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

Knowing how to get paid as a family caregiver in Vermont comes down to two main routes: Vermont's Choices for Care Medicaid long-term care program and VA programs for veteran families. Choices for Care is administered by the Department of Disabilities, Aging and Independent Living (DAIL), and under it a spouse or civil union partner can be paid for personal care with activities of daily living (ADLs) only.1 Participants who direct their own care can hire their own caregivers.2 For help applying, call the Vermont Senior Helpline at 1-800-642-5119.1 For veteran families, VA programs offer another direct path to compensating a caregiver, including a spouse.

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to the designated Primary Family Caregiver of an eligible veteran, and a spouse can be that caregiver.3 VA says the stipend is a non-taxable benefit.4 VA Aid and Attendance provides up to $34,488 a year for a veteran with one dependent in 2026.5

The Short Version

If the care recipient is a veteran, VA programs are a strong route. PCAFC pays a monthly stipend to a Primary Family Caregiver, who can be a spouse or other family member, when the veteran clears VA's screen (including a VA disability rating of 70% or higher) and VA's application process.3 Veteran-Directed Care gives the veteran a flexible budget for services and lets them hire their own personal care aides, which VA says might include a family member.8 Aid and Attendance is a higher VA pension rate for veterans and surviving spouses who qualify for it.5

If the care recipient qualifies for Choices for Care, a spouse or civil union partner can be paid for ADL personal care,1 and a participant who directs their own care can hire their own caregivers.2 For help applying, call the Vermont Senior Helpline at 1-800-642-5119.1

If neither VA benefits nor Choices for Care applies, a private personal services contract is the fallback. It should be written before care begins, at a fair-market rate, with documentation, because Vermont looks back 60 calendar months, from the month the person both requests long-term care Medicaid and meets the other eligibility rules, for transfers for less than fair market value.7

What Vermont Offers

Choices for Care

Vermont's Choices for Care (High/Highest) provides a package of long-term services and supports to Vermonters who need nursing home level of care. Age 18 is only the floor: DVHA requires an applicant to be at least 65, at least 18 with a physical disability, or eligible for Medicaid under Medicaid for Children and Adults rules. For services other than nursing facility care, DAIL's Choices for Care manual also requires a functional physical limitation from a physical condition (such as stroke, dementia or a traumatic brain injury) or associated with aging, and a person whose need for services is due to a developmental disability, autism or mental illness is not eligible. Administered by DAIL, it lets eligible people choose where to receive services: at home, in their family's home, an Adult Family Care home, Enhanced Residential Care or a nursing facility. Applicants must meet both clinical and financial eligibility for long-term care Medicaid.1

Enrollees can self-direct their services, have a qualified designated representative direct services on their behalf, or choose traditional agency-based services. CMS's approval of Vermont's Global Commitment to Health demonstration (approval period July 1, 2022 through December 31, 2027) authorizes spending on personal care provided by a participant's spouse or legal guardian, but DAIL's own rules are narrower. A spouse or civil union partner can be paid for personal care with ADLs only, not for instrumental activities of daily living (IADLs), respite care or companion care, and DAIL's July 2023 memo ended the COVID-era expansion of paid spouse categories.1

DAIL's Guidelines for Paying Spouses as Caregivers (effective May 1, 2007) add conditions. The paid spouse must meet the same minimum requirements as every other personal care provider, cannot be the participant's surrogate employer or legal guardian, and needs a plan in place for their own relief. A family member of the paid spouse can act as surrogate only if they don't live in the immediate household. A legal guardian appointed by probate court may not be paid for personal care, apart from DAIL's case-by-case individual variance process.1

NFCSP Through Vermont's Area Agencies on Aging

The National Family Caregiver Support Program is carried out by area agencies on aging, and Vermont provides family caregiver support through its five. Federal law requires a state's caregiver support services to include information about services, help gaining access to them, individual counseling, support groups and caregiver training, respite care, and supplemental services on a limited basis.6,1

NFCSP serves adult family members and other informal caregivers of people age 60 or older, caregivers of people of any age with Alzheimer's disease and related disorders, older relatives (not parents) age 55 and older caring for children under 18, and older relatives, including parents, age 55 and older caring for adults ages 18 to 59 with disabilities. An older relative caregiver must live with the child or adult with a disability, provide their in-home care, and be their primary caregiver; for a child, the caregiver must be a relative other than a parent, be the primary caregiver because the parents are unable or unwilling to serve, and have a legal relationship to the child or be raising the child informally. Respite care and supplemental services for a caregiver of an older person are limited to cases where that person cannot perform at least two activities of daily living without substantial help or, because of a cognitive or other mental impairment, needs substantial supervision because they behave in a way that poses a serious health or safety hazard.6 For paid care, see Choices for Care and the VA pathways.

