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

In Wisconsin, a relative can become a paid family caregiver through IRIS Self-Directed Personal Care. IRIS is the state's self-directed Medicaid long-term care program for older adults and adults with disabilities, and the person receiving care has a budget for goods, supports, and services and is responsible for hiring and managing their own providers.1,2

Under IRIS Self-Directed Personal Care, the participant hires, trains, and oversees their own personal care workers, and Wisconsin DHS says they may hire family members. DHS's public page does not address spouses, so a husband or wife should confirm with the IRIS SDPC Oversight Agency before counting on being paid. Whoever represents the participant with IRIS SDPC cannot also provide their personal care.2

This guide lays out every legitimate way to be paid as a family caregiver in Wisconsin 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 you are an adult child, other relative, or friend of someone who qualifies for IRIS, the most direct Medicaid route is IRIS Self-Directed Personal Care. Your loved one enrolls in IRIS, receives a budget, and hires you as their personal care worker. If you are a spouse, confirm with the IRIS SDPC Oversight Agency first, because DHS's public page does not address spouses.1,2

If your loved one is a veteran, check the VA programs too. VA's caregiver program (PCAFC) can designate a spouse or other family member as the Primary Family Caregiver and pay them a monthly stipend.3

If your family has enough private assets, a written personal services contract can pay a relative now while documenting the arrangement for later Medicaid planning. Wisconsin applies a 60-month look-back, and when the payments are greater than 10 percent of the maximum Community Spouse asset share, the agreement must have been notarized at the time the relative began providing care.4

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

What Makes Wisconsin Different: IRIS Self-Direction

Wisconsin's self-directed route is IRIS, which stands for Include, Respect, I Self-Direct. IRIS is a Medicaid long-term care program for older adults and adults with disabilities, a federally approved Home and Community-Based Services (HCBS) waiver run by the Wisconsin Department of Health Services (DHS). Its eligible target groups include adults with developmental disabilities, adults with physical disabilities, and frail elders.1

A nursing-home or ICF-IID level of care on the Long-Term Care Functional Screen is necessary but not enough. DHS lists eight criteria, and a participant must meet each one: be at least 18; meet Wisconsin residency requirements; be in an eligible target group; meet that level of care; meet Medicaid financial eligibility; meet Medicaid non-financial eligibility; live in a program-eligible setting; and need long-term care supports and services. The long-term care condition must be expected to last more than 12 months.1

In IRIS, the participant has a budget for goods, supports, and services. Self-direction means the participant or their legal decision maker chooses supports and services within that budget, sticks to it, hires and manages providers, and follows program rules. That hiring role is where a family caregiver comes in.1

Within IRIS, the piece that pays a family caregiver is Self-Directed Personal Care (SDPC), one of two choices for someone who meets the criteria for Medicaid Personal Care. The other is agency-based personal care through the Medicaid ForwardHealth card. The participant hires, trains, and oversees their own personal care workers and may hire family members. Under Wisconsin law, a nurse must help develop each personal care plan; the IRIS SDPC Oversight Agency provides that nurse, and a doctor also helps create the plan.2 A fiscal agent processes the worker's payroll and tax withholding so the family does not have to run a payroll operation. For who carries workers' comp when a fiscal agent runs payroll, see our guide to workers' comp and liability for paid family caregivers.

DHS names three limits. Whoever represents the participant with IRIS SDPC cannot also provide their personal care. A person living in a group residential setting, including an adult family home or a residential care apartment complex, is not eligible for IRIS SDPC unless the residential provider is a relative. And a person cannot be in agency-based personal care and IRIS SDPC at the same time, though they can transfer between the two.2

What about spouses? DHS's public IRIS SDPC page does not say which relatives count as family members and does not mention spouses. The federal definition of Medicaid personal care, 42 CFR 440.167, excludes a family member, meaning a legally responsible relative, from being the paid worker unless a state defines it differently for a waiver. No source this guide cites says how Wisconsin defines it for IRIS SDPC. If you are a spouse, confirm with the IRIS SDPC Oversight Agency (ClinicalServices@wisconsin-iris.com, 844-747-7372) or the current IRIS policy manual before relying on being paid.2

The Wisconsin Paid Family Caregiver Pathways

1. IRIS Self-Directed Personal Care: The Main Medicaid Route

Who pays: Wisconsin's Medicaid program, through the IRIS waiver.

