Can You Be Paid as a Family Caregiver?

If you are doing the work of a paid aide without being paid, this page is for you. There are real programs. They are not easy to find, and nobody hands you a list.

The short answer is yes, sometimes. Whether you qualify depends on who you are caring for, what insurance or benefits they have, and what state you live in. None of it is automatic. Every route below requires you to go find it.

Start with Medicaid, even if you assume they do not qualify

This is the largest source of pay for family caregivers in the country, and the one most people never look into.

Most states run what are called Home and Community Based Services waivers. The idea behind them is simple. It costs Medicaid far less to keep someone in their own home than in a nursing facility, so the program will pay for care at home instead.

Many of those waivers include an option called self-direction or consumer direction. Under it, the person receiving care controls a budget and gets to choose who provides the care. In a lot of states, that person can be their own son, daughter, or other family member. You go on the books as their paid caregiver.

Things to know before you call:

• Eligibility is based on the care recipient’s income and assets, not yours.
• Rules on paying a spouse are stricter than rules on paying an adult child. Some states allow it, some do not.
• Many states have waiting lists. Get on the list before you are sure you want it, because the list is the long part.
• The program names differ everywhere. Ask for “self-directed care” or “consumer-directed care” and let them translate.

Who to call: your state’s Medicaid office, or your local Area Agency on Aging. The Area Agency is usually the more helpful of the two, because helping people navigate this is literally their job. You can find yours through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116.

If the person you care for is a veteran

The VA has more than one program, and they work differently. It is worth understanding which one you are asking about.

Program of Comprehensive Assistance for Family Caregivers. This pays a monthly stipend directly to the family caregiver of an eligible veteran with a serious service connected injury or illness. It also comes with training, respite, and health coverage for the caregiver in some cases. This is the most substantial program of the group and also the hardest to qualify for.

Veteran Directed Care. The veteran receives a budget and decides how to spend it, including hiring family. Closer in spirit to Medicaid self-direction.

Aid and Attendance. This is an increase to a VA pension for veterans who need help with daily activities. The money goes to the veteran, not to you. But the veteran can then use it to pay you under a written care agreement.

Start at the VA Caregiver Support Line, 1-855-260-3274. Ask for the Caregiver Support Coordinator at your nearest VA medical center. They are the person who actually knows the answers.

Check the long term care insurance policy

If the person you care for bought a long term care policy years ago, read it. Do not assume you know what it says.

Some policies pay only licensed agency care. Others will pay an informal or family caregiver, sometimes at a reduced rate, sometimes with a requirement that you complete a training course. Policies written more recently are more likely to allow it than very old ones.

Call the carrier and ask directly: does this policy permit payment to a family member, and what documentation do you require. Get the answer in writing.

Write a personal care agreement, even inside the family

If the person you care for is paying you out of their own money, put it in writing. This feels strange and formal when it is your own mother. Do it anyway.

A personal care agreement is a plain contract that says what care you provide, how many hours, at what rate, and starting when. It matters for three reasons.

• Medicaid look back. If the person you care for ever applies for Medicaid, the state reviews roughly five years of their financial history. Money that moved to you without a contract can look like a gift, and gifts can trigger a penalty period where they are ineligible. A written agreement makes it wages instead.
• Family peace. A contract signed while everyone is well prevents the conversation that starts “and where exactly did the money go” after a death.
• Taxes. Money you are paid is income and needs to be reported. A contract makes that clean rather than murky.

An elder law attorney can draft one, usually in a single visit. If you are already going to see one about a power of attorney, add this to the same appointment.

Worth pairing with this: what caregiving actually costs, because knowing the number makes it much easier to judge whether a program is worth the paperwork.

Look at your own employer and your own state

A handful of states run paid family leave programs that cover caring for a seriously ill family member, not just new babies. The list changes as more states pass laws, so check your state’s labor department rather than trusting an article.

Separately, ask your employer’s HR department what they have. Some larger employers offer caregiver leave, flexible scheduling, or backup care benefits that nobody advertises because almost nobody asks.

What to do this week

You do not have to do all of this. Do the first one.

1. Call the Eldercare Locator at 1-800-677-1116 and ask to be connected to your Area Agency on Aging.
2. Ask them one question: “Does my state have a self-directed Medicaid program that would let me be paid to care for my mother, and is there a waiting list?”
3. If the answer involves a waiting list, get on it that day. You can always turn it down later.

That one call is the whole first step. Everything else follows from what they tell you.

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Program rules vary by state and change over time, so treat this as a map of where to look rather than a determination of what you qualify for. Confirm details with your state Medicaid office, your Area Agency on Aging, or an elder law attorney.