- Many families can be paid to care for a relative, but not through Medicare. Medicaid and the VA are the main routes, and each state runs its own rules.
- Every state that responded to KFF's 2025 survey pays family caregivers through at least one Medicaid home care program.
- The person you care for is the one who has to qualify. You are hired as their paid caregiver.
- Spouses are often excluded, or paid only for extraordinary care. Adult children and other relatives are allowed in more programs.
- Pay is set by the program and is often modest. Treat it as partial support until you know the rate.
If you are caring for a parent, spouse or other relative, you may have wondered whether anyone pays you for it. Some programs do. Which ones depends on your state, the program and the person you care for, and most families never hear about the options until they have been caregiving for years.
This guide explains the main routes, who they usually cover, what the pay looks like and the questions to ask. It cannot tell you what you qualify for, because your state and your family’s situation decide that. Medicare Open Enrollment runs through December 7, which is a good moment to review the person’s coverage at the same time.
The short answer
Three things pay family caregivers in the United States, plus some private arrangements. Medicaid home care programs are the biggest. VA programs pay some veterans’ caregivers. A few other sources, such as long-term care insurance the person already holds, may pay for care at home. Medicare generally does not.
That last number comes from AARP’s 2025 caregiving report, and most caregivers are still unpaid. The share who are paid varies a great deal by state, from 10% in Iowa to 28% in New Jersey, according to AARP’s state-level data.
What Medicare does not cover
Original Medicare generally does not pay for custodial care. That is help with bathing, dressing, eating, getting in and out of a chair, or using the bathroom, when it is the only care a person needs. Medicare.gov says the same about nursing homes: long stays are generally not covered unless the person needs skilled nursing. Home health aide visits can be covered when a person also needs skilled services such as nursing or therapy, but that is short-term help for a medical need, not a way to pay a relative for daily care.
If the person has a Medicare Advantage plan, check the plan’s own materials for any extra home benefits instead of assuming.
Medicaid: the main route
Medicaid is where most paid family caregiving comes from. KFF’s 2025 survey of state Medicaid programs, published in January 2026, found that every responding state pays family caregivers through one or more Medicaid home care programs. The survey went to states between April and July 2025, and Florida did not respond.
Two things shape how it works.
Federal details are on the Medicaid.gov page for self-directed personal assistance services. It is written for states, so use it as background, not a sign-up guide.
Who can be paid, and who often cannot
Whether a relative can be paid depends on how the person is related to the care recipient.
- Other relatives and friends. Every responding state allows payments to family and friends through at least one waiver. In regular state plan services, 24 states allow it.
- Spouses and parents of minor children. Medicaid calls these legally responsible relatives. In state plan services, federal rules bar payment for care by spouses and parents of minor children. In waiver programs, 44 states allow payment to legally responsible relatives, but generally only for extraordinary care, meaning care beyond what such a relative would ordinarily provide and that is necessary to keep the person healthy and out of an institution.
- Adult children. CMS gives the customary definition of a legally responsible individual as the parent of a minor child or a spouse. An adult child is not on that list, which is why many adult-child caregivers can be paid where a spouse cannot. States set their own rules, so confirm it locally.
Coverage also depends on why the person needs care. Of the states with waivers for older adults and people with physical disabilities, 43 of 45 allow payments to family caregivers. The figure is 47 of 47 for waivers serving people with intellectual or developmental disabilities, and 19 of 21 for traumatic brain and spinal cord injury waivers.
A caution on the data: more than two-thirds of states could not tell KFF what share of their waiver participants actually receive paid family care.
VA programs for veterans
If the person you care for is a veteran, there are VA programs to ask about. They work differently from each other, so do not assume one answer covers all of them.
Program of Comprehensive Assistance for Family Caregivers (PCAFC). This one pays the caregiver directly. According to the VA Caregiver Support Program, the veteran needs a single or combined service-connected disability rating of 70% or more and a need for in-person personal care services for at least six continuous months. A veteran can name one primary family caregiver and up to two secondary caregivers. The primary caregiver receives a monthly stipend, and the page lists other benefits: health coverage through CHAMPVA if the caregiver has no other insurance, mental health counseling, certain travel benefits and at least 30 days of respite care a year for the veteran. Secondary caregivers get mental health counseling and certain travel benefits. The VA says people already in the program have a transition period through September 30, 2028, before reassessment can lower a stipend, with some exceptions.
