Paid Family Caregiver Guide: How to Get Paid to Care for a Relative

Yes.

The Department of Labor's Wage and Hour Division states that family or household members can be paid employees under Medicaid-funded and other publicly funded home care programs, with the paid hours and services set in a program-approved plan of care.

The scale is real.

PHI estimates there are at least 1.5 million Medicaid-funded independent providers — direct care workers employed directly by consumers through publicly funded consumer-direction programs.

Being paid does not turn every hour of family help into a job.

The DOL notes that for a paid family caregiver, the employment relationship under the FLSA is generally limited to the paid hours in a reasonable plan of care, and help outside those hours stems from the family relationship.

That limit only holds if the plan is fair.

The DOL treats a plan of care as not reasonable when a program cuts paid hours because the participant picked a family member — its example is a plan cut from 30 hours to 15 once a daughter was chosen as the provider.

Medicare, by contrast, does not pay a family caregiver.

Medicare covers part-time or intermittent home health aide care only when the person is also getting skilled nursing or therapy at the same time, and it does not pay for ongoing non-medical caregiving on its own.

Program pay is also not the same thing as paid family leave.

The DOL Women's Bureau notes there is currently no federal law providing or guaranteeing paid family and medical leave for private-sector workers, though paid leave programs exist at the state level.

The money comes from a handful of program families, and the program you use shapes the rest: who counts as the employer, who can be hired, and how the paycheck arrives.

• Medicaid self-direction. The participant holds what CMS calls "employer authority" to recruit, hire, train and supervise their workers, plus "budget authority" over how the money is spent. CMS lists self-direction under several Medicaid authorities, including state plan personal care, 1915(c) waivers, 1115 demonstrations and the 1915(i), 1915(j) and 1915(k) options. Financial Management Services must be available to people with budget authority, typically handling payroll, tax withholding and filing, workers' compensation, timesheets and benefits.
• 1915(c) HCBS waivers. Federal rules let these waivers cover case management, homemaker, home health aide, personal care, adult day health, habilitation and respite care services, among others.
• State plan personal care, plus the relative-hiring option. The default federal rule requires a qualified provider who is not the recipient's legally responsible relative, unless a waiver defines family differently. States using the 1915(j) option can let participants hire any capable individual — including legally liable relatives such as spouses — as paid personal assistance providers.
• Named state programs. New York's CDPAP lets Medicaid members hire their own personal assistant, including a friend or family member, subject to the exclusions below. California's IHSS makes the approved recipient the provider's employer, responsible for hiring, training, supervising and firing, and CDSS reports over 800,000 people enrolled as IHSS providers. Massachusetts' MassHealth PCA program makes the consumer-employer responsible for hiring, training, managing and terminating the PCA, as the employer on the I-9 and W-4.
• VA programs. PCAFC pays an eligible veteran's Primary Family Caregiver a monthly stipend directly, along with CHAMPVA health coverage if not otherwise insured, certain travel benefits and at least 30 days of respite care a year for the veteran. Veteran-Directed Care gives eligible veterans a budget, managed with a counselor's help, to hire their own workers — which may include a family member or neighbor.
• Structured family caregiving. A program model you may see named in your state. Our research could not confirm from primary sources which states offer it, who it pays or how much — ask your state Medicaid agency whether your state has one and what it requires.
• Direct private arrangements. A family can also pay a relative directly, outside any public program. What private-pay dollars mean at tax time is covered below.

Whichever program applies, its own rulebook decides eligibility, exclusions and pay — the next sections take those one at a time.

Two people have to qualify: the person receiving care, and the person providing it.

On the Medicaid side, each program sets its own need criteria.

New York, for example, began applying new Minimum Needs Requirements to new CDPAP and personal care assessments for people 21 and over on September 1, 2025.

The threshold is limited assistance with physical maneuvering for more than two activities of daily living, or, with a dementia or Alzheimer's diagnosis, supervision for more than one.

The VA's PCAFC publishes its criteria on both sides.

The veteran must have a single or combined service-connected disability rating of 70% or more and need in-person personal care services for at least six continuous months.

That means an inability to perform an activity of daily living, or a need for supervision, protection or instruction.

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

Programs also screen the caregiver.

California bars a person convicted of — or incarcerated after a conviction for — specified crimes in the last 10 years from being an IHSS provider, including fraud against a government health or supportive services program and elder or dependent adult abuse.

The rules are not uniform from program to program, and the same relative can be eligible in one and barred in the next.

Federal Medicaid state plan personal care must be provided by a qualified individual who is not a member of the recipient's family.