To find your local AAA, use the Eldercare Locator at 1-800-677-1116, which refers callers to their local area agency on aging.9

The Five Ways to Get Paid as a Family Caregiver in Vermont

Pathway 1: Choices for Care

For Vermonters who qualify for Choices for Care, a participant who directs their own care can hire their own caregivers, and a spouse can be paid for ADL personal care.2 The enrollment steps:

Pathway 2: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either be a family member (VA lists a 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.3

VA's first screen for the veteran is a VA disability rating (individual or combined) of 70% or higher, a discharge or date of medical discharge, a need for at least 6 months of continuous, in-person personal care services, and enrollment in VA health care. Meeting those is not a decision: the caregiver and veteran apply together, and VA's application process determines eligibility. The stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's locality pay area, divided by 12. That monthly figure is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i), and which factor applies depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant:3

• 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."3
• Legacy participant or legacy applicant (the veteran meets 38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead, and no self-sustain determination is required. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25.3

A veteran who meets both the current-program and the legacy requirements 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 runs for eight years beginning October 1, 2020 and lapses October 1, 2028, after which the current-program factors govern alone. If your household was in the program before October 1, 2020, 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

VA says the monthly stipend is a non-taxable benefit and points to the Caregivers and Veterans Omnibus Health Services Act of 2010 (Public Law 111-163).4 The stipend is paid only after the caregiver enrolls in direct deposit through the VA customer engagement portal. Primary and Secondary Family Caregivers can both receive caregiver education and training and mental health counseling. A Primary Family Caregiver may also get CHAMPVA health care benefits if they don't already qualify for care under another health care plan, plus at least 30 days of respite care per year.3 In Vermont, the White River Junction VA Healthcare System's two main locations are the White River Junction VA Medical Center and the Burlington Lakeside VA Clinic.10

Pathway 3: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care gives veterans of all ages the opportunity to receive home and community services in a consumer-directed way. It was developed by VA and the Administration for Community Living. Veterans in the program get a flexible budget for services that the veteran or the family caregiver can manage, and they can hire their own personal care aides, which VA says might include their own family member or neighbor.8

VA medical centers deliver VDC with an aging and disability network agency, such as an area agency on aging, and the budget is based on the veteran's needs. Everyone who self-directs in VDC must use the program's financial management services provider, which acts as payroll agent, pays payroll taxes on the veteran's behalf, and issues W-2 forms to employees. The veteran cannot hire anyone until the spending plan and budget are approved and background checks are complete. ACL's model handbook is a template local agencies adapt, so details can vary.11

All veterans enrolled in VA health care are eligible if they meet the clinical need for the service and it is available, and VA says the program is only available in certain locations. A copay may be charged based on the veteran's service-connected disability status. Talk with the veteran's VA social worker to find out whether VDC is available where you live.8

Pathway 4: VA Aid and Attendance

VA Aid and Attendance is a higher pension rate that VA sets for veterans and surviving spouses who qualify for Aid and Attendance benefits.5

2026 Aid and Attendance maximums (effective December 1, 2025 through November 30, 2026): each a ceiling, and VA pays the difference between it and countable income.5

• Veteran with no dependents: up to $29,093 per year5
• Veteran with one dependent: up to $34,488 per year
• Surviving spouse (no dependents): up to $18,697 per year

The net worth limit is $163,699. VA pension also applies a 36-month asset-transfer look-back and penalty period under 38 CFR 3.276, and the look-back does not reach any date before October 18, 2018. Not every transfer for less than fair market value draws a penalty.5

