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Guide

How to get paid to care for a family member in the U.S.

Updated October 15, 2026 · Reviewed against official sources

Yes, in many cases. The most common route is Medicaid: many states have self-directed programs in which the person with Medicaid chooses and hires their own caregiver, and that caregiver can be a son, a daughter or another relative. Well-known examples are IHSS in California and CDPAP in New York. If your loved one is a veteran, the VA has programs that can also pay family members. In almost every case, your loved one has to qualify for the program, and an assessment has to show that they need the help.

Caring for Mom or Dad often means giving up hours at work. Getting paid for that effort doesn't make your care any less loving: it lets you keep caring for them without neglecting your own family. For unpaid support (respite care, counseling, time off work), see help for family caregivers.

The main options at a glance

ProgramWho it's forWho can be paidWhere to apply
Self-directed MedicaidPeople with Medicaid who need help at homeRelatives who meet the state's requirementsState Medicaid agency
IHSS (California)People with Medi-Cal who are 65 or older, blind or disabledRelatives, including those who live in the homeCounty IHSS office
CDPAP (New York)People with Medicaid who need home careAdults, including sons and daughters; not the spouse or the designated representativePlan or LDSS; payroll through PPL
Structured family caregivingPeople in certain waivers who live with their caregiverThe caregiver who lives with the personWaiver coordinator
Veteran-Directed CareVeterans enrolled in VA health careRelatives or neighborsVA social worker
PCAFCVeterans with a service-connected disability rating of 70% or higherThe primary family caregiverVA Form 10-10CG

Self-directed Medicaid: your loved one is the employer

According to CMS, in self-directed services the person has employer authority: they decide whom to recruit, hire, train and supervise. In some programs, they also have budget authority, which means they decide how to use the money Medicaid assigns them. These services are found in 1915(c) waivers, in the 1915(i) and 1915(j) state plan options and in Community First Choice (1915(k)). Read Medicaid home care programs (waivers) to understand those program names.

In practice, a state assessment decides how many hours or what budget your loved one gets; they or their representative hire the caregiver, and a Financial Management Services (FMS) provider, called a fiscal intermediary in some states, runs payroll and handles the employer's taxes. A support broker helps the family get organized.

Who can be paid: children, spouses and guardians

The rules vary a lot from state to state:

  • Adult children, grandchildren, siblings and other relatives: according to CMS, states can allow a relative to provide waiver services if they meet the provider requirements and the state oversees them the same way as any other provider.
  • Spouse: a spouse is a "legally responsible individual," just like the parent of a minor child. For state plan personal care services, the federal rule doesn't allow paying a legally responsible relative. In a waiver, the state can decide to pay them, but only for extraordinary care, meaning care that goes beyond what a husband or wife would normally do.
  • Legal guardian or representative: some states don't pay someone who also makes decisions for the person.

California: IHSS

In IHSS, the person who receives services is the employer of their provider, and a son, daughter or other relative can be that provider. The application (SOC 295) is filed with the county, and a social worker visits the home. To enroll as a provider, you go to a county orientation, turn in form SOC 426, sign the SOC 846 agreement and go through fingerprinting and a background check by the California Department of Justice. There are special rules for spouses: ask your county. More details in Medi-Cal and IHSS.

New York: CDPAP

In CDPAP, the person with Medicaid chooses and directs their personal assistant. According to the New York State Department of Health, it can be a friend or relative, as long as it's not the spouse, the designated representative, or the parent of a consumer under 21. Since 2025, payroll has gone through a single statewide fiscal intermediary, PPL. See the minimum wage for personal assistants in New York Medicaid.

Structured family caregiving

In this model, the caregiver lives with the person and helps them every day. Medicaid pays a daily rate to an agency, which pays the caregiver and supports them with visits from a coach and a nurse. For example, Indiana offers it in its PathWays for Aging waiver and allows the caregiver to be the spouse; Missouri has a waiver like this for adults 21 or older with Alzheimer's or a related disorder. It isn't available in every state: ask whether yours has it.

If your loved one is a veteran

  • Veteran-Directed Care: the veteran gets a budget for services and, with help from a counselor, hires their own workers, who can be a relative or a neighbor. Ask the VA social worker whether it's available in your area.
  • PCAFC (Program of Comprehensive Assistance for Family Caregivers): for veterans with a disability rating of 70% or higher who need at least 6 months in a row of in-person personal care. The veteran must be enrolled in VA health care. The caregiver must be 18 or older and be the veteran's spouse, son or daughter, parent, in-law or other relative, or live with the veteran full time (or be willing to). The primary caregiver gets a monthly stipend, may get CHAMPVA health coverage and at least 30 days of respite care a year. You apply with VA Form 10-10CG.
  • VA Caregiver Support Line: 1-855-260-3274.

