Money & Benefits
How to Get Paid to Care for a Parent (Medicaid, VA & More)
This article contains affiliate links. As an Amazon Associate I earn from qualifying purchases. How affiliate links work on this site.
Key Takeaways
- Medicare generally doesn't pay family caregivers. It doesn't cover long-term custodial care (Medicare.gov).
- Medicaid is the main route. In KFF's 2024 survey, every responding state reported paying family caregivers under some circumstances through Medicaid home care programs, often through "self-directed" care. Rules, waiting lists and pay vary by state.
- Veterans have their own programs. VA's Program of Comprehensive Assistance for Family Caregivers can pay a monthly stipend to a son or daughter who is the primary caregiver of an eligible veteran. Veteran-Directed Care lets eligible veterans hire family members.
- Other options include long-term care insurance (depending on the policy), a written caregiver agreement paid from your parent's own funds, and state paid leave programs where they exist.
- Start with one call to your parent's state Medicaid office or the local Area Agency on Aging.
This guide is general information, not legal, tax, or financial advice. Medicaid and VA rules vary and change. Before you sign anything or move money, talk with your state agency, a VA-accredited representative, or an elder law attorney.
You cut your hours to drive Mom to appointments. Then you cut them again. Now you're doing her shopping, managing her pills, and helping her shower, and the paycheck that used to cover your own bills is half what it was. At some point a quiet question shows up: Is there any way to get paid for this?
Sometimes there is. It's rarely quick, and it depends a lot on your parent's income, health, and state. But real programs exist, and many families never ask about them. Here's how the main routes work.
First, why Medicare usually isn't the answer
This is the most common dead end, so let's clear it up. Medicare doesn't pay for long-term care, also called custodial care: help with bathing, dressing, eating, and using the bathroom (Medicare.gov). It may cover some short-term skilled home health care under specific conditions, but it doesn't pay a family member to be the caregiver.
KFF notes that Medicare generally doesn't cover home care, while Medicaid paid for two-thirds of home care spending in the U.S. in 2022. That's why most "get paid" paths run through Medicaid.
Option 1: Medicaid home care programs
How it works
Medicaid home- and community-based services (often called HCBS) help people with daily activities so they can stay at home instead of moving to a nursing home. In many programs, the person getting care can self-direct their services: they choose, train, and dismiss their own caregiver. In some cases, that caregiver can be a family member who gets paid.
KFF's 2024 survey of state Medicaid officials found:
- All responding states pay family caregivers under some circumstances. (48 responded; Florida, Indiana, and Utah did not.)
- All reporting states except Alaska allow people to self-direct their home care in at least some programs.
- 39 states allow payments to family caregivers in waivers serving adults 65 and older or people with physical disabilities.
- Payment rules are stricter for "legally responsible relatives," which KFF says include spouses and parents of minor children. Ask your state how it treats an adult child caring for a parent.
The catch: eligibility and waiting lists
Your parent has to qualify for Medicaid, which means meeting the state's financial limits and, for most waiver programs, needing a certain level of care. KFF also notes that waiver programs are often limited to a set number of people, which can mean waiting lists.
Structured family caregiving
A few states have a program called structured family caregiving. Instead of an hourly wage, Medicaid pays an agency a daily rate, and the agency passes part of it to the family caregiver along with coaching and home visits. KFF reported that, for seniors and people with disabilities, this was offered in seven states: Connecticut, Georgia, Indiana, Louisiana, North Carolina, North Dakota, and South Dakota. KFF cites an overview that found payments to family members of around $40 to $50 a day in the examples it reported.
What to ask your state
When you call your parent's state Medicaid office or Area Agency on Aging, you might say: "My parent needs help with daily activities at home. Do you have a self-directed or consumer-directed home care program, and can an adult child be the paid caregiver?" Then ask:
- Which program fits my parent's age and needs?
- What are the income and asset limits?
- Is there a waiting list, and how do we get on it?
- Can I be paid, and do I need training or a background check?
- Who handles payroll and taxes? (Many programs use a "fiscal intermediary" for this.)
Option 2: Programs for veterans and their families
If your parent served in the military, look at VA programs right away. Some can pay family caregivers directly.
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
According to VA, the family caregiver must be at least 18 and be a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or live full time with the veteran. The veteran must, among other requirements:
- have a VA disability rating of 70% or higher,
- need at least six months of continuous, in-person personal care services, and
- be enrolled in VA health care.
A Primary Family Caregiver may receive a monthly stipend, access to health coverage through CHAMPVA if they don't already have coverage, at least 30 days of respite care per year, mental health counseling, and some travel benefits (VA). You and your parent apply together using VA Form 10-10CG. VA says it will assign a caregiver no later than 90 days after it receives the application.
Veteran-Directed Care
In Veteran-Directed Care, an eligible veteran gets a budget for services and, with a counselor's help, hires their own workers, which VA says can include their own family member or a neighbor. It isn't available everywhere, so ask the veteran's VA social worker.
Aid and Attendance or Housebound benefits
These are monthly payments added to a VA pension for qualified veterans and survivors who need help with daily activities or are housebound (VA). The money goes to your parent, not to you. Your parent may be able to put it toward the cost of their care. Ask a VA-accredited representative whether, and how, it could be used to pay a family member.
