Get Paid as a Family Caregiver: State-by-State Guide

Yes, you can get paid to care for a family member in many states. The fastest routes are Medicaid self-directed care, VA caregiver stipends, state paid family & medical leave, and state vouchers. Use the map-style table below to check your state, then follow the step-by-step section to start payments. NCSL+3medicaid.gov+3medicaid.gov+3

Quick answer: 4 ways to get paid (and who qualifies)

Medicaid self-directed home care (the most common route)

Most states let a Medicaid participant hire and pay a family member as their caregiver under self-directed or consumer-directed models. These are built on HCBS waiver authorities (e.g., 1915(c) waivers) or state plan/self-directed personal assistance (1915(j)). The person receiving care (or their representative) controls the budget and selects the caregiver. Spouses may or may not be allowed, depending on the state and waiver. medicaid.gov+2medicaid.gov+2

Bottom line: If your loved one has (or can qualify for) Medicaid LTSS/HCBS, self-direction is usually the fastest way to pay a family caregiver.

Source: Medicaid.gov (Self-Directed Services; HCBS Authorities). Last checked: November 26, 2025. medicaid.gov+1

VA caregiver benefits (Veterans & some survivors)

If your loved one is a Veteran, apply for the Program of Comprehensive Assistance for Family Caregivers (PCAFC) for a monthly stipend (tiered by the Veteran’s needs and local nurse pay), plus training and support. The VA also offers Aid & Attendance (A&A) or Housebound as monthly pension add-ons that can help pay for in-home care. On Nov 20, 2025, VA extended “legacy cohort” PCAFC eligibility through Sept 30, 2028. Veterans Affairs+2Veterans Affairs+2

Bottom line: For Veterans, PCAFC and A&A can meaningfully supplement caregiver income.

Source: VA (PCAFC; A&A; Nov 2025 press release). Last checked: November 26, 2025. Veterans Affairs+2Veterans Affairs+2

State Paid Family & Medical Leave (PFML) for caregiving

Thirteen states plus DC have passed PFML programs that pay a percentage of your wages for a limited number of weeks when you take leave to care for a seriously ill family member: CA, CO, CT, DE, ME, MA, MD, MN, NJ, NY, OR, RI, WA + DC. Rules, weeks, and wage replacement rates vary. Example: California PFL pays benefits to eligible workers who contributed to SDI. NCSL+1

Bottom line: If you work in a PFML state and paid into the program, you can get temporary paid leave to care for family.

Source: NCSL (PFML states list); CA EDD (caregiver eligibility). Last checked: November 26, 2025. NCSL+1

State stipends/vouchers & respite

Some states, AAAs, or respite programs offer modest caregiver stipends or vouchers (often income-tested, reimbursement-based, or for respite only). Your Area Agency on Aging or the Lifespan Respite portal is the right doorway. Amounts are smaller but can help cover supplies or short-break care. archrespite.org

Bottom line: Small but real dollars—check your local AAA/ADRC and state respite voucher page.

Source: ARCH/Lifespan Respite. Last checked: November 26, 2025. archrespite.org

State-by-state: Do these programs pay family caregivers?

The table below flags two big payment levers by state: Medicaid self-direction (lets the care recipient hire family) and PFML (temporary paid leave from work). We also note one notable state program where applicable.

Fast interpretation: “Self-direction” is available in nearly every state via HCBS waivers; specifics (spouse eligibility, hours, rates) vary by waiver. PFML exists only in the listed states + DC. Always confirm with your state’s Medicaid or labor site. medicaid.gov+1

50-state comparison table (snapshot)

* “Yes” indicates the state operates HCBS/self-directed options allowing a participant to hire family in at least some programs. Always verify spouse/relative eligibility and caps in the specific waiver or state plan option. PFML “Yes” reflects states with paid family & medical leave laws (some newer programs may be in rollout). Authoritative references: Medicaid.gov (HCBS authorities; widespread 1915(c)); NCSL PFML list; state labor portals; CA EDD. Sources checked Nov 26, 2025. medicaid.gov+2NCSL+2

Which path is right for you? (3-minute decision checklist)

Use this to pick your route today:

• Does your loved one have (or qualify for) Medicaid LTSS/HCBS?

  • Yes → Self-directed Medicaid. Ask your case manager/FMS to enroll you as the paid caregiver. medicaid.gov

  • No/Unsure → Apply for Medicaid or explore other routes (PFML, VA, vouchers).

• Is your loved one a Veteran (or survivor)?

