How can I get paid as a caregiver for my parent?

Updated October 6, 2026 · General information, not professional advice

How can I get paid as a caregiver for my parent?

Medicare does not pay family caregivers. The main paths are:

1. Medicaid self-directed home care.
2. VA caregiver and veteran-directed programs.
3. Long-term care insurance, depending on the policy.
4. Your parent's own funds, through a written caregiver agreement.

Each has rules about who can be paid, how much and for what.

Medicaid: self-directed home care

Every state Medicaid program offers some home and community-based services. Many states offer self-directed options in which your parent (or their representative) can recruit, hire and supervise their own caregivers, and many of these allow paying family members. Some states restrict paying a spouse or a legal guardian.

• Your parent must qualify for Medicaid financially and usually need help with daily activities at a nursing-home level of care.
• Pay rates and allowed hours are set by the state program after an assessment.
• Some programs have waitlists.

Contact your state Medicaid agency or Area Agency on Aging and ask about "self-directed," "consumer-directed" or "participant-directed" personal care.

VA programs for caregivers of veterans

• Program of Comprehensive Assistance for Family Caregivers (PCAFC): for veterans with a VA disability rating of 70% or higher who need at least 6 months of continuous personal care. Primary family caregivers can receive a monthly stipend, CHAMPVA health coverage if eligible, at least 30 days of respite a year, and training. Apply with VA Form 10-10CG.
• Veteran-Directed Care: in participating areas, veterans who need help with daily activities get a flexible budget to hire their own caregivers, which can include family members.
• VA pension with Aid and Attendance: paid to the veteran, who can use it to pay a caregiver.

Long-term care insurance and private pay

Long-term care insurance: some policies pay a cash benefit or allow informal caregivers, including family; many require a licensed agency. Read the policy or call the insurer.

Personal care agreement: your parent can pay you from their own money under a written contract that lists duties, hours and a fair hourly rate. Put it in writing before payment starts. This matters if your parent may later need Medicaid: payments without a written agreement at a fair rate can be treated as gifts under the 5-year look-back. Payments are taxable income to you, and your parent may have household employer tax obligations. An elder law attorney can draft the agreement.

Before you leave a job to provide care, think about lost wages, retirement savings and health insurance, and compare them with what a program would actually pay.

Questions to ask your state Medicaid program

• Does our state have a self-directed or consumer-directed personal care program, and is there a waitlist?
• Can an adult child be the paid caregiver? Can a spouse? Does the caregiver have to live with or apart from my parent?
• What is the hourly pay rate, and how many hours could my parent be approved for?
• Do I need training, a background check or certification?
• Will I be paid directly, through a financial management agency, or through a home care agency?
• How do we apply, and who does the needs assessment?

Your local Area Agency on Aging or Aging and Disability Resource Center can usually answer these or connect you with the right state office.

If you keep your job

• The federal Family and Medical Leave Act gives eligible employees up to 12 weeks of unpaid, job-protected leave a year to care for a parent with a serious health condition.
• Some states have paid family leave programs that replace part of your wages.
• Ask your employer about caregiving benefits, flexible schedules or employee assistance programs.

If you need backup or relief, seniorcare.si can show licensed home care agencies near your ZIP code; some states require Medicaid-paid caregivers to be hired through an agency.