For questions about VA caregiver programs, the VA Caregiver Support Line is 1-855-260-3274 (VA).
Option 3: Other ways families make it work
Long-term care insurance
If your parent has a long-term care policy, read it. Some policies may pay for home care, and some may allow payment to a family member, while others don't. Look for the words "informal care" or "family caregiver," and call the insurer to ask.
A caregiver agreement paid from your parent's own money
Some families write a personal care agreement: your parent pays you, from their own income or savings, for specific care at a fair rate. This can feel uncomfortable, but it often prevents sibling tension later. Our guide to splitting caregiving responsibilities among siblings can help with that conversation.
Do this carefully. Payments to family can matter for Medicaid eligibility later, and they can have tax consequences for both of you. Have an elder law attorney draft or review the agreement.
Paid leave from work
The federal FMLA protects some workers' jobs during family caregiving, but it's unpaid leave. Some states and some employers offer paid family leave. Check your state labor department and your HR handbook. Our guide to caring for a parent while working covers the basics.
Comparing the main options
| Option | Who pays | Who usually qualifies | Can an adult child be paid? | Where to start |
|---|---|---|---|---|
| Medicaid self-directed home care | State Medicaid | Parent meets state financial and care-need rules | Often, depending on state and program | State Medicaid office or Area Agency on Aging |
| Structured family caregiving | State Medicaid (through an agency) | Parent in a qualifying waiver; only some states | Yes, in participating states | State Medicaid office |
| VA PCAFC | VA (stipend to caregiver) | Veteran with 70%+ rating needing 6+ months of personal care | Yes, as Primary Family Caregiver | VA Form 10-10CG; VA caregiver support team |
| VA Veteran-Directed Care | VA budget managed by veteran | Eligible veterans where offered | VA says workers can include family | Veteran's VA social worker |
| VA Aid and Attendance | VA (paid to parent) | Veterans or survivors on VA pension who need daily help | Not directly; ask VA how your parent may use it | VA, or a VA-accredited representative |
| Long-term care insurance | Insurer | Depends on policy | Some policies only | Insurer, policy documents |
| Caregiver agreement | Your parent | Anyone, but Medicaid and tax effects | Yes | Elder law attorney |
Sources: KFF, VA, Medicare.gov. Details vary by state and change over time.
Protect yourself while you wait
Applications can take months. In the meantime:
- Keep a care log: what you do, how often, how long. It helps with assessments and agreements. Our documents checklist has a place to keep records.
- Ask about respite care. KFF found that 47 responding states cover respite care through Medicaid home care. Our respite care guide explains how to use it.
- Watch your own health and finances. If you're stretched thin, read our guide to caregiver burnout.
Frequently asked questions
Can I get paid to take care of my mom?
Possibly. The most common path is a Medicaid home care program that lets your mom self-direct her care and hire you. If she's a veteran, VA programs may also apply. Eligibility depends on her income, assets, care needs, and state.
How much do family caregivers get paid?
It depends on the program and state. In many Medicaid programs, family caregivers are paid hourly like other home care workers (KFF). In structured family caregiving, KFF cites examples of around $40 to $50 a day. The VA stipend has its own formula; see VA's Program of Comprehensive Assistance for Family Caregivers page for how it's set.
Does Medicare pay family caregivers?
Generally no. Medicare doesn't cover long-term custodial care (Medicare.gov).
Can a spouse be paid instead of me?
Rules for spouses are stricter. KFF explains that some Medicaid programs prohibit paying spouses, while some waiver programs allow it for "extraordinary care." Ask your state.
Do I have to pay taxes on caregiver payments?
Possibly. It depends on the program and your situation. Ask a tax professional.
A place to keep it all organized
Applying for these programs means tracking hours, forms, phone calls, and deadlines. My book, When You're Caring for a Parent: A Practical Workbook for Adult Children, has fill-in worksheets for splitting caregiving, money, and appointment duties among siblings and for organizing essential paperwork. It's on Amazon in Kindle and paperback.
Related reading: How much does it cost to care for an aging parent?
Sources
- KFF, "How do Medicaid Home Care Programs Support Family Caregivers?" (January 13, 2025): https://www.kff.org/medicaid/how-do-medicaid-home-care-programs-support-family-caregivers/
- Medicare.gov, "Long-term care": https://www.medicare.gov/coverage/long-term-care
- VA, "The Program of Comprehensive Assistance for Family Caregivers": https://www.va.gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers/
- VA Caregiver Support Program, PCAFC: https://www.caregiver.va.gov/support/support_benefits.asp
- VA, "Veteran-Directed Care": https://www.va.gov/geriatrics/pages/Veteran-Directed_Care.asp
- VA, "Aid and Attendance benefits and Housebound allowance": https://www.va.gov/pension/aid-attendance-housebound/
- Medicaid.gov, "Home & Community-Based Services 1915(c)": https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c
- Eldercare Locator (to find your Area Agency on Aging): https://eldercare.acl.gov
About the Author
Ellen Carter writes practical, plain-language guides for adult children caring for aging parents. She learned most of what she shares the hard way, through her own family's caregiving. Read more about Ellen.