Medicaid programs for family caregivers: who can be paid, and the rules in 12 states

Does Medicaid pay family caregivers?

Yes, in most states, but which relatives can be paid differs. Medicaid is run by each state within federal rules, so there is no single national "family caregiver" benefit. What exists instead is a set of federal options a state can use to fund care at home, several of which let the person receiving care hire someone they know. The person receiving care has to qualify for Medicaid and be assessed as needing help; for waiver programs, that means needing a level of care that would otherwise be provided in an institution such as a nursing facility.

Three questions decide if you can be paid:

1. Does your relative qualify for Medicaid and for the home-care program, financially and by assessed need?
2. Does the program let the person receiving care choose the worker (self-directed or consumer-directed care), or does it use a family-caregiver service such as structured family caregiving?
3. Are you a "legally responsible" relative? Adult children, siblings and other relatives are usually treated like any other worker. Spouses and parents of minor children face extra rules or an outright bar, depending on the state.

If you live in California, the program is In-Home Supportive Services (IHSS), and the state-specific detail (hours, county wages, the spouse rules, taxes) is in how to get paid to care for a family member in California.

Self-directed care and consumer directed care: how the money reaches a relative

CMS (the federal Centers for Medicare & Medicaid Services) uses the term self-directed services for arrangements where "participants, or their representatives if applicable, have decision-making authority over certain services". States and programs call the same idea consumer directed care, participant-directed services or self-determination. Two powers matter:

• Employer authority: the power "to recruit, hire, train and supervise the individuals who furnish their services". This is what lets your relative pick you.
• Budget authority: decision-making over how the Medicaid funds in a budget are spent.

Financial Management Services must be available where people have budget authority. In practice this is the payroll organization (often called a fiscal intermediary or fiscal agent) that handles wages, tax withholding and employer paperwork, so the family is not running payroll itself.

The federal options states use

• 1915(c) home and community-based services waivers. States design waivers for people who would otherwise need institutional care; CMS says about 257 are active nationwide, and a waiver can be targeted by age or diagnosis.
• 1915(k) Community First Choice. A state plan option created by the Affordable Care Act and available since 1 October 2011, providing home and community-based attendant services, with a 6 percentage point increase in federal matching payments for those services. California and Washington both use it.
• 1915(j) self-directed personal assistance services. Personal care provided under the state plan or an existing 1915(c) waiver, where participation is voluntary. CMS lists hiring "legally liable relatives (such as parents or spouses)" and managing a cash disbursement as options a state may choose to allow.

A CMS training deck on family caregivers in 1915(c) waivers states that relatives and legal guardians may provide any waiver service, including personal care, if they meet the provider qualifications the state sets and the state monitors them like any other provider.

What is structured family caregiving?

Structured family caregiving is a waiver service rather than a self-direction model. The family caregiver usually lives with the person receiving care, an agency is the provider, and the agency receives a daily rate and supports the caregiver. Indiana's Family and Social Services Administration describes it this way in its families FAQ (updated 18 June 2024):

• The state "pays a daily rate to the Structured Family Caregiving provider" on days services are delivered under an approved service plan.
• A caregiver coach and nursing staff from the provider make occasional home visits to train and support the principal caregiver; they do not provide skilled care.
• Separate payment is not made for attendant care, home and community assistance, assisted living or adult family care while someone receives it.

Among the 12 states below, Georgia's Elderly and Disabled Waiver includes a Structured Family Caregiver service, and Ohio added structured family caregiving to its waivers by rule (Ohio Administrative Code 5160-44-33, effective 12 August 2025). In Georgia, spouses are excluded.

Can a spouse be a paid caregiver? The legally responsible relative rule

Federal guidance treats two relationships differently from the rest of the family. CMS describes the customary definition of a legally responsible individual as "the parent of a minor child, biological or adoptive, or a spouse", adds that parents of adult beneficiaries and other relatives are typically not legally responsible individuals unless state law says so, and notes that federal regulation does not define the term, so each state must.

• The default is no payment for ordinary care. The CMS deck cites section 4442.3 of the State Medicaid Manual: federal matching funds are not available for personal care provided by legally responsible relatives, but payment to qualified legally responsible individuals is allowed for "extraordinary" care, meaning care beyond what a spouse or parent would ordinarily provide.
• Each waiver answers yes or no. In the 1915(c) waiver application a state either says it does not pay legally responsible individuals, or says it does and lists who may be paid, for which services, when extraordinary care can be authorised and how it checks that payments are only for services delivered.
• It varies even within a state. CMS counted 253 active waivers on 30 June 2020; 67 waivers across 27 states allowed legally responsible individuals to provide personal care, and some states allow it in one waiver and not another.

