Caregivers

How to Get Paid as a Family Caregiver

Can You Get Paid as a Caregiver for a Family Member?

Yes. The main ways to become a paid caregiver for family are Medicaid self-directed programs, which let the person who needs care hire a relative, and, for veterans, VA's Program of Comprehensive Assistance for Family Caregivers, which pays a monthly stipend to a Primary Family Caregiver, and Veteran-Directed Care. Medicare doesn't pay family caregivers. If you work, FMLA can protect your job for up to 12 workweeks while you provide care. Check your state's Medicaid programs on the state pages.

Reviewed by Michael Rupe ·October 1, 2026

A young man and a woman support an older man by the arms as he walks across a sunny bedroom — Photo: Kampus Production / Pexels

The Main Ways to Get Paid for Caring for Family

A few public programs will pay a relative instead of an agency worker. Which one fits depends on who needs care and what coverage they have.

Program	Who needs care	Who gets paid	Where to start
Medicaid self-directed services	A Medicaid member who qualifies for home care or a waiver	A worker the member hires, which can be a relative in some state programs	The state Medicaid agency or local aging and disability office
Structured family caregiving	A Medicaid member in a state that offers it	A live-in caregiver, paid through an enrolled provider	The state Medicaid or aging agency
VA Program of Comprehensive Assistance for Family Caregivers	A veteran with a VA rating of 70% or higher who needs ongoing personal care	The Primary Family Caregiver, as a monthly stipend	VA Form 10-10CG, filed jointly
Veteran-Directed Care	An enrolled veteran who needs help with daily activities	Workers the veteran hires, which might include a family member	A VA social worker
State paid family leave	Anyone with a serious health condition	You, as wage replacement while you take leave from your job	Your state’s paid leave program

Medicare isn’t on this list. It covers part-time or intermittent home health care from a Medicare-certified agency, but it doesn’t pay for 24-hour care at home, homemaker services unrelated to a care plan, or personal care like bathing and dressing when that’s the only care someone needs. See Medicare for people on disability for what it does cover.

How to Become a Paid Caregiver for Family Through Medicaid

For most families, the path runs through what Medicaid calls self-directed services. In self-direction, the person who needs care, or their representative, decides who provides it. Medicaid.gov describes two kinds of control:

Employer authority: the person can recruit, hire, train and supervise their own workers.
Budget authority: the person decides how the Medicaid money in their budget is spent.

States offer self-direction through several federal options, including home and community-based services (HCBS) waivers under section 1915(c), Community First Choice under 1915(k), and self-directed personal assistance services under 1915(j). The person gets a written service plan and an individualized budget based on an assessment of their needs.

You don’t have to run payroll yourself. Medicaid.gov says financial management services can handle billing, payroll, tax withholding and filing, workers’ compensation, timesheets and paychecks. Each state also has to provide a supports broker or consultant to help.

The first step is the care recipient’s eligibility, not yours. They need Medicaid and an assessed need for home care or a waiver. Read Medicaid for people with disabilities for the eligibility paths. Then ask the state Medicaid agency or local aging and disability resource office about self-direction. Some programs limit the number of people they serve each year, so apply early.

State Programs That Let Relatives Be Hired

Every state sets its own rules about which relatives can be paid. These examples come straight from state agency pages:

New York, CDPAP. The Consumer Directed Personal Assistance Program lets Medicaid members who qualify for home care choose and hire their own personal assistant, including a friend or family member. The assistant can’t be the member’s spouse, their designated representative, or the parent of a consumer under 21. All recipients use the statewide fiscal intermediary, Public Partnership LLC, for payroll. See New York disability help.
Minnesota, CDCS. Consumer Directed Community Supports lets people eligible for a waiver or the Alternative Care program hire the people they want, including parents and spouses. The person acts as the employer, with help from a financial management services provider, and the budget comes from their assessment. See Minnesota disability help.
Wisconsin, IRIS. IRIS (Include, Respect, I Self-Direct) is a self-directed Medicaid long-term care program for older adults and adults with disabilities. Participants choose their services within a budget and hire and manage their own providers. The local aging and disability resource center (ADRC) can check eligibility. See Wisconsin disability help.

Other states use different program names. Your state page lists the Medicaid agency and its home and community-based waivers, so you know which programs to ask about.

Structured Family Caregiving

Structured family caregiving pays a live-in caregiver through an enrolled provider agency. Missouri and Nevada each list a Structured Family Caregiving waiver.

Missouri’s program, as its manual describes it, works like this:

The person must be 21 or older, diagnosed with Alzheimer’s disease or a related dementia, meet nursing facility level of care, have active Medicaid, and live full time with the primary caregiver.
The primary caregiver must be the live-in caregiver already providing care. Primary and substitute caregivers may be family members, non-family members or a legal guardian.
Care covers homemaking, help with bathing and dressing, medication oversight and escorting to appointments.
The daily rate is 60% of the nursing facility daily rate. The provider can keep no more than 35% of it and must pay the primary and substitute caregivers.
Slots are limited each waiver year, which runs July 1 to June 30.

See the Missouri and Nevada state pages for each state’s Medicaid agency.

VA Caregiver Stipend for Veterans’ Families

VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to the Primary Family Caregiver of an eligible veteran.

