Can I Get Paid for Taking Care of My Husband?

Yes, you can get paid for taking care of your husband, and there are four main ways it happens: Medicaid’s self-directed home care programs, Veterans Affairs caregiver benefits if he served, state paid family leave for a temporary stretch, and a long-term care insurance policy if he bought one. Which route fits depends on his medical needs, the couple’s finances, his military history, and the state you live in. Most families end up combining two of them rather than relying on just one.

Getting Paid Through Medicaid

Medicaid’s Home and Community-Based Services (HCBS) waiver programs are designed for people who would otherwise qualify for nursing-home care but want to stay at home. Many of these waivers include a self-direction option, which lets your husband choose his own caregiver, set the schedule, and manage the arrangement. Under self-direction he can hire you, and the state pays you a wage for the hours you work.¹

The catch is that not every state allows a spouse to be the paid caregiver under its waiver. Some prohibit it outright. Others allow it but require certification or training. Call your state Medicaid office before you do anything else and ask specifically whether spousal caregivers are permitted under the waiver your husband would apply to.

Does He Qualify?

Your husband has to clear two thresholds, financial and medical.

Financially, most states cap the applicant’s countable assets at roughly $2,000. You, as the “community spouse,” keep a separate protected share. For 2026 the maximum community spouse resource allowance is $162,660. Income limits vary by state and are usually tied to a percentage of the federal poverty level or the Supplemental Security Income standard.

Medically, he has to meet a “nursing-facility level of care.” A state assessor will look at how much help he needs with the activities of daily living — bathing, dressing, eating, transferring, toileting — along with cognitive and behavioral needs. He doesn’t have to be dependent in every category, but the assessment has to show he needs the kind of hands-on help a nursing home would provide.

What the Pay Looks Like

The state Medicaid agency sets the hourly rate, funded by a mix of federal and state dollars, and rates vary widely across the country. The state also caps the number of hours per week or month based on his assessed needs. In practice you submit timesheets to a fiscal intermediary that issues your paycheck.

Getting Paid Through the VA

If your husband is a veteran, two separate VA benefit streams can pay you or reimburse the family for the care you provide.

Program of Comprehensive Assistance for Family Caregivers

PCAFC pays a monthly stipend directly to the designated primary family caregiver and also provides health insurance through CHAMPVA, mental health counseling, respite care, and training.² A spouse can be the primary family caregiver.

To qualify, your husband must have a serious injury — including traumatic brain injury, psychological trauma, or another mental or physical condition — that was incurred or aggravated during active military service.³ He must also carry a combined VA service-connected disability rating of 70 percent or higher and need in-person personal care services for at least six continuous months due to an inability to perform daily activities, a need for supervision because of neurological impairment, or a need for regular instruction without which his daily functioning would be seriously impaired.⁴

The stipend is calculated from the Office of Personnel Management’s General Schedule pay table at the GS-4, Step 1 rate for the geographic area where the veteran lives, divided by 12 to give a monthly figure.⁵ That number is then multiplied by one of two percentages:

Level One, 62.5 percent, for veterans who can still sustain themselves in the community with caregiver support.
Level Two, 100 percent, for veterans the VA determines can’t sustain themselves in the community without caregiver assistance.

Because GS pay is tied to locality, the stipend differs by where you live, and the VA adjusts rates annually when OPM updates the General Schedule. The stipend is not taxable income.⁶

Aid and Attendance

Aid and Attendance is a separate benefit that sits on top of the VA’s basic pension for wartime veterans who need help with daily activities or who are housebound.⁷ It doesn’t require a service-connected disability. Eligibility turns on age, wartime service, financial need, and functional limitations.

For 2026, the maximum annual pension rate for a veteran who qualifies for Aid and Attendance is $29,093 with no dependents, or $34,488 with one dependent.⁸ The money is paid to the veteran, not to a caregiver, but the family can use it to compensate a spouse who provides care. If you do it that way, put a written personal care agreement in place so the payments hold up later if either of you ever applies for Medicaid.

State Paid Family Leave

More than a dozen states and the District of Columbia have paid family leave laws that let workers take time off with partial wage replacement to care for a seriously ill spouse. The programs are funded mostly through small employee payroll deductions, and some states also collect from employers.

Wage replacement is tied to your regular earnings. Lower-wage workers usually get a higher percentage of their pay, often 80 to 95 percent, while higher earners get 50 to 70 percent, subject to a weekly cap. Leave lengths run from about 6 to 12 weeks in most states, with a few going longer.

Eligibility depends on your work history, not your husband’s condition or the couple’s finances. You generally have to have earned wages or worked a minimum number of hours during a base period before leave starts. Most private-sector employees in covered states qualify, and some states also cover state employees and self-employed workers who opt in.

One boundary worth naming: paid family leave replaces wages but doesn’t protect your job. Whether your employer has to hold your position depends on whether you also qualify for the federal Family and Medical Leave Act or a state job-protection law. When both apply, they usually run at the same time.

Because these programs are built for temporary crises, they work best as a bridge — say, right after your husband first becomes seriously ill — while you set up longer-term support through Medicaid or the VA.

Long-Term Care Insurance

If your husband bought a long-term care insurance policy, it may cover home-based care. Whether it will pay you specifically depends on the policy language.⁹ Some policies pay only licensed home health agencies. Others include provisions for family members to provide care and be reimbursed.