Veteran-Directed Care. According to a VA Veteran-Directed Care fact sheet (revised February 2022), veterans in this program get a flexible budget that the veteran or the family caregiver can manage, and they can hire their own personal care aides, who might include a family member or neighbor. The program is only available in certain locations, and a copay may be charged based on service-connected disability status. Ask a VA social worker whether it is offered near you.
Aid and Attendance. This is an extra monthly amount added to a VA pension for qualified veterans and survivors who need help with everyday tasks. It goes to the veteran or survivor. The VA Aid and Attendance page does not say whether it can be used to pay a relative, so ask the VA or an accredited representative before you plan on it.
The number to call is the VA Caregiver Support Line, 1-855-260-3274.
What the pay looks like
Do not assume the pay matches what the work is worth. Medicaid generally pays family caregivers hourly wages, like other home care workers, and the state sets the rates. We do not give a national figure because there is no good one. Ask your state for its rate.
One model is different. In structured family caregiving, an agency receives a daily stipend and pays the family caregiver part of it. KFF reports that 11 states use this model, that family payments are around $40 to $70 a day, and that agencies usually pass on 50% to 65% of the stipend.
Our guide to the real cost of family caregiving prices the same hours at market rates, so you can compare them with what a program pays. Run your own hours in the free caregiver cost calculator to see what time off work could cost your retirement, and compare that with what a program would pay.
Pay from any of these programs may count as income. Ask a tax professional how it will be treated for you before you plan around it.
How to find out what your state offers
There is no single national application. These steps get you to the right office quickly.
Questions to ask the program, written down so you do not forget them:
- Does this program let a family member be the paid caregiver?
- Which relatives are allowed? Is a spouse or a parent of a minor child treated differently?
- What does the person I care for need to qualify, and how long does approval take?
- How many hours a week can be paid, and at what hourly rate?
- Is training or an agency required, and who handles payroll?
- Is there a waiting list?
Many programs ask for proof of the person’s care needs. Keeping diagnoses, medication lists and doctor notes in one place saves time at the application stage. Our guide to organizing medical records for an aging parent shows one way to do it.
Before you say yes
Getting paid solves one problem and can add others. Consider these before you sign anything.
- You may become an employee. Some programs treat the caregiver as a worker with timesheets, training and limits on paid hours. That is more structure than informal caring.
- The rest of the family may step back. When one person is paid, siblings sometimes assume the job is handled. Agree on who does what, in writing, and keep the person who is paid from becoming the only one who knows the details.
- Paid hours may not match real hours. A program may pay for fewer hours a week than you actually work. Count both.
- Medicaid has income and asset rules for the person. They vary by state. If you are thinking about moving money or property to help the person qualify, talk to an elder-law attorney first, because the rules about transfers are strict and vary by state.
- Do not leave your job lightly. If the program pays less than your salary, leaving work can cost your retirement more than the pay brings in now. Run the numbers first.
This is general information, not financial, legal or tax advice. Rules and eligibility vary by state and change over time, so confirm details with the program or a professional before you decide.
For the money side, our article on the hidden retirement cost of caregiving works through the numbers. For the emotional side, read grieving the years caregiving took.
Frequently Asked Questions
Sometimes. Every state that responded to KFF's 2025 survey pays family caregivers through at least one Medicaid home care program, and 43 of 45 states with waivers for older adults and people with physical disabilities allow it. The person you care for has to qualify for the program, and each state sets its own rules. Start by calling your state Medicaid agency or your area agency on aging.
No. Original Medicare generally does not pay for custodial care, which is help with bathing, dressing, eating or using the bathroom when that is the only care a person needs. It can cover home health aide visits when a person also needs skilled care such as nursing or therapy. Medicaid, the VA and some long-term care insurance policies are the usual routes to paid care.
Often not, but it depends on the program. Under a regular Medicaid state plan, federal rules bar payment for services provided by spouses and parents of minor children. In waiver programs, 44 states allow payment to legally responsible relatives, usually only for extraordinary care that goes beyond what a spouse would ordinarily do. Ask the program how it treats spouses before you plan around the income.
It can. The VA's Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a primary family caregiver. The veteran needs a service-connected disability rating of 70% or more and a need for in-person personal care for at least six continuous months. Other VA programs help with care costs but work differently, so ask the VA Caregiver Support Program which one fits.
It can, so talk about it before you start. A paid caregiver often takes on more hours, and siblings may step back because the job now looks covered. Agree in writing which tasks are yours, which are shared and how you will each be updated. Pay is set by the program and is often modest.