Also see Aid and Attendance.

Taxes and paperwork

  • Keep your pay stubs and timesheets.
  • According to the IRS (Notice 2014-7), if you live in the same home as your loved one and get Medicaid waiver payments for caring for them under their plan of care, those payments may be excluded from your taxable income. This doesn't apply if you live in a different home. Check with a tax preparer.
  • If the family pays you with your mom's money, without Medicaid, put it in a written agreement and read about your obligations as employers in home care for seniors. If your mom may need Medicaid later on, talk to an elder law attorney first: Medicaid reviews payments to family members. See Medicaid, the family home and assets.

How to get started, step by step

  1. Confirm whether your loved one has Medicaid or could qualify: read Does Medicaid pay for nursing homes? and, if there are immigration questions, immigration status and benefits.
  2. Ask for a needs assessment from the Medicaid agency or your local aging agency. If you don't know whom to call, use the Eldercare Locator: 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m. Eastern time; if you prefer Spanish, ask for it when you call.
  3. Ask about self-directed options and ask clearly whether, in your case, they can pay you.
  4. Enroll as a provider: forms, training and a background check.
  5. Write down your hours every day and turn them in on time.

The Katz and Lawton scales help you describe the help your loved one needs (they're only a guide).

Frequently asked questions

Can I get paid to care for my husband or wife?

It depends on the state and the program. In New York's CDPAP, a spouse can't be the personal assistant. In some waivers, the state does pay the spouse for extraordinary care. Ask the Medicaid agency or the program coordinator.

How much would I get paid?

Each program sets the authorized hours and the pay rate. You're paid for the approved care hours, not for every hour you spend with your loved one.

Do I have to live with my mom?

In most self-directed programs, no. In structured family caregiving, yes. In PCAFC, living with the veteran is only required of caregivers who aren't family members.

What if my loved one doesn't have Medicaid and isn't a veteran?

Check whether they have long-term care insurance and what the policy says about family caregivers. And take breaks with respite care.

This guide is for information only and is not legal or financial advice. Rules vary by state and program.

Sources

  • Medicaid.gov, Self-Directed Services: https://www.medicaid.gov/medicaid/long-term-services-supports/self-directed-services (accessed October 15, 2026)
  • CMS, Leveraging Family Caregivers for Personal Care Services in 1915(c) Waiver Programs: https://www.medicaid.gov/medicaid/home-community-based-services/downloads/leveraging-family-care.pdf (accessed October 15, 2026)
  • eCFR, 42 CFR 440.167, personal care services: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-A/section-440.167 (accessed October 15, 2026)
  • California Department of Social Services, In-Home Supportive Services: https://www.cdss.ca.gov/in-home-supportive-services (accessed October 15, 2026)
  • California Department of Social Services, IHSS Provider Orientation: https://www.cdss.ca.gov/inforesources/ihss/ihss-providers/orientation-process (accessed October 15, 2026)
  • New York State Department of Health, Consumer Directed Personal Assistance Program: https://www.health.ny.gov/health_care/medicaid/program/longterm/cdpap/ (accessed October 15, 2026)
  • Indiana FSSA, Structured Family Caregiving FAQ: https://www.in.gov/fssa/files/SFC-FAQ-Families-FINAL.pdf (accessed October 15, 2026)
  • Missouri Department of Social Services, Structured Family Caregiving Waiver: https://dss.mo.gov/mhd/waiver/structured-family-caregiving (accessed October 15, 2026)
  • VA, Veteran-Directed Care: https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp (accessed October 15, 2026)
  • VA, Program of Comprehensive Assistance for Family Caregivers: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers/ (accessed October 15, 2026)
  • VA Caregiver Support Program: https://www.caregiver.va.gov/ (accessed October 15, 2026)
  • IRS, Certain Medicaid Waiver Payments May Be Excludable From Income: https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income (accessed October 15, 2026)
  • ACL, Eldercare Locator: https://acl.gov/HousingandServices/FindHelp (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

Keep reading

Help for family caregivers

What the National Family Caregiver Support Program is, who qualifies, its five services and how to apply. Plus FMLA and Medicaid for family caregivers.

Home care

A caregiver from an agency or hired by your family, Medicare home health and Medicaid (IHSS, STAR+PLUS): typical costs and your duties as an employer.

Medi-Cal and IHSS

How Medi-Cal pays for a nursing home and how IHSS pays a caregiver at home, even a family member. The 2026 asset limit, CBAS and how to apply.

New York Medicaid LTC

How New York Medicaid pays for nursing homes and home care: MLTC, CDPAP with PPL, the NYIA assessment and the Assisted Living Program.

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