Who can be paid: An adult child, other relative, or friend, hired as the participant's personal care worker; DHS says participants may hire family members. Whoever represents the participant with IRIS SDPC cannot also be the paid worker. DHS's public page does not address spouses, so a spouse should confirm with the IRIS SDPC Oversight Agency.2

What it covers: Personal care and the supports authorized in the participant's IRIS plan and budget. IRIS SDPC can be used at work or in other settings outside the home, not only at home.2

Eligibility, recipient: Meet all eight IRIS criteria, including being at least 18, a nursing-home or ICF-IID level of care on the Long-Term Care Functional Screen, Medicaid financial and non-financial eligibility, and a program-eligible setting.1 For SDPC, a person in a group residential setting such as an adult family home is not eligible unless the provider is a relative.2

Eligibility, caregiver: Meet the worker requirements and background screening, and not serve as the participant's IRIS representative if you are the paid worker.

How you get paid: Through the IRIS fiscal agent's payroll, with taxes withheld. The participant directs your work within their budget.

Best for: A relative caring for someone who qualifies for IRIS and wants to direct their own care.

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

Who can be paid: A designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a family member (a spouse, son, daughter, parent, stepfamily member, or extended family member) or someone who lives full time with the veteran, or is willing to if VA designates them.3

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. Which factor applies depends on whether the veteran qualifies under the current program or as a legacy participant or legacy applicant, under 38 CFR 71.40(c)(4)(i):3

• 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.3
• 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 0.25.3
• Both at once: a veteran who meets the current-program criteria and the legacy criteria is paid whichever of the two amounts is higher.3
• When legacy tiering ends: the legacy tiering applies for eight years beginning October 1, 2020, so it lapses October 1, 2028.3

If your loved one has been in PCAFC since before October 1, 2020, ask which schedule they are paid under. Confirm your exact stipend with your VA Caregiver Support Coordinator.3

Veteran eligibility: VA lists four requirements that must all be true: a VA disability rating (individual or combined) of 70 percent or higher; a discharge from the U.S. military or a date of medical discharge; a need for at least six months of continuous, in-person personal care services; and enrollment in VA health care. These are a first screen, not a decision: you and the veteran apply together and go through an application process to determine eligibility.3

Why it stands out: The caregiver can be a spouse or other family member, or someone who lives full time with the veteran, and a Primary Family Caregiver may also receive at least 30 days of respite care per year.3

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

3. VA Veteran-Directed Care (VDC)

Who can be paid: A caregiver the veteran chooses to hire. No source this guide cites says whether Veteran-Directed Care can pay a spouse, so ask the VA care team before counting on it.

How it works: The veteran receives a flexible monthly budget set by their VA care team and uses it to hire and pay caregivers at a rate they set within that budget. A fiscal agent handles 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 Wisconsin veteran who wants to direct their own care. Confirm how the program works at your VA medical center before counting on it.

4. 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.5

2026 maximums (effective December 1, 2025 through November 30, 2026): a single veteran with Aid and Attendance can receive up to $29,093 per year; a veteran with one dependent up to $34,488 per year. VA publishes these as annual ceilings, not flat payments: it pays the difference between countable income and the ceiling, so income lowers the amount received.5

Eligibility: A veteran or a surviving spouse who also meets the Aid and Attendance criteria, with income for VA purposes under the ceiling and net worth within VA's limit, which is $163,699 from December 1, 2025 to November 30, 2026. VA's net worth calculation includes the claimant's and dependents' assets and income for VA purposes. Ask a county Veterans Service Officer to confirm the veteran's service meets VA's requirements.5

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

Best for: A veteran or surviving spouse with income and net worth under VA's limits who needs help with daily activities.