So an adult child caring for a parent usually has an easier path than a spouse. The table shows what each state's own pages say.

Medicaid programs for family caregivers in 12 states

Each cell below comes from an official state or federal page fetched on 14 October 2026. "Exception" means the page allows payment only under named conditions (summarised beneath the table). "Not stated" means the pages we could fetch did not answer the question; it does not mean no. Rules change, so confirm with the agency before relying on any cell.

What sits behind each answer

• California. No one is paid for housework-type tasks while an able and available spouse is in the home; a spouse can be paid for transportation and protective supervision only after leaving, or being unable to take, full-time work because no other suitable provider is available (CDSS regulations 30-763). A parent cannot be a minor's provider in the Personal Care Services Program but can in the CFCO, IPO and IHSS-R sub-programs (CDSS, IHSS for children).
• Arizona. Under AHCCCS policy 1240-A a spouse or parent is paid only for care assessed as extraordinary, is employed through a provider agency, and is capped at 40 hours a week (parents: per child, and 16 hours a day). Policy 1320-A bars both from self-directed attendant care.
• Texas. The CDS FAQ (revised 6 February 2026) lists the spouse, "except in the Consumer Managed Personal Attendant Services program", and the parent of a person under 18 among those who cannot be hired.
• Florida. The waiver application lets recipients choose a spouse under the Participant Direction Option for personal care, adult companion, respite, attendant care and some nursing services. We could not fetch the current approved waiver, so check with the plan.
• New York. The assistant can be "a friend or family member, as long as they are not the Medicaid member's spouse, their designated representative or the parent of a CDPAP consumer under the age of 21". Public Partnerships LLC (PPL) is the single statewide fiscal intermediary (1-833-247-5346).
• Pennsylvania. The Community HealthChoices waiver (effective 1 July 2026) says it "will not pay for services furnished by the participant's spouse".
• Illinois. The Home Services Program handbook (2021) excludes "a legally responsible person: such as your spouse or a parent and guardian if you are under the age of 18". The Department on Aging says Community Care participants may choose any family member, including a spouse, but "Not all In-Home Service providers employ family members."
• Ohio. Rule 5160-44-32 allows a spouse or parent of a minor to be paid only when no other willing and able provider is available, the care is extraordinary, the state is satisfied health and safety can be ensured, the work is through an agency or participant direction, and hours stay at 40 a week unless an exception is granted.
• Georgia. The Department of Community Health manual (version dated 1 April 2026) says Medicaid "will not reimburse for personal care services or any waiver services when provided to recipients by legally responsible relatives, i.e., spouses, legal guardians or parents of minor children", while other relatives may be employed as consumer-directed caregivers. Every georgia.gov page refused our requests, so this comes from an archived copy dated 9 June 2026. Phone: 866-552-4464.
• North Carolina. CAP/DA policy 3K-2 (amended 1 September 2025) says a spouse can be hired as the employee of a beneficiary aged 18 or over, but its glossary says family, including a spouse, may not be paid "unless exemptions are granted", so ask the case manager. Under CAP/C policy 3K-1 a parent can be paid only in listed extraordinary circumstances, up to 40 hours a week.
• Michigan. Adult Services Manual 135 (1 July 2026): "Do not pay Home Help services to: A responsible relative (a spouse caring for a spouse or a parent caring for a minor child)." The MI Choice chapter of the Medicaid Provider Manual excludes spouses and legally responsible individuals from self-determined services.
• Washington. DSHS has a "Spouse or Domestic Partner" training category for individual providers, and the state's rules (WAC 388-71) cover workers providing services only for a spouse. A December 2025 report by the Washington State Institute for Public Policy says the state "does not allow parents to be paid as providers" of care for children with developmental disabilities; bills to change that (HB 1200, SB 5211) had not passed when we checked.

Finding the Medicaid program for family caregivers in your state

For the other states we have not verified the rules, so we do not list them. To find your own:

1. Start with your state Medicaid agency. Medicaid.gov's "Where can people get help with Medicaid and CHIP?" page lets you choose your state and gives the agency's contact details and links for eligibility and enrollment.
2. Ask locally. The Eldercare Locator, a public service of the Administration for Community Living, connects older adults and families with services in their community: search by location or call 1-800-677-1116.
3. Use the right words. Ask about a self-directed, consumer-directed or participant-directed option for in-home personal care, whether a family member, spouse or parent can be hired, and whether structured family caregiving is offered.
4. Get the answer in writing: the program manual, the waiver's provider qualifications or a written reply from the case manager.

How to apply, and what to expect

Names and forms differ, but the order is broadly the same in the states above.