Read the policy’s definitions of “qualified provider” and “eligible care” first. If the policy requires a licensed professional or agency, you have two workable options: get hired by a qualifying home health agency so your work is covered under the policy, or ask the insurer whether it makes exceptions for trained family members.

Nearly all long-term care policies also have an elimination period, a waiting window after care starts before benefits begin. Ninety days is the most common length, though policies run from zero to 180 days. During that window, the family pays out of pocket. Watch how the days are counted. Some policies count only days when care is actually received rather than calendar days, so a 90-service-day elimination period could take roughly 30 weeks to satisfy if he receives care three days a week. Confirm the counting method and required documentation with the insurer up front.

Put a Personal Care Agreement in Writing

Whichever program you pursue, a written personal care agreement between you and your husband is one of the most important steps. It’s a formal contract that spells out what care you provide, how many hours you work, and what you’re paid. If your husband ever applies for Medicaid — even years later — the agency will look at every financial transaction in the previous five years. Payments to you without a written contract are likely to be treated as gifts, and those gifts trigger a penalty period of Medicaid ineligibility.

A solid agreement should include:

A start date on or before the day services actually begin. You can’t backdate it or pay yourself retroactively for care already provided.
A specific list of duties: bathing help, meal prep, medication reminders, transportation, and so on.
Hours per week and the days you work them.
An hourly rate that matches what a professional home care aide in your area would charge. Overpayment gets treated as a gift.
No overlap with services someone else is already being paid to provide.
Payment issued at the time services are performed, not in a lump sum months later.

An elder law attorney familiar with your state’s Medicaid rules can draft one that meets every requirement. Fees typically run from about $1,000 to several thousand depending on complexity, and that’s small next to a Medicaid penalty that could delay coverage for months or years.

Taxes on What You Receive

How your caregiver pay is taxed depends on which program is paying you and where you live.

If you’re paid through a Medicaid HCBS waiver and you live in the same home as your husband, your payments may be completely excluded from federal gross income. Under IRS Notice 2014-7, Medicaid waiver payments to a care provider — related or not — for services provided in the provider’s own home are treated as tax-free “difficulty of care” payments.¹⁰ The exclusion applies as long as you share a home and don’t maintain a separate residence where you carry out your daily private life. Vacation pay under the program is not excludable.

Self-employment tax is a separate question. If you’re simply getting a state-agency payment to care for a family member and you’re not running a caregiving business, you don’t owe self-employment tax; you report the income on Schedule 1, Line 8j of Form 1040.¹¹ If you operate as a sole proprietor caregiving business, you’d owe self-employment tax and report on Schedule C and Schedule SE.

When your husband directly employs you as a household employee, rather than pay flowing through a Medicaid waiver, there’s a separate federal break. Wages paid to a spouse are exempt from Social Security and Medicare taxes regardless of amount.¹² Federal income tax withholding may still apply depending on your filing situation.

PCAFC stipends aren’t considered taxable income, similar to VA disability compensation, and you don’t report them on your federal return.⁶

How to Apply

The steps differ by program, but every one of them wants medical documentation and proof of financial eligibility. Plan to gather:

Your husband’s official diagnosis and a letter of medical necessity from his treating physician describing the care he needs.
Bank statements, tax returns, and income and asset records for both spouses. Medicaid applications typically require several years of financial history.
Social Security numbers and proof of residency for both of you.
For VA programs, his DD-214 or other documentation of service dates and discharge status.

Medicaid HCBS waiver applications go through your state Medicaid office, and a state assessor will come to the home to evaluate his functional needs and the hours he qualifies for. PCAFC applications go through the VA Caregiver Support Program, online, by mail, or in person at a VA medical center.⁴ Aid and Attendance runs through the VA pension process. State paid family leave claims go to the state’s designated agency, usually through an online portal.

If You’re Denied

A denial isn’t the last word. For Medicaid, you can request a “fair hearing,” an administrative review where you present evidence and argue that the denial was wrong. Deadlines vary by state, typically 30 to 90 days from the notice.¹³ The denial letter has to include instructions on how to file.

For VA programs, you can file a supplemental claim with new evidence, request a higher-level review by a senior claims adjudicator, or appeal to the Board of Veterans’ Appeals. If PCAFC was denied because the disability rating is below 70 percent, look at whether more medical evidence could support a higher rating before you reapply.

If any program denied you on financial grounds, look at whether restructuring — spending down countable resources or setting up a compliant personal care agreement — could bring your husband within the limits on a later application. An elder law attorney or accredited VA claims agent can pin down the exact reason for the denial and help you build a stronger case.

1
Centers for Medicare & Medicaid Services. Self-Directed Home and Community-Based Services: Understanding Your Role
2
U.S. Department of Veterans Affairs. VA to Extend Caregiver Support Program Eligibility for Legacy Veterans, Caregivers
3
Office of the Law Revision Counsel. 38 USC 1720G – Assistance and Support Services for Caregivers
4
U.S. Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers
5
VA Caregiver Support Program. PCAFC Monthly Stipend for Primary Family Caregivers Fact Sheet
6
U.S. Department of Veterans Affairs. Information for Caregivers
7
Veterans Affairs. VA Aid and Attendance Benefits and Housebound Allowance
8
Veterans Affairs. Current Pension Rates for Veterans
9
National Institute on Aging. Paying for Long-Term Care
10
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
11
Internal Revenue Service. Family Caregivers and Self-Employment Tax
12
Internal Revenue Service. Household Employer’s Tax Guide
13
Medicaid.gov. Understanding Medicaid Fair Hearings