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

Washington pays family members to provide in-home care more readily than most states, but it runs the money through a structure that confuses almost everyone the first time. You do not get a check from the state. Instead, the person you care for qualifies for Apple Health Medicaid long-term care, you become a paid "Individual Provider," and a single statewide employer, Consumer Direct Care Network Washington, issues your paycheck.1

The one rule that trips up the most families is the spousal rule: under Apple Health and its long-term services and supports program, you cannot be paid to care for your spouse. DSHS names two Washington programs that do allow spouses to be paid caregivers: Veteran Directed Care and the WA Cares Fund, whose benefits became available July 1, 2026.2

This guide lays out every legitimate way to be paid as a family caregiver in Washington for 2026: who can be hired under each program, how the pay works, and how to pick the route that fits your family.

The Short Version

If you are an adult child, sibling, or other relative of someone who qualifies for Washington Apple Health long-term care, the fastest route is to become that person's paid Individual Provider through Community First Choice.2 Your loved one's DSHS case manager assesses their need, authorizes monthly care hours, and you deliver those hours as a CDWA employee.

If you are a spouse, Medicaid's Individual Provider route is closed to you. The two programs DSHS names for spouses are Veteran-Directed Care (if your spouse is a veteran and qualifies) and the WA Cares Fund, whose benefits became available July 1, 2026.

If your loved one is a veteran, check the VA programs first. A spouse is among the family members VA lists as eligible caregivers for its caregiver stipend program,6 and Veteran-Directed Care may allow you to be hired as your spouse's paid caregiver if your spouse is a veteran and qualifies.2

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. Federal Medicaid law reviews asset transfers made in the 60 months (five years) before the date of a long-term care Medicaid application, so the contract format matters.7

The rest of this guide walks through each pathway in detail.

What Makes Washington Different: Individual Providers and CDWA

Washington delivers most of its Medicaid in-home care through Individual Providers, caregivers hired and directed by the person receiving care rather than scheduled by an agency. The care recipient selects, schedules, supervises, and can dismiss their provider.3 That provider can be a paid family caregiver.2

Every Individual Provider in the state has the same legal employer: Consumer Direct Care Network Washington, known as CDWA, Washington's Consumer Directed Employer. The care recipient is the managing employer, who keeps the primary right to select, dismiss, assign hours to, and supervise their providers. CDWA employs the state's roughly 46,000 Individual Providers, manages credentialing, payroll, and other administrative employer responsibilities, and verifies that each provider has met training requirements and passed a background check. Its main number is 866-214-9899.1

To be hired as an Individual Provider you must:2

• Pass a background check
• Provide a valid photo identification and be authorized to work in the United States
• Complete caregiver training through the SEIU 775 Benefits Group. Most paid family caregivers must complete 35 hours of training and finish within 120 days of hire; requirements vary based on your relationship to the person you care for (WAC 388-71-0523).

Individual Provider wages are set through the SEIU 775 collective bargaining agreement and rise with tenure and credentials rather than being negotiated case by case. Because the wage scale and benefits change with each contract cycle, confirm the current base wage with CDWA when you apply rather than relying on a figure you read secondhand.

The Washington Paid Family Caregiver Pathways

1. Community First Choice (CFC): The Main Medicaid Route

Who pays: Washington Apple Health (Medicaid). Home and Community Services (HCS) authorizes CFC, or the Developmental Disabilities Administration does for its clients. In May 2025 DSHS consolidated key functions of several administrations, including the Aging and Long-Term Support Administration, into two new administrations; the Home and Community Living Administration is now responsible for Washington's long-term services and supports for older adults and people with disabilities.3

Who can be paid: Family members who provide care to a relative, hired as the care recipient's Individual Provider through CDWA, when the care recipient qualifies for Medicaid long-term services and supports. An adult child caring for a parent is within that rule. Cannot be paid: a spouse; under Apple Health and its long-term services and supports program, you cannot be paid to care for your spouse.2

What it is: Community First Choice is a Medicaid state plan benefit under Section 1915(k) of the Social Security Act, added by the Affordable Care Act, not a Section 1915(c) waiver like COPES.3

What it covers: Personal care, meaning hands-on help with activities of daily living (bathing, dressing, toileting, transferring, eating) and instrumental activities (meal preparation, medication reminders, light housekeeping, shopping), plus certain health-related tasks, caregiver skills training, and personal emergency response.