1. Your relative applies for Medicaid and the home-care program. Financial eligibility is usually decided by the state Medicaid agency or its partner; in Florida, for example, the Department of Children and Families decides financial eligibility while the Department of Elder Affairs and local Aging and Disability Resource Centers handle screening. Waiver programs also require an assessed need for an institutional level of care.
2. An assessment sets the hours or the budget. A case manager or social worker assesses needs and writes a service plan. In California a county social worker sets the monthly IHSS hours; in Arizona the ALTCS case manager decides a spouse's paid hours.
3. Your relative chooses the self-directed option and names you. Where the program allows it, they (or their representative) become the employer and choose the worker.
4. You enroll as the worker. Expect paperwork, provider qualifications set by the state, and in many programs a background check and training. Washington, for example, requires training before a spouse provides paid care.
5. Payroll runs through a financial management service. New York uses PPL as its statewide fiscal intermediary; Ohio routes participant-directed services through the state's payment vendor. Some models, such as Arizona's spouse and parent options and structured family caregiving, employ you through a provider agency instead.
6. Keep records of the care you give. Payment is for authorised services, and where a spouse or parent is paid, CMS requires the state to describe the controls it uses to make sure payments are made only for services rendered.

If Medicaid is not an option: VA programs and long-term care insurance

• Program of Comprehensive Assistance for Family Caregivers (PCAFC). For a veteran with a VA disability rating of 70% or higher who was discharged from the military or has a date of medical discharge. The caregiver must be at least 18 and a spouse, son, daughter, parent, stepfamily member or extended family member of the veteran. The Primary Family Caregiver receives a monthly stipend, at least 30 days of respite care a year, and CHAMPVA health coverage if not covered by another plan. Apply jointly on VA Form 10-10CG. The Caregiver Support Line is 1-855-260-3274, Monday to Friday, 8am to 8pm Eastern. Note that a spouse can be paid here even in states whose Medicaid program bars spouses.
• Veteran Directed Care. The veteran receives a budget for home and community-based services and hires their own workers, "which might include their own family member or neighbor". Services vary by location, so ask the VA social worker whether it is available locally.
• Long-term care insurance. These policies are designed to cover long-term services and supports, including personal and custodial care, in settings that include your home, and many have limits on how long or how much they pay. Whether a policy pays a relative depends on its wording, so read the outline of coverage for terms such as "informal care" or "immediate family" and ask the insurer.

Where CaregiverConnect fits

Medicaid pays for the hours or tasks in the assessment, which often leaves evenings, weekends, overnights or the paid family caregiver's own time off uncovered. Families commonly fill those gaps by hiring a private caregiver directly. On CaregiverConnect you post the hours and tasks free of charge, independent caregivers apply, and you hire and pay them directly as the household employer, with no commission taken. CaregiverConnect is a marketplace, not an agency: we do not employ caregivers and do not run background checks (caregivers may upload proof of one). How to hire a private caregiver covers screening, taxes and a written agreement, and what in-home care costs in California gives rate reference points. You can post a care need when you are ready.

If you are the family member approved as a paid caregiver, the experience counts: you may also take private clients for the hours your relative's program does not use. A caregiver profile is free, you set your own rate and hours, and optional premium plans exist. In California, how to become an IHSS provider walks through enrollment step by step.

Frequently asked questions

Sources

1. Medicaid.gov, Self-Directed Services (employer and budget authority, Financial Management Services)
2. Medicaid.gov, Home & Community-Based Services 1915(c)
3. Medicaid.gov, Community First Choice (CFC) 1915(k)
4. Medicaid.gov, Self-Directed Personal Assistant Services 1915(j)
5. CMS, Leveraging Family Caregivers for Personal Care Services in 1915(c) Waiver Programs (legally responsible individuals, extraordinary care)
6. Indiana FSSA, Structured Family Caregiving FAQ for families (updated 18 June 2024)
7. Medicaid.gov, Where can people get help with Medicaid and CHIP? (state agency contacts)
8. ACL, Eldercare Locator
9. VA, Program of Comprehensive Assistance for Family Caregivers
10. VA, Veteran Directed Care
11. VA Caregiver Support Program (Caregiver Support Line)
12. ACL LongTermCare.gov, What is long-term care insurance?
13. AHCCCS Medical Policy Manual 1240-A (Spouse and Parent as Paid Caregiver)
14. Ohio Administrative Code 5160-44-32 (legally responsible family members as paid providers)
15. Georgia DCH, EDWP-CCSP and SOURCE General Services manual, version 1 April 2026 (archived copy, 9 June 2026)
16. NYSDOH, Consumer Directed Personal Assistance Program (CDPAP)