteran's 2019 clinical ratings, at 0.25, 0.625 or 1.00, until October 1, 2028, and a veteran who meets both sets of criteria is paid the higher amount. Ask your VA Caregiver Support Coordinator which factor applies and the current GS-4, Step 1 rate for your locality.4

Veteran eligibility: VA's first screen has four requirements, all of which must be true: a VA disability rating (individual or combined) of 70 percent or higher; discharged from the U.S. military or a date of medical discharge; a need for at least 6 months of continuous, in-person personal care services; and enrollment in VA health care. A 70 percent rating alone does not qualify anyone: the caregiver and veteran apply together and go through VA's application process, which decides eligibility.4

Best for: Families of eligible veterans where one person provides substantial daily care.

5. VA Veteran-Directed Care (VDC)

Who can be paid: Personal care aides the veteran hires, which VA says "might include their own family member or neighbor." VA's VDC pages don't say whether a spouse can be the paid worker, so ask the VA medical center.6

How it works: The veteran gets a flexible budget that the veteran or the family caregiver manages. Enrolled veterans who meet the clinical need qualify, but VDC is only available in certain locations, so ask your VA social worker.6

Best for: Utah veterans with daily-living needs who want to choose their own caregiver.

6. VA Aid and Attendance Pension

2026 maximums: The VA publishes these as annual amounts, and pays the difference between the veteran's countable income and that ceiling rather than the full figure to everyone who qualifies. A veteran with no dependents receives up to $29,093/year; a veteran with one dependent up to $34,488/year. Confirm current rates at the VA pension rate page before applying.9

Eligibility: Wartime veteran or surviving spouse who meets the Aid and Attendance functional criteria and whose net worth, which counts income as well as assets, falls under the limit ($163,699 in 2026).9,10 A veteran also needs a discharge that isn't dishonorable and must be 65 or older, have a permanent and total disability, be a nursing home patient because of a disability, or get SSDI or SSI.10

How caregivers get paid: VA pays the pension to the veteran or surviving spouse, not to a caregiver, so any pay to a family caregiver comes out of it by private arrangement.10 Veteran Service Officers at the Utah Department of Veterans and Military Affairs help with VA claims and applications for free.11

7. Private Personal Services Contract

Who can be paid: An adult child, sibling, other relative or friend, under a written contract.

Why the format matters: Utah enforces a 60-month Medicaid look-back. At application the eligibility worker asks for asset and income information from the prior 60 months, and transfers for less than fair market value can make the person ineligible for nursing home or home and community based waiver services for a period of time. Federal law excepts a transfer where the person shows the State they intended to dispose of the assets at fair market value or for other valuable consideration, which is what a written contract at fair-market rates is meant to document. The penalty period is the uncompensated value transferred divided by a state-set average private-pay nursing-facility figure that Utah updates periodically; confirm the current figure with Utah Medicaid or an elder-law attorney.5

One exception for live-in caregivers: transferring the home to a son or daughter who lived there for at least two years immediately before the parent entered an institution, and who (as the State determines) provided care that let the parent stay at home, does not make the parent ineligible.5

Best for: Families with enough assets to private-pay now who want to protect future Medicaid eligibility.

Comparing the Utah Pathways

How to Choose

Where to Get Help in Utah

Call these offices to confirm eligibility and ask what a paid family caregiver would earn.

Tax Considerations

• EPAS: the participant employs the assistant, and a Department-approved fiscal intermediary coordinates the employer-based taxes.1
• VA PCAFC: VA treats the monthly stipend as a non-taxable benefit.12
• VA Aid and Attendance: VA pension payments are exempt from federal tax for the veteran.13
• Private pay, including a personal services contract: the IRS says in-home caregivers are typically employees of the person they care for; a caregiver who isn't an employee still reports the pay as income and may owe self-employment tax.14

IRS Notice 2014-7: Pay from a 1915(c) Medicaid waiver, such as the Aging, Physical Disabilities or New Choices waiver, can be excluded from federal gross income when you provide the care in your own home and the person you care for lives there with you. It doesn't apply if you have a separate home.15 EPAS is a state plan benefit, not a waiver, and the IRS says whether non-waiver Medicaid pay is excludable depends on the program, so confirm EPAS pay with a tax professional.15 Ask how the exclusion carries to your Utah return, too.

Utah state income tax: Utah has a single income tax rate for all income levels, so any paid-care income that is taxable in Utah is taxed at the same rate as your other taxable income. The Utah State Tax Commission publishes the current rate at incometax.utah.gov.5

Common Misconceptions

"Medicare will pay me to be Mom's caregiver." Medicare doesn't pay family members a wage to provide personal care. Its home health benefit pays a Medicare-certified agency for part-time or intermittent skilled care for someone who is homebound.16

"I can informally get paid out of Dad's savings." Risky without a written personal services contract. Utah's 60-month look-back reviews transfers for less than fair market value, and they can make Dad ineligible for nursing home or waiver Medicaid services for a period of time.5

Related Terms

• Consumer Directed Services (CDS): A general name 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 everyday tasks, like bathing and dressing, that EPAS personal assistants help with.1
• Nursing Facility Level of Care: The clinical threshold for the Aging Waiver.

Learn More

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.