Get Paid to Care for Your Spouse in Vermont (2026)

Can you get paid to care for your spouse in Vermont? Yes, and Vermont is one of the states where that is written down. If you have been told a husband or wife can never be the paid caregiver, that is a rule from somewhere else.

In many states a husband or wife is turned away as a "legally responsible relative" who is already expected to help for free. Vermont went the other way. The federal government's approval of Vermont's Global Commitment to Health demonstration authorizes Medicaid spending on personal care provided by a Choices for Care participant's spouse, so a spouse can be the paid attendant. If the person you care for is also a veteran, the VA pays spouses too, and the two routes are worth comparing.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Vermont?
• The Medicaid Self-Directed Route: Choices for Care
• Why You May Still Hear No: 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 Vermont: Who to Call
• Frequently Asked Questions
• Learn More

Can You Get Paid to Care for Your Spouse in Vermont?

The honest answer has two parts: possibly through Medicaid, and yes through the VA. That is different from the flat yes some states can give, and it is worth understanding why, because the difference changes what you should ask for and who you should call.

Start with how the rules are built. When Medicaid pays a family member for personal care, federal rules draw a line between relatives who choose to help and relatives the law already expects to help. Medicaid calls the second group "legally liable relatives," meaning people who have a duty under state law to care for another person, and the federal definition says that group may include a spouse rather than always doing so. Where a state does treat a spouse that way, that status can block payment under the most basic Medicaid home-care benefit.2

But that block only applies to one kind of benefit, and Vermont is not relying on it. CMS's approval of Vermont's Global Commitment to Health section 1115 demonstration authorizes Medicaid spending on personal care services provided by Choices for Care participants' spouses and legal guardians, and it allows spouses and parents of minor children to provide personal care services.1 That is the answer for Vermont, in the federal approval document itself. The practical question left for DAIL is timing rather than permission: Vermont may not draw federal matching funds under that authority until CMS approves its Caregiver Reimbursement Protocol, so ask DAIL whether the route is open for your case. If the person you care for is a veteran, the VA offers a second path that does not depend on Medicaid at all, and the rest of this guide walks both.

The Medicaid Self-Directed Route: Choices for Care

Vermont's main long-term-care Medicaid program is Choices for Care, administered by the Department of Disabilities, Aging, and Independent Living (DAIL). It provides long-term services and supports to Vermonters age 18 and over who need a nursing-home level of care but want to receive that care at home or in the community rather than in a facility. To use it, the person you care for has to meet both a clinical test (needing nursing-home level of care) and Vermont's financial eligibility rules for long-term-care Medicaid.1

Choices for Care rests on the idea of self-direction. Instead of an agency assigning a stranger to your home, self-direction lets the person receiving care, or their authorized representative, help choose and direct their own attendant, with a supporting organization handling the employer paperwork, payroll, and taxes.6 That authority is what can let a family member become the paid worker.

Vermont gives Choices for Care enrollees a genuine choice of delivery. You can self-direct your services, have a qualified designated representative direct them on your behalf, or take traditional agency-based delivery. The middle route is the one that fits a household where the participant cannot direct their own care, and Vermont commits to providing support for a participant or their proxy, such as a surrogate, parent, or legal guardian, in directing that care.1

One distinction still matters. The federal approval settles that a spouse may be paid for personal care under Choices for Care; it does not tell you what your own care plan will authorize, how many hours it will cover, or when the reimbursement route opens. Those are DAIL questions. So do not accept a general no, and do not count the income before the plan is written. The Who to Call section below has the exact questions to ask.1

Why You May Still Hear No: the Legally Responsible Relative Rule

It helps to understand the rule at the center of all this, both so you can explain your situation clearly on the phone and so you know what to ask.

Under the standard Medicaid state plan personal care benefit, the services must be provided by someone "who is not a member of the individual's family," and for that benefit a family member "means a legally responsible relative." Where state law puts a spouse in that category, the plain personal care benefit will not pay them.2 That is the rule behind the no in many states, and it is why a general question to a caseworker can draw a general no even in Vermont, where a different authority governs.

That regulation is also narrower than it sounds. It is prefaced "Unless defined differently by a State agency" for a section 1915(c) waiver, so it does not carry over automatically to waiver-funded care, and federal self-direction rules let a state choose to let participants hire "any individual capable of providing the assigned tasks, including legally liable relatives."2 Vermont has made its choice, through the section 1115 authority described above. So if a caseworker gives you the general no, the thing to name is Choices for Care and the federal approval that covers a participant's spouse, not the abstract question of whether "family" can be paid.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 Vermont and does not depend on Medicaid, which makes it the more reliable spouse-pay route when it fits. Three VA routes come up most often, and they differ on the one question that matters most here: whether a spouse can be paid.

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 amount is not a single national figure. The PCAFC stipend starts from the federal pay scale for the veteran's local area: the Office of Personnel Management (OPM) GS-4, step 1 annual rate for that locality, divided by 12. That monthly figure is then multiplied by one of four factors set in 38 CFR 71.40(c)(4)(i), so the amount depends both on where in Vermont you live and on which schedule your household is paid under.3

Under the current program (the veteran meets 38 CFR 71.20(a)), the factor is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community." For a legacy participant or legacy applicant (38 CFR 71.20(b) or (c)), the factor comes instead from the sum of the veteran's 2019 clinical ratings, and no self-sustain determination is required: 1.00 for a sum of 21 or higher, 0.625 for 13 to 20, and 0.25 for 1 to 12.3 A veteran who meets both the current and the legacy criteria is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran stays at the address on record. The legacy schedule lapses October 1, 2028. If your household was in the program before that 2020 date, ask which schedule you are being paid on, because the rating-sum route can reach the full 1.00 factor with no self-sustain finding at all.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 set by the VA and uses it to hire and supervise their own workers, including family, friends, and neighbors, with a financial management service handling payroll. Unlike the VA pension and Aid and Attendance benefit, VDC has no rule against paying a spouse from the veteran's budget.4 Vermont veterans can ask about both programs through the White River Junction VA Medical Center, which serves the state, or through the VA Caregiver Support Line.1

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. For 2026, a single veteran with no dependents who meets the VA pension's service requirements and qualifies for Aid and Attendance can receive up to $29,093 a year, and a surviving spouse can receive up to $18,697 a year. The VA publishes these as annual maximums, not guaranteed payments: it pays the ceiling minus the claimant's countable income.7 Aid and Attendance requires the veteran or survivor to already qualify for a VA pension, with income and net worth under $163,699, reaching 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 Vermont: Who to Call

Because the Medicaid path runs through a state long-term-care program and hinges on a question you have to get answered, it usually takes a few calls rather than one. Here is the order that works.

If Medicaid does not pay you directly, Vermont still offers real support to family caregivers. Through the National Family Caregiver Support Program, delivered by Vermont's 12 area agencies on aging, you can get free respite care, counseling, and training. That is not a wage, but it can lighten the load while you sort out the paying programs.1

One caution before you set anything up informally: Vermont Medicaid reviews past asset transfers when it decides long-term-care eligibility, so paying a family caregiver out of pocket, without a written agreement, can complicate a later application.1 The clean way to handle it is to set the arrangement up formally through the Medicaid program, with an employment arrangement and a financial management company handling the payroll, so everything is documented from the start. 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 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 Vermont 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.