5. Private Personal Services Contract

Who can be paid: A 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 transfers between spouses are treated differently.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver. When the payments will be greater than 10 percent of the maximum Community Spouse asset share, it must be notarized at the time the relative begins providing care (see below). 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: Wisconsin applies a 60-month Medicaid look-back: transfers of nonexempt income or assets in the five years before the month of application are evaluated for divestment. Wisconsin's Medicaid Eligibility Handbook treats a payment to a relative for care as an unallowable divestment, with a penalty period, unless it meets the allowed-divestment criteria. The services must have directly benefited the person and the payment must not exceed reasonable compensation. When the amount is greater than 10 percent of the maximum Community Spouse asset share, there must also be a written, notarized agreement specifying the service and the amount, notarized at the time the relative began providing the services. An agreement written afterwards does not cure payments already made.4

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

Comparing Wisconsin Paid Family Caregiver Pathways

How to Choose a Wisconsin Pathway

Start with the care recipient's situation and work through these questions in order:1,2

Tax Considerations

Most Wisconsin caregiver pay is reportable income, with one valuable federal exception.

• IRIS Self-Directed Personal Care pays W-2 wages through the IRIS fiscal agent, with taxes withheld.
• VA PCAFC and VA Aid and Attendance: the sources this guide cites do not address how the stipend or the pension is taxed, or how payments a veteran makes to a caregiver from the pension are treated. Ask a tax preparer before filing.
• Personal services contracts pay W-2 or 1099 income depending on how the caregiver is classified.

IRS Notice 2014-7: Certain payments to an individual care provider under a state Medicaid home and community-based services waiver program are difficulty of care payments excluded from income, whether or not the caregiver is related to the person receiving care. The exclusion only applies to care in the caregiver's own home where the care recipient lives under their plan of care. A caregiver who works in the care recipient's home but has a separate home where they live and regularly perform the routines of their private life may not exclude the payments. The Wisconsin Department of Revenue states that Medicaid waiver payments treated as difficulty of care payments and excluded from federal income are also excluded from Wisconsin income. Even excluded payments generally are still wages for Social Security and Medicare tax purposes. Talk to a tax preparer familiar with the rule before filing.4

Wisconsin state income tax: Wisconsin has a graduated state income tax, with rates from 3.50% to 7.65% depending on marital status and income. Confirm how your caregiver wages are treated with the Wisconsin state Department of Revenue or a tax preparer.4

Common Misconceptions

"IRIS definitely pays spouses." Not confirmed. IRIS Self-Directed Personal Care lets participants hire family members, but DHS's public page does not mention spouses, and the federal default for Medicaid personal care excludes a legally responsible relative unless a state defines it differently for a waiver. Confirm with the IRIS SDPC Oversight Agency before relying on it.2

"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 Wisconsin comes through Medicaid (IRIS), the VA, or a private contract.

"I can just start getting paid out of Dad's account." Not safely. Wisconsin treats a payment to a relative for care as an unallowable divestment unless the care directly benefited Dad and the pay was reasonable, and a payment above 10 percent of the maximum Community Spouse asset share also needs a notarized agreement made when the care began. Otherwise a penalty period can delay his Medicaid eligibility later.4

"I can be both the representative and the paid worker." No. Wisconsin DHS states that whoever represents the participant with IRIS SDPC cannot also provide their personal care. Those two roles have to be different people.2

Where to Get Help in Wisconsin

Related Terms

• Participant-directed services: The national umbrella term for programs like Wisconsin's IRIS, where the care recipient directs and hires their own worker.
• HCBS waiver: The federal authority behind IRIS, which is a federally approved home and community-based services waiver program.1
• Activities of Daily Living (ADLs): The functional basis for the personal care that IRIS workers provide.
• Nursing Facility Level of Care: The functional threshold IRIS requires, alongside its other eligibility criteria.1

Learn More

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