Eligibility, recipient: The CARE assessment must show the person needs an institutional level of care, such as a nursing facility, or will likely need it within thirty days without CFC, and they must be eligible for a categorically needy or alternative benefit plan Apple Health program (or for a home and community based waiver while receiving at least one waiver service a month). Through HCS or an Area Agency on Aging, the client must be 18 or older.3 The case manager then authorizes monthly personal care hours. Income and asset rules depend on which Medicaid pathway the person qualifies under; a benefits specialist can confirm the limits that apply.8

Eligibility, caregiver: Pass the background check, provide a valid photo identification, be authorized to work in the United States, complete the required training, and be hired through CDWA.2

How you get paid: CDWA is your legal employer and manages payroll. It works with your loved one to assign their assessed hours among their providers.1

Best for: A non-spouse relative caring for someone who qualifies for Apple Health long-term care and needs help with daily activities.

2. COPES Waiver and Medicaid Personal Care

Community First Choice is the most common route, but it is not the only Medicaid program that pays Individual Providers.8

• COPES (Community Options Program Entry System) is Washington's Section 1915(c) home and community-based services waiver. An applicant must meet all of its criteria, including being 65 or older (or 18 or older and blind or with a disability), meeting nursing-facility level of care, being eligible for institutional categorically needy coverage, and having needs that exceed what is available in CFC. Since July 1, 2015 COPES no longer delivers personal care itself: COPES clients receive their Individual Provider personal care through CFC, and the COPES waiver adds wraparound services beyond personal care, such as home-delivered meals and environmental modifications. Most COPES clients receive CFC and COPES together.
• Medicaid Personal Care (MPC) is a state plan personal care benefit for people who do not meet nursing-facility level of care, have an unmet or partially met need found by the CARE assessment, and are eligible for non-institutional categorically needy or alternative benefit plan coverage. When Home and Community Services or an Area Agency on Aging authorizes the services, the client must be 18 or older. It covers help with instrumental activities only when the person also needs help with activities of daily living.8

For caregivers, the practical point is the same across all three: the care recipient is assessed by a DSHS case manager, monthly personal care hours are authorized, and you deliver those hours as a CDWA Individual Provider. The differences are about the recipient's eligibility pathway and what else gets bundled in, not about who can be hired.

3. WA Cares Fund: The New Spousal Pathway

Who pays: The WA Cares Fund, Washington's state long-term care benefit funded by a payroll premium.

Who can be paid: Family caregivers, including a spouse. WA Cares benefits became available July 1, 2026, and WA Cares is one of the two Washington programs (alongside Veteran-Directed Care) that DSHS names as allowing a spouse to be paid.4,2

How it works: The care recipient must be 18 or older, live in Washington, and have contributed in at least 10 years, in three of the past six years, or (if born before January 1, 1968) in at least one year for a pro-rated benefit; only years with at least 500 hours of work count. They apply to DSHS, which must find that they need help with at least three activities of daily living and will continue to need it for at least 90 days. Once approved, they choose CDWA or a home care agency registered with WA Cares, you become an employee of that provider, and they must approve a pre-authorization in their benefits account before services begin.4

The benefit amount: WA Cares is a capped lifetime benefit. WA Cares states the full benefit amount is $36,500 in 2026, and it is adjusted for inflation.4

Best for: Spouses, and other family caregivers whose loved one paid into WA Cares but is not financially eligible for Medicaid.

4. MAC and TSOA: Support for Unpaid Caregivers

Who pays: Apple Health, through Washington's Medicaid Transformation Section 1115 demonstration.

What they are: Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA) provide support and services to unpaid caregivers; TSOA also offers some services to people who do not have a family caregiver. Both require the care receiver to be 55 or older, meet nursing facility level of care, and live in a private residence rather than a residential or institutional setting.5

• MAC is for someone who is Medicaid-eligible but not using Medicaid-funded long-term services and supports, has an unpaid caregiver age 18 or older, and chooses MAC instead of COPES or CFC.5
• TSOA is for someone who does not currently meet Medicaid financial eligibility. It has its own income and resource test, and it does not require an unpaid caregiver.5

The important caveat: MAC and TSOA do not pay a family member an hourly wage. They fund caregiver assistance services, which include short-term respite so the caregiver can attend an educational event or training series.5 Think of them as help for the unpaid caregiver, not a paycheck.