Federal rules define that family member as a legally responsible relative, unless a waiver defines it differently.

Under the 1915(j) self-directed personal assistance rule, "legally liable relatives" includes a parent of a minor child, legally assigned caretaker relatives, and a spouse — and states using the option can let participants hire any capable individual, including those relatives, as paid providers.

Named programs differ.

New York CDPAP excludes the member's spouse, designated representative, and the parent of a consumer under age 21.

MassHealth's PCA program excludes the consumer-employer's spouse, a parent or foster parent of a minor consumer, and a surrogate — a legally responsible decision maker.

Other programs admit some of these relatives.

VA PCAFC accepts a spouse as the family caregiver.

California's IHSS lets a parent be the paid provider for a minor child in the CFCO, IHSS Plus Option and IHSS-Residual sub-programs, but not in the Personal Care Services Program, where federal rules bar parent providers.

Our research did not confirm IHSS's rules for spouses.

So whether a spouse can be paid depends on the specific program — and on whether a state has turned on the option behind it.

Every route runs through the body that operates the program — a state or county agency, a fiscal intermediary the program requires, or the VA.

The paperwork differs by program, but the shape is the same.

The named programs show how much step three varies.

California IHSS enrollment runs through a county provider orientation, the Provider Enrollment Form (SOC 426), the Provider Enrollment Agreement (SOC 846) and California DOJ fingerprinting and a criminal background check.

MassHealth PCAs hired after January 2014 complete a one-time, mandatory four-hour New Hire Orientation within nine months of hire.

The program's three fiscal intermediaries are Stavros, Northeast ARC and Tempus Unlimited.

New York CDPAP goes through one statewide fiscal intermediary, Public Partnerships LLC, which all CDPAP recipients are required to work with.

A PCAFC application is VA Form 10-10CG, filed online, by mail to the 10-10CG Evidence Intake Center in Janesville, Wisconsin, or in person with a local Caregiver Support Program team.

There is no single number: pay is set program by program, and inside some programs it is set locality by locality.

The VA's PCAFC stipend is a formula, not a flat rate.

Under 38 CFR 71.15, the monthly stipend rate is the OPM General Schedule annual rate for grade 4, step 1 in the veteran's locality pay area, divided by 12.

The Primary Family Caregiver receives 62.5% of that rate, or 100% when VA finds the veteran unable to self-sustain in the community.

Legacy participants and applicants have different rules, and VA has extended their transition period through September 30, 2028.

California's IHSS sets pay locally: hourly wage rates vary by county because unions negotiate with each county's employer of record, and the state issues the paychecks, withholding applicable disability insurance and Social Security taxes when the provider qualifies.

Tax treatment depends on the program.

Under IRS Notice 2014-7, qualified payments to individual care providers under a state Medicaid HCBS 1915(c) waiver — for care of an eligible individual living in the provider's home — are difficulty-of-care payments excludable from gross income under the Internal Revenue Code.

Not every dollar qualifies.

Direct payments from a care recipient paying with private funds are not excludable.

Even excludable waiver payments may still be subject to Social Security and Medicare taxes, depending on whether the agency, the care recipient, or no one is the employer.

Confirm your own situation with the IRS guidance or a CPA.

These program amounts are not occupational wage data either.

For the broader caregiver occupation's federal wage tables, see our caregiver pay page.

It can — paid family caregiving is real employment, and that shows up in your records.

In MassHealth's PCA program, PCAs are not independent contractors and taxes are withheld.

In self-direction, a financial management entity processes payroll, withholding, employment taxes and insurance.

The work you have been doing is worth describing in the field's own terms when you apply: personal care, safe mobility, meals, housekeeping routines, and reliable attendance on a schedule set by someone else's needs.

That history — hours, pay stubs, an employer of record — is worth keeping, too: the settings that hire caregivers include home care agencies, home health providers, assisted living communities and nursing homes.

Routes from there include agency-employed caregiver roles, personal care aide positions, or the clinical step up to certified nursing assistant or home health aide.

Those credentials carry their own training and testing requirements, set in federal and state rules.

For nurse aides, the federal floor is 75 clock hours of training, including at least 16 hours of supervised practical training — and state totals can exceed that floor.

When you are ready to look, our caregiver jobs board lists open positions from home care agencies, home health and hospice providers, and senior living employers.

Career information, not legal, tax or medical advice. Program rules change: confirm current requirements with your state Medicaid agency, the VA or the IRS, and talk with a CPA about your own tax and employment situation.