VA pays the pension to the veteran or surviving spouse, not to the caregiver, so paying a family caregiver from it is the household's own arrangement, such as a personal services contract.5

Pathway 5: Private Personal Services Contract

For families outside both VA and Choices for Care systems, a personal services contract documents and compensates caregiving work. To give it the best chance of passing Medicaid's fair-market-value test later, make it:

• Written and signed before care begins
• Specific about services, schedule, and rate
• Priced at or below what local home care agencies charge for the same services
• Supported by ongoing service logs

Vermont Medicaid imposes no transfer penalty on a transfer for less than fair market value made more than 60 calendar months before the first month the person both requests long-term care Medicaid and meets all other eligibility rules.7 Because the rule turns on fair market value, a written contract at a fair-market rate executed before care begins provides a defensible paper trail for payments made inside that window. Confirm current Vermont look-back rules with a Vermont elder-law attorney.

If the caregiver is the care recipient's spouse, talk with a Vermont elder-law attorney before relying on a contract: when an applicant has a spouse, Vermont performs a resource assessment and allocation for the couple at the start of long-term care.7

How to Choose

Veteran household: If the veteran meets VA's four requirements (a VA disability rating of 70% or higher, a discharge or date of medical discharge, a need for at least 6 months of continuous, in-person personal care services, and enrollment in VA health care), apply for PCAFC together, knowing VA's application process makes the final call. A spouse can be the caregiver, and a Primary Family Caregiver may also get CHAMPVA health care benefits if they don't already qualify for care under another health care plan.3 VA says the stipend is non-taxable.4 Ask VA whether the veteran also qualifies for Aid and Attendance pension, and ask the veteran's VA social worker whether Veteran-Directed Care is available where you live.8

Non-veteran Medicaid household: For help applying for Choices for Care, call the Vermont Senior Helpline at 1-800-642-5119. If the caregiver is a spouse, plan around the ADL-only rule and the relief-plan requirement.1

Private-pay household: A personal services contract is the right structure for families outside both systems. Involve a Vermont elder-law attorney if the care recipient might apply for Vermont long-term care Medicaid within the next five years, the length of Vermont's 60-month look-back.7

IRS Notice 2014-7 and Taxes

IRS Notice 2014-7 treats certain payments for personal care under a state's section 1915(c) Medicaid home and community-based services waiver as difficulty-of-care payments excludable from the caregiver's federal gross income, but only when the care is given in the caregiver's own home (where the caregiver lives and regularly carries on private life) and the care recipient lives there too. A caregiver who keeps a separate home elsewhere cannot exclude the payments. The exclusion covers federal gross income only: whether Social Security and Medicare taxes apply depends on whether the caregiver is an employee of the agency, an employee of the care recipient, or an independent contractor.12 Choices for Care operates under Vermont's Global Commitment to Health section 1115 demonstration,2 and for Medicaid programs other than a 1915(c) waiver, the IRS says whether payments qualify depends on the nature of the payments and the purpose and design of the program. Ask a tax professional whether Choices for Care payments in your arrangement qualify.12

VA says PCAFC stipends are a non-taxable benefit.4

Ask a tax professional how pay under a private personal services contract is taxed in your situation.

Common Misconceptions

"Choices for Care automatically pays any family member as an attendant." Enrollees must meet clinical and financial eligibility, and DAIL limits who is paid for what. A spouse or civil union partner is paid for ADL personal care only, a paid spouse cannot be the surrogate employer or legal guardian, and a probate-court guardian may not be paid for personal care outside DAIL's individual variance process.1

"Medicare pays for ongoing personal care." Medicare does not cover custodial care, meaning help with bathing, dressing and using the bathroom, when that is the only care a person needs. It can cover skilled nursing and therapy care, the kind only professionals can safely provide, in settings such as a Medicare-certified skilled nursing facility or through the home health benefit.13 That's why this guide turns to Vermont Medicaid and VA programs for ongoing personal care.

"A verbal arrangement is enough for Medicaid purposes." Vermont's 60-month look-back reaches transfers for less than fair market value. A written contract, executed before care begins and priced at a fair-market rate, helps show payments were compensation rather than a transfer that could trigger a penalty.7

Learn More

Find personalized help choosing the right Vermont paid-caregiver pathway 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.