The caregiver must be at least 18 and be the veteran’s spouse, son, daughter, parent, stepfamily member or extended family member, or live full time with the veteran (or be willing to).

The veteran must:

have a VA disability rating, individual or combined, of 70% or higher,
be discharged from the military or have a date of medical discharge,
need at least 6 months of continuous, in-person personal care services, and
be enrolled in VA health care.

The veteran can name one Primary Family Caregiver and up to two Secondary Family Caregivers. Both get caregiver training, mental health counseling and certain travel benefits. The Primary Family Caregiver may also get the monthly stipend, CHAMPVA health coverage if not covered by another plan, free legal and financial planning help, and at least 30 days of respite care a year.

How the stipend is set: VA starts with the federal General Schedule annual salary for grade 4, step 1, in the locality where the veteran lives, and divides by 12. Level One caregivers get 0.625 of that monthly rate. Level Two caregivers, for veterans VA finds unable to self-sustain in the community, get the full rate. You must enroll in direct deposit to be paid.

To apply, you and the veteran apply together online, by mail with VA Form 10-10CG to the 10-10CG Evidence Intake Center, PO Box 5154, Janesville, WI 53547-5154, or in person with the caregiver support team at a VA medical center. Don’t send medical records. You’ll complete caregiver training and a home care assessment, and VA says it assigns caregivers no later than 90 days after it gets the application.

If the rating is the barrier, see how VA disability ratings work and the VA combined rating calculator. The VA disability compensation guide covers filing for an increase.

Veteran-Directed Care

Veteran-Directed Care is VA’s version of self-direction. The veteran gets a budget for home and community-based services, managed by the veteran or a representative. With a counselor’s help, the veteran hires their own workers, which VA says might include a family member or neighbor.

It’s for veterans who need help with daily activities such as bathing, dressing, eating, using the bathroom, moving around or grocery shopping. It’s also for veterans who are isolated, or whose caregiver is under strain. Enrolled veterans are eligible if they qualify for community care, meet the clinical criteria and the program is offered locally. Services vary by location, so ask a VA social worker whether it’s available at your VA.

FMLA and Paid Leave for Caregivers Who Work

If you have a job, you may not need to quit to provide care. The federal Family and Medical Leave Act (FMLA) lets eligible employees take up to 12 workweeks in a 12-month period to care for a child, spouse or parent with a serious health condition. It allows up to 26 workweeks of military caregiver leave for a current servicemember or recent veteran with a serious injury or illness.

You’re eligible if you’ve worked for a covered employer for at least 12 months, worked at least 1,250 hours in the past 12 months, and work where the employer has at least 50 employees within 75 miles. Public agencies and schools are covered regardless of size.

It protects your job and health coverage. You return to the same or an equivalent job, and your group health insurance continues.
You can take it in pieces. When medically necessary, you can take leave in separate blocks or on a reduced schedule, such as a few hours to drive a parent to dialysis.
It’s unpaid unless you use paid leave. You can use your employer’s paid leave at the same time, and your employer can require it.

Some states pay you while you’re on caregiving leave. New York Paid Family Leave pays up to 12 weeks at 67% of your average weekly wage, up to $1,228.53 a week in 2026. California Paid Family Leave pays up to 8 weeks, at up to $1,765 a week. Read the New York disability benefits and California SDI guides, or compare every state on the state disability insurance page.

Frequently Asked Questions

Does Medicare Pay Family Members to Be Caregivers?

No. Medicare covers part-time or intermittent home health services from a Medicare-certified agency. It doesn't pay for 24-hour care at home, homemaker services unrelated to your care plan, or personal care like bathing and dressing when that's the only care you need.

Can a Spouse Be Paid as a Caregiver?

It depends on the program. Minnesota's CDCS lets people hire parents and spouses. New York's CDPAP allows family members but not the person's spouse, designated representative, or the parent of a consumer under 21. VA's caregiver program includes spouses.

How Much Does the VA Pay a Family Caregiver?

VA bases the monthly stipend on the federal GS grade 4, step 1 annual salary for the locality where the veteran lives, divided by 12. Level One caregivers get 0.625 of that monthly rate, and Level Two caregivers, for veterans VA finds unable to self-sustain in the community, get the full rate.

Can I Get Paid Leave From Work to Care for a Family Member?

In some states. New York Paid Family Leave pays up to 12 weeks at 67% of your average weekly wage, up to $1,228.53 a week in 2026. California Paid Family Leave pays up to 8 weeks at up to $1,765 a week. Federal FMLA leave protects your job but can be unpaid.

Who Handles Payroll and Taxes When Medicaid Pays a Family Caregiver?

Usually a financial management service. Medicaid.gov says these services can handle payroll, tax withholding and filing, workers' compensation, timesheets and paychecks for people who self-direct. New York requires all CDPAP recipients to use its statewide fiscal intermediary.

What if the Veteran Doesn't Qualify for the Caregiver Stipend?

Family caregivers of veterans who aren't eligible for the comprehensive program may still get support through VA's Program of General Caregiver Support Services. A VA caregiver support team can explain the options.

More on Caregivers

This guide explains official rules in plain language. It isn't legal advice, and only the agency that runs a program can decide your case.