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

You can get paid to care for your spouse in Wyoming, and the state's own waiver rules say so rather than leaving it to a phone call. Under the Community Choices Waiver's participant-directed option, the Employer of Record may hire the participant's relative or spouse as a paid employee, provided it is authorized in the CMS-approved waiver agreement and the worker meets the standards the Department sets.

One condition in the same chapter decides who in your household plays which part, and it catches couples off guard: the Employer of Record cannot also be the paid worker. This guide walks through how that works, what Wyoming Medicaid needs from you, and the separate VA route when the person you care for is a veteran.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Wyoming?
• The Medicaid Self-Directed Route in Wyoming
• The Legally Responsible Relative Rule, and Why It Doesn't End the Question
• 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 Wyoming: Who to Call
• Frequently Asked Questions
• Learn More

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

Yes, in principle, and Wyoming is unusually direct about it. Wyoming Medicaid, administered by the Department of Health's Division of Healthcare Financing, delivers home and community-based long-term care through the Community Choices Waiver, a Section 1915(c) waiver for adults 65 and older and adults 19 to 64 with a disability, as an alternative to nursing-facility care. Its covered services include adult day services, homemaker, personal support services, home health aide, and respite.1

The CCW has a participant-directed track built on an Employer of Record. The participant, their legal guardian, or another appropriate individual the participant designates serves as the EOR, and the EOR may hire the participant's relative or spouse as a paid employee, provided that is authorized in the CMS-approved waiver agreement and the worker meets the requirements and standards the Department has established.1

That is a state rule naming a spouse, not a maybe you have to fish for. What it does not do is make you both the boss and the employee. Chapter 34 Section 18(c) says the EOR cannot delegate or assign the EOR's responsibilities and cannot be reimbursed to provide CCW services to the participant. So a spouse who takes the EOR role gives up being the paid caregiver, and a couple that wants the husband or wife paid needs a different person, or the participant, in that seat.1 Work that out before you call, because it is the first thing the program will ask you to settle.

The Medicaid Self-Directed Route in Wyoming

Self-direction is the concept worth understanding, because it is the mechanism that lets a spouse be paid, and it is the option you will name on the phone.

Under self-direction, sometimes called consumer direction or participant direction, the person receiving care, or their authorized representative, controls the budget and chooses, hires, trains, and supervises their own attendant, while a financial management company handles payroll and taxes.4 That authority is what makes a spouse a candidate for the paid role, because the member is doing the hiring rather than an agency assigning a stranger. Federal rules give each state the option, under self-directed personal assistance authority, to let participants hire "any individual capable of providing the assigned tasks, including legally liable relatives," a category defined as people with a state-law duty to care for another and one that may include a spouse.2 The key word there is option, and Wyoming's CCW rule shows the state exercising it.

Two things still have to be true before anyone is paid. The person you care for has to clear the CCW gate: a trained public health nurse evaluates them with the Long-Term Care 101 (LT-101) assessment tool, the Department has to determine they need a nursing-facility level of care (before enrollment and at least annually after), and they have to be otherwise eligible for Wyoming Medicaid or qualify for the Special HCBS Waiver Group, generally with income at or below 300 percent of the Federal Benefit Rate and limited countable resources. And the hire has to be authorized in the CMS-approved waiver agreement, which is a program-level question for the state rather than something you can read off a website. Ask Wyoming Medicaid HCBS at 1-307-777-7531 or 1-800-510-0280 to confirm both for your household.1

One more piece of the eligibility picture. Wyoming Medicaid denies LTSS coverage to someone who transferred assets for less than fair market value during the five years before applying, and that rule reaches transfers by the applicant or their spouse.1 Which is a reason to run a spouse's pay through the CCW's participant-directed option from the start, with a written agreement and a financial management company handling payroll, rather than moving money informally between you.

The Legally Responsible Relative Rule, and Why It Doesn't End the Question

If a caseworker tells you a spouse cannot be paid, this is the rule behind it, and knowing its edges is what lets you ask the right follow-up.