Current status: Effective December 1, 2025, MAC and TSOA paused new enrollment and opened a statewide, first-come, first-served waitlist because of projected overspending. People already enrolled keep their enrollment. If you are interested, you can still ask to be added to the waitlist, but verify the current enrollment status before counting on these programs.5

Best for: An unpaid caregiver of someone 55 or older who needs respite and training rather than a wage, and who can wait for a slot.

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

Who can be paid: The designated Primary Family Caregiver of an eligible veteran. You must be at least 18 and either be a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or live full time with the veteran (or be willing to if VA designates you).6

2026 stipend: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by a level factor. Under 38 CFR 71.40(c)(4)(i), which factor applies depends on whether the veteran is in the current program or is a legacy participant or legacy applicant:6

• 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.6
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings, 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 0.25.6
• A veteran who meets both the current-program and the legacy criteria is paid whichever of the two amounts is higher.6
• A legacy participant under 71.20(b) cannot be paid less than what the caregiver was eligible for the day before October 1, 2020, as long as the veteran stays at the address VA has on record. The legacy provisions run through October 1, 2028.6

If your veteran has been in PCAFC since before October 1, 2020, ask which schedule applies before you assume the lower factor. Confirm your exact stipend with your VA Caregiver Support Coordinator.6

Veteran eligibility: VA lists four requirements that must all be true: a VA disability rating of 70 percent or higher, a military discharge or date of medical discharge, a need for at least 6 months of continuous in-person personal care, and enrollment in VA health care. These are a first screen; you and the veteran apply together and go through an application process to determine eligibility.6

Why it stands out: VA has described the monthly caregiver stipend as a nontaxable benefit, and a spouse is among the family members VA lists as eligible caregivers. A Primary Family Caregiver may also receive at least 30 days of respite care per year and access to CHAMPVA health care benefits if they do not already qualify for care under another health care plan.9,6

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

6. VA Veteran-Directed Care (VDC)

Who can be paid: Caregivers the veteran hires, including a spouse. DSHS names Veteran Directed Care as one of two Washington programs that allow spouses to be paid caregivers: if your spouse is a veteran and qualifies, the program may allow you to be hired as their paid caregiver.2

How it works: The veteran receives a flexible monthly budget set by their VA care team based on assessed need and uses it to hire and pay caregivers at a rate they set within that budget. A fiscal agent handles the payroll.

Availability: Veteran-Directed Care is offered through participating VA medical centers in partnership with Area Agencies on Aging. Ask your VA social worker or Caregiver Support Coordinator whether VDC is available at the facility serving your area.

Best for: A Washington veteran with daily-living needs who wants to pay a spouse or to set their caregiver's schedule and rate directly.

7. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension directly, and a family caregiver is typically paid out of it under a private arrangement.10

2026 maximums (effective December 1, 2025 through November 30, 2026), which VA pays each claimant minus their countable income: a single veteran with Aid and Attendance receives up to $29,093 per year; a veteran with one dependent up to $34,488 per year; two veterans married to each other who both qualify for Aid and Attendance up to $46,143 per year. Confirm current figures on the VA pension rate page before applying.10

Eligibility: Aid and Attendance is added to a VA pension, so the veteran must qualify for the pension and meet at least one Aid and Attendance requirement. The pension's service test can be met in one of three ways, each with at least 1 day during wartime: starting active duty before September 8, 1980 and serving at least 90 days; starting active duty as an enlisted person after September 7, 1980 and serving at least 24 months or the full period called or ordered to active duty (with some exceptions); or starting active duty as an officer after October 16, 1981 without having previously served at least 24 months on active duty. VA may also count active-duty training (ADT) or inactive duty training (IADT) if a service-connected condition resulted from that training. The veteran also must not have a dishonorable discharge, must be 65 or older, permanently and totally disabled, a nursing-home patient for long-term care because of a disability, or getting SSDI or SSI, and must have yearly family income and net worth within VA's limits (the net worth limit is $163,699 through November 30, 2026). The Aid and Attendance requirements are needing another person's help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large part of the day in bed, because of illness; being a nursing-home patient due to the loss of mental or physical abilities related to a disability; or eyesight limited, even with glasses or contact lenses, to 5/200 or less in both eyes or to concentric contraction of the visual field to 5 degrees or less. Housebound is a separate benefit with a lower rate. VA also pays Aid and Attendance to qualified survivors through its Survivors Pension. A county Veterans Service Officer can confirm whether you qualify.11,10

