Can a Family Member Get Paid to Be a Caregiver? A State-by-State Guide

Can a family member get paid to be a caregiver?

Yes, sometimes. Three kinds of programs may pay a relative: Medicaid, VA programs, and a few insurance policies. None of them is automatic. The person who needs care must qualify first, and each program sets its own rules about who can be paid.

Here is the short version:

• Medicaid. Some states let a person with care needs hire a relative through a self-directed program.
• The VA. One program pays a stipend to a family caregiver of a seriously disabled Veteran. Another gives a Veteran a budget to hire workers.
• Long-term care insurance. Most policies do not pay family. Some may. Read the policy.
• Other help. Many states fund respite and training for family caregivers, but these programs do not pay a wage.

Be careful with anything that promises quick pay. Payment follows approval. Care you give before approval may not be repaid. If you are unsure, call the program and ask before you quit a job.

How does a self-directed Medicaid program pay a relative?

In a self-directed program, the person receiving care acts as the employer. They choose the worker, set the schedule within program rules, and approve the hours. A fiscal agent usually handles payroll. See our glossary entry on the participant-directed Medicaid program.

The steps look like this:

1. The person with care needs applies for Medicaid and a home and community-based services waiver or personal care program.
2. The state assesses needs and approves a plan with a set number of hours or a budget.
3. The person picks self-direction, if the program offers it.
4. The person names a worker. Ask whether a relative is allowed.
5. The relative completes enrollment, any training and payroll paperwork.
6. The relative is paid for approved hours worked.

Programs that pay a relative still keep control over hours and tasks. You may be paid only for personal care tasks listed in the plan. Many programs check the work with timesheets or electronic visit verification. See electronic visit verification.

Which states pay family caregivers?

The table below covers the nine states where HomeCare.com serves families. It shows the main program, who qualifies, and whether a family caregiver can be paid. State names link to our state pages. For more detail on each Medicaid program, read Medicaid home care waivers by state.

“Limited” means we could not confirm that a relative can be paid, or the rule has conditions. It does not mean no. Call the program and ask.

What does each state require?

Michigan

Michigan’s Home Help Program pays for bathing, dressing, eating, grooming, mobility, toileting and transferring. It also pays for light housework, laundry, meal preparation and shopping. An MDHHS adult services worker does an in-home assessment. The client is the employer. A relative or friend age 18 or older can be hired. The caregiver cannot be the client’s spouse, a parent caring for a minor child, or someone who also receives Home Help. Apply at your county MDHHS office. See Michigan Home Help.

Texas

Primary Home Care and Community Attendant Services need a score of at least 24 on Form 2060 and at least six hours of service a week, with some exceptions. Through Consumer Directed Services, you hire and manage the attendant. The state handbook says relatives can generally be attendants, but not the recipient’s spouse. Learn more about Texas Primary Home Care.

Arizona

AHCCCS policy lets family members be paid caregivers in ALTCS. Members who live in their own home can use Self Directed Attendant Care or Agency with Choice. If the caregiver is a spouse or the parent of a minor, the care must also be extraordinary, beyond what that person would normally do. Apply in Health-e-Arizona Plus or call 602-417-7000.

Colorado

Under Community First Choice, members can self-direct through CDASS or IHSS. Family members, friends and others can be paid attendants, with some restrictions. Your local Case Management Agency starts the process.

Virginia

In the CCC Plus Waiver, members can direct their own personal care and respite. The state lists spouses and parents of minors, called legally responsible individuals, as eligible to be paid for extraordinary personal care, up to 40 hours a week. DMAS’s 2025 fact sheet also lists a soft cap of 56 personal care hours a week, with exceptions.

North Carolina

CAP/DA offers Consumer Directed Services. The participant or a representative acts as employer and hires, supervises and sets pay for a personal assistant. Home Care Independence is a consumer-directed program for adults 60 or older, available in some counties. The older adult may hire family, friends or others. The person who directs the care cannot be the paid caregiver.

Ohio

PASSPORT participant direction is voluntary. The person recruits and hires a provider independent of a personal care agency. The Ohio Home Care Waiver added self-direction on October 1, 2024. The official pages we reviewed do not say whether relatives may be hired, so ask the agency.

Alabama and Maryland

The pages we reviewed for Alabama and Maryland do not say that Medicaid pays relatives. Alabama’s Personal Choices program lets waiver members direct their own services. Maryland’s Attendant Care Plus program lets you choose and manage your caregiver. Ask each program whether a relative can be your paid worker.

What does the VA pay family caregivers?

The VA has two programs that may pay a family caregiver. Both are only for Veterans. See our VA benefits for home care guide for the full picture.

Program of Comprehensive Assistance for Family Caregivers

This program pays a monthly stipend to an approved Primary Family Caregiver. The Veteran must have a VA disability rating of 70% or higher, need at least 6 months of continuous in-person personal care, and be enrolled in VA health care. The caregiver must be 18 or older and be a spouse, son, daughter, parent, stepfamily member or extended family member, or live full time with the Veteran.

Benefits can include training, mental health counseling, travel benefits, CHAMPVA health coverage if the caregiver has no other coverage, free legal and financial planning help, and at least 30 days of respite care a year. VA says it assigns caregivers no later than 90 days after it receives an application. The Caregiver Support Line is 855-260-3274. Veterans who do not qualify may still get help through VA’s Program of General Caregiver Support Services, which is support, not a stipend.

Veteran-Directed Care

Veteran-Directed Care gives a Veteran a budget for services, managed by the Veteran or a representative. With a counselor’s help, the Veteran hires workers. VA says those workers might include a family member or neighbor. All enrolled Veterans are eligible if they are eligible for community care, meet clinical criteria and the service is available. Services vary by location. Ask your VA social worker.

Will long-term care insurance pay a family member?

Usually not. The NAIC’s shopper’s guide says most policies do not pay benefits to family members who provide care. It also says care they provide may not count toward your elimination period. Some policies may differ, so read the exclusions and definitions in your own policy and ask the insurer in writing. Do not plan around payment until the insurer confirms. See long-term care insurance and our guide on long-term care insurance claims.

What else should I know before I quit my job?

Paid family caregiving can change your taxes, your own benefits and your relationship. Think it through first. Questions to settle:

Paid family care can also be hard on the caregiver. See caregiver burnout and respite care.

Next step

If you want help for a relative so you can rest or keep working, a HomeCare.com care advisor can talk through payment options that may apply to your situation. Call 800-974-3458 or request a call. HomeCare.com care is non-medical. See personal care.