Under the standard Medicaid state plan personal care benefit, the services must be "provided by an individual who is qualified to provide such services and who is not a member of the individual's family," and for that benefit a family member "means a legally responsible relative." Where a spouse is one, that particular benefit cannot pay them.2 But this is narrower than it gets repeated as, in two ways.

First, whether a spouse counts as a legally responsible relative is a question of state law rather than a federal given. The federal self-directed services regulation defines legally liable relatives as people who have a duty under state law to care for another person, and says that group may include a spouse, not that it always does. Second, the whole state plan rule is prefaced "Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter," which is the 1915(c) waiver program. The Community Choices Waiver is a 1915(c) waiver. So the state plan exclusion does not carry over to it automatically, and Wyoming's own CCW rule names a spouse as someone the Employer of Record may hire.2,1 If someone tells you a flat no, the follow-up is: "What about the Community Choices Waiver's participant-directed Employer of Record option?"

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 its centerpiece names a spouse outright. It applies anywhere in Wyoming and does not depend on Medicaid, on the CCW level-of-care finding, or on Wyoming's waiver rules.

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 stipend is not a single national figure, and it is monthly rather than hourly. It starts from the Office of Personnel Management (OPM) General Schedule grade 4, step 1 annual rate for the veteran's locality, divided by 12, and that monthly base is then multiplied by a factor. 38 CFR 71.40(c)(4)(i) sets four factors, and which one applies turns first on whether the veteran is in the current program or is a legacy participant or legacy applicant.3

• Current program, meaning the veteran meets 38 CFR 71.20(a): the multiplier is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."
• Legacy participant or legacy applicant under 38 CFR 71.20(b) or (c): the multiplier is set by the sum of the veteran's 2019 clinical ratings, with no self-sustain determination required. A sum of 21 or higher pays 1.00, 13 through 20 pays 0.625, and 1 through 12 pays 0.25.
• A veteran who meets both sets of criteria is paid whichever of the two amounts is higher.
• A legacy participant also has a floor: the stipend cannot drop below what the caregiver was eligible to receive the day before October 1, 2020, while the veteran remains at the address on record. The legacy schedule itself lapses October 1, 2028.3

So the amount depends both on where in Wyoming you live and on which schedule applies to your household. If yours is a legacy household, the 2019 rating sum alone can reach the full 1.00 multiplier, so do not assume the "unable to self-sustain" finding is the only route to the top amount.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 budget, managed by the veteran or their representative, and uses it to hire and supervise their own workers, and VA says veterans may hire family, friends, and neighbors. The veteran works with a person-centered options counselor at an Aging and Disability Network Agency, such as an Area Agency on Aging, and a financial management service helps handle the employer responsibilities.5 One honest gap: VA's and ACL's own VDC pages do not address a spouse specifically, in either direction, so treat this as a question for the VA medical center serving you rather than a settled yes.

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, including making up for income a spouse gave up to provide it. For 2026, VA publishes these as annual maximums, up to $29,093 a year for a veteran with no dependents and up to $18,697 a year for a surviving spouse, but each is a ceiling, not a payment: VA pays it minus the claimant's countable income, so someone with income receives less, and any monthly figure is just that annual ceiling divided by 12.6 Aid and Attendance also requires that the veteran or survivor already qualify for a VA pension, with its own income and net-worth tests (the 2026 net-worth limit is $163,699).6 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.

How to Get Paid to Care for Your Spouse in Wyoming: Who to Call

The rule is on your side here, so the calls are about getting enrolled and getting the paperwork right rather than about winning an argument.

One note on taxes for when the pay starts. 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 the 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. And if the Medicaid answer for a spouse turns out to be no, remember that Wyoming's National Family Caregiver Support Program, channeled through the state's aging network to local Area Agencies on Aging, offers respite, counseling, and training, though it is a support service rather than a direct caregiver wage.1

Learn More

Find personalized help getting paid to care for your spouse in Wyoming 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.