How caregivers get paid: The pension goes to the veteran, who then pays the family caregiver, ideally under a written caregiver agreement. Washington's county Veterans Service Officers and the Washington Department of Veterans Affairs help file at no cost; avoid for-profit pension consultants who charge a fee.

Best for: A wartime veteran or surviving spouse with income and assets under the limit who needs help with daily activities.

8. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, because federal law does not penalize assets transferred to the individual's spouse.7

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income on their taxes.

Why the format matters: Federal law (42 U.S.C. 1396p) sets a 60-month Medicaid look-back, counted back from the date the person applies for Medicaid, for assets transferred for less than fair market value. Without a written contract, money that flows from an aging parent to an adult child for care can be treated as one of those transfers and create a penalty period when the parent later applies for Medicaid long-term care. During that period Medicaid will not pay for nursing facility services or home and community-based waiver services, though the rest of the parent's Medicaid coverage is not withdrawn. A properly drafted contract documents that the parent received care in exchange for the payment. The penalty length is figured by dividing the value transferred by the average monthly private-pay cost of nursing facility care in the state, so confirm Washington's current figure with DSHS or a Washington elder-law attorney before relying on it.7

Best for: Families with enough assets to private-pay a caregiver who also want to preserve eligibility for future Medicaid planning. Work with a Washington elder-law attorney to draft the contract.

Comparing the Washington Pathways

How to Choose a Washington Pathway

Start with the care recipient's situation:

Tax Considerations

How caregiver pay is taxed depends on the program, so check with a tax preparer before you file.

• VA PCAFC: VA has described the monthly caregiver stipend as a nontaxable benefit.9
• IRS Notice 2014-7: The IRS treats certain payments to individual care providers under a state Medicaid Section 1915(c) home and community-based services waiver as difficulty-of-care payments excludable from gross income, when the person you care for lives in your home. If you have a separate home where you live, you may not exclude the payments. For a state program other than a 1915(c) waiver, the IRS says the treatment will depend on the nature of the payments and the purpose and design of the program.12 Community First Choice and Medicaid Personal Care are Medicaid state plan benefits, not 1915(c) waivers, so do not assume the exclusion applies to your Washington pay; confirm it with a tax professional.3,8

Common Misconceptions

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. Paid family caregiving in Washington comes through Apple Health, the VA, WA Cares, or a private contract.

"The state will send me a paycheck." No. Your legal employer is CDWA, the statewide Consumer Directed Employer, not the state directly, and CDWA manages your payroll.

"I can just start getting paid out of Dad's bank account." Not without a written personal services contract. An informal transfer of a parent's money to a child for care can count as a transfer for less than fair market value under Medicaid's 60-month look-back, triggering a penalty period during which Medicaid will not pay for the parent's long-term care.7

"MAC or TSOA will pay me to be the caregiver." They will not pay you an hourly wage. They fund respite and other caregiver supports, and as of December 1, 2025 they are not accepting new enrollees, only waitlist requests.

Related Terms

• Consumer Directed Services (CDS): The national term for self-directed programs like Washington's Individual Provider model, where the care recipient directs their own worker.
• HCBS waiver: The federal authority behind COPES; Community First Choice, by contrast, is a Medicaid state plan benefit, not a waiver.
• Activities of Daily Living (ADLs): The functional basis for authorizing personal care hours across all of Washington's programs.
• Nursing Facility Level of Care: The clinical threshold for COPES waiver eligibility.

Learn More

Find personalized help getting paid as a family caregiver in Washington 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.