  • Yes → Apply for PCAFC (stipend) and check Aid & Attendance. Veterans Affairs+1

• Do you work in a PFML state and pay into the program?

  • Yes → File a caregiving PFML claim (weeks + wage % by state). Example: CA EDD. Employment Development Department

• Need short-term help only (supplies/respite)?

  • Yes → AAA/ADRC & Lifespan Respite vouchers. archrespite.org

Bottom line: Most families should pursue Medicaid self-direction (if eligible) and PFML (if employed in a PFML state); Veterans should add PCAFC/A&A.

Step-by-step: How to start and actually get paid

1) Apply to the right program

• Medicaid self-direction: Contact your state Medicaid HCBS office or your loved one’s case manager. Ask for self-directed services and whether spouses/relatives can be hired. You’ll enroll through a Fiscal Management Service (FMS) to handle payroll/taxes. medicaid.gov

• VA PCAFC: Submit Form 10-10CG online; complete the training and home visit; stipends are tiered. Check the Nov 2025 extension note for legacy eligibility. For lower-acuity needs or non-service-connected pensioners, apply for A&A. Veterans Affairs+2VA News+2

• PFML (if in an eligible state): File with your state’s program (e.g., CA EDD). You must have paid into the program and have an eligible relationship/reason. Employment Development Department

• Vouchers/AAA: Call your Area Agency on Aging or apply via Lifespan Respite portals for respite/supplies reimbursement. archrespite.org

2) Build the care plan & budget

Your case manager (or VA clinician) will document activities of daily living (ADLs), instrumental ADLs, weekly hours, and the caregiver rate within your budget. Self-directed programs use an individual budget; you submit timesheets to FMS. medicaid.gov

3) Complete onboarding (background check, training, payroll)

Expect identity checks, I-9/W-4, direct deposit, and timesheet procedures. FMS issues a W-2 (you’re an employee of the participant or fiscal agent), or occasionally contractor paperwork—confirm your status. medicaid.gov

4) Keep records that pass audits

Maintain care logs, training certificates, doctor orders, and mileage receipts (if reimbursable). For vouchers, keep proof of purchases. archrespite.org

Bottom line: The fastest wins come from correctly matching your situation to one primary program and completing FMS onboarding.

How much do family caregivers get paid?

Medicaid (self-directed)

Rates vary widely by state, waiver, and local market. Many programs mirror local agency rates with caps; expect hourly pay and limits based on assessed need. Check your state’s HCBS waiver manual or your case manager for the exact rate/units. medicaid.gov

VA PCAFC stipend (monthly)

Stipends are calculated from the local GS nurse pay rate and tiered by the Veteran’s care level. VA publishes methodology and updates; eligibility for legacy cohorts was extended to Sept 30, 2028. Apply via PCAFC and confirm your tier. medicaid.gov+2Veterans Affairs+2

PFML wage replacement & weeks

PFML programs typically pay a percentage of your wages for 6–12+ weeks (varies by state) when caring for a seriously ill family member. Example: CA PFL pays eligible workers who contributed to SDI for caregiving leave. Confirm percentage/maximums with your state portal. NCSL+1

Bottom line: Expect Medicaid to pay hourly; VA to pay a monthly stipend; PFML pays temporary wage replacement for defined weeks.

Taxes, benefits, and paperwork (read this)

• Employee vs contractor: Under Medicaid/FMS you’re commonly treated as an employee (W-2) for payroll/FICA; some arrangements differ—ask FMS. medicaid.gov

• IRS perspective: Family caregivers may be subject to self-employment tax in certain arrangements; Social Security/FICA rules can be complex. Review IRS guidance and consider a CPA. IRS

• PFML benefits are typically taxable income at the state/federal level (confirm in your state).

• Caregiver agreements: If paying outside Medicaid/VA/PFML (e.g., private pay or A&A), use a written caregiver contract to document hours, duties, and pay—this can help with Medicaid look-back later. (General planning note; consult elder law counsel for your state.)

Bottom line: Clarify your tax status early; a 20-minute call with FMS or a tax pro prevents costly mistakes.

Disclaimer: This article offers general information, not legal, tax, or benefits advice. Talk to your state program office, VA, or a qualified professional for your specific situation.

Common roadblocks (and fixes)

• “Medicare pays for caregivers, right?” No—Medicare does not pay family caregivers for long-term personal care. Use Medicaid, VA, PFML, or vouchers instead. Source: USA.gov caregiver pay overview. Last checked: Nov 26, 2025. USAGov

• “Our state said spouses can’t be paid.” Some waivers allow spouses; others don’t. Ask about alternate waivers or state plan options (1915(j)/CFC/CFCO) that may treat spouses differently. medicaid.gov

• “We were denied PCAFC.” Appeal if appropriate; consider A&A pension add-ons. Veterans Affairs

• “We can’t quit our job to provide care.” If you’re in a PFML state, claim temporary paid leave to stabilize finances while you set up Medicaid self-direction. NCSL

• “Small dollars only.” Add Lifespan Respite vouchers or county AAA reimbursements while your main program is pending. archrespite.org

Mini-table: PFML states for caregiving (as of Nov 26, 2025)

“How to” recap (fast start)

1. Pick your primary path: Medicaid self-direction; or VA PCAFC/A&A (Veterans); or PFML (if employed in PFML state).

2. Call the right office today: Medicaid case manager/HCBS; VA Caregiver Support; PFML state portal; AAA/ADRC.

3. Complete FMS onboarding: W-4, direct deposit, timesheets; confirm W-2 vs 1099 status. medicaid.gov

4. Submit claims on time: PFML weekly claims; Medicaid timesheets; VA monthly verification.

5. Keep records: Care logs, hours, receipts for audits/voucher reimbursements.

Source callouts (for sensitive facts)

• Self-direction & HCBS prevalence — Medicaid.gov: self-directed services & HCBS authorities; most states run 1915(c) waivers. Checked Nov 26, 2025. medicaid.gov+1

• PFML states list — NCSL: 13 states + DC with PFML. Checked Nov 26, 2025. NCSL

• VA caregiver programs — VA PCAFC/A&A; Nov 2025 press update extending legacy eligibility. Checked Nov 26, 2025. Veterans Affairs+2Veterans Affairs+2

• USA.gov overview — Confirms states may pay family through Medicaid programs. Checked Nov 26, 2025. USAGov

• IRS — Caregiver income & self-employment/FICA nuances. Checked Nov 26, 2025. IRS

Takeaways & next steps

Takeaways

1. Most states can pay family caregivers through Medicaid self-direction; Veterans have PCAFC/A&A routes; some workers can use PFML. NCSL+3medicaid.gov+3medicaid.gov+3

2. Spouse eligibility and pay rates vary—confirm your specific waiver. medicaid.gov

3. Taxes apply—clarify W-2 vs 1099 and caregiver contracts. IRS

4. Small programs (vouchers/respite) can bridge gaps. archrespite.org

5. Keep timely documentation (care plan, timesheets, receipts).

Next steps

• Use the state table above to pick your route.

• Contact your Medicaid HCBS office/case manager or VA Caregiver Support today.

• If you’re in a PFML state, file your claim with the state portal (example: CA EDD). Employment Development Department

FAQs

1. Which states pay family caregivers in 2025?
   Most states can pay family through Medicaid self-directed programs; PFML wage-replacement exists in CA, CO, CT, DE, ME, MA, MD, MN, NJ, NY, OR, RI, WA + DC; Veterans may qualify for PCAFC stipends and A&A pension add-ons. Veterans Affairs+3medicaid.gov+3NCSL+3

2. Does Medicare pay family caregivers?
   No. Medicare doesn’t pay family for long-term personal care; use Medicaid, VA, PFML, or state vouchers. USAGov

3. Can a spouse be paid as a caregiver?
   Sometimes. It depends on your state’s waiver or state plan option. Ask specifically about spouse eligibility in self-direction. medicaid.gov

4. How much do VA family caregivers get?
   PCAFC stipends vary by tier and local nurse pay rates; VA publishes methodology and periodically updates. Apply to determine tier. Veterans Affairs

5. How many weeks does PFML pay for caregiving?
   Varies by state (often 6–12+ weeks). Check your state portal; California EDD has a caregiving PFL benefit for eligible workers. NCSL+1

6. Is caregiver pay taxable?
   Usually yes. Under Medicaid/FMS you’re often a W-2 employee; other situations may trigger self-employment tax. See IRS guidance and ask FMS/CPA. IRS

7. Can I be reimbursed for supplies or respite while I wait?
   Check AAA/ADRC and Lifespan Respite vouchers; amounts are modest but real. archrespite.org

8. Where do I start?
   Pick your path (Medicaid, VA, PFML, vouchers), call the program office, complete FMS onboarding, and submit timesheets/claims. medicaid.gov