Ever wondered if you could be paid to take care of a family member, especially when that’s all you want to do anyway? The truth is, it’s not just a rumor—several states do have programs that let you earn money for caregiving. But the process isn’t simple, and the facts are way more interesting than you’d expect. If you’re juggling kids—like me, with Tamar and Larissa—or you’ve left a job to look after your mom, it matters to know: which states pay you, how much, and what hoops you’ll need to jump through.
How States Support Paid Family Caregivers
If you picture a paycheck arriving every two weeks for taking Grandma to physical therapy, you might be in for a surprise. States support paid family caregivers in a mix of ways. Most programs aren’t simple “jobs” but part of state-run Medicaid programs, pilot projects, or special waivers. Medicaid is a big player here. More than 40 states have at least one program that pays family members (sometimes even spouses or adult children) to deliver care at home instead of an institution. These waivers vary by state, but the idea is to keep folks with disabilities or chronic illnesses somewhere comfortable—definitely better than a nursing home, if you ask almost anyone who’s been through that.
States break down their programs into a few common types. There are Personal Care Services (PCS), Consumer-Directed Services—or Self-Directed Services—and state-funded Home- and Community-Based Services (HCBS) waivers. In simple terms, these let the person who needs care pick their caregiver, and yes, they can often choose a family member. States set their own rules about who qualifies, the level of need required, who can get paid (grown daughters, sons, sometimes spouses, but rarely minors), and how payments work. Sometimes, direct cash is given to the individual receiving care, who then “hires” the family member. In other cases, the state pays the caregiver through an agency. It’s a patchwork, but it works for tens of thousands of American families.
States with big populations, like California and New York, have especially large programs, but even smaller ones like New Hampshire or Wyoming sometimes offer lesser-known options. In 2024, a report from AARP showed around 48 states operate some form of consumer-directed care, though not all include payment for family members or cover the same services. And the rules change often, so what works this year may look different in 2026—but for now, things are the most flexible they’ve ever been.
Keep in mind: Federal money, mostly through Medicaid, funds the lion’s share of these programs, but states can decide how generous—or tight—those benefits are. Every state sets its own pay rates and eligibility requirements, and, to be honest, the pay rarely matches a full-time job’s salary. But for people who have to cut hours at work, any extra income goes a long way. Some states add bonus programs with state-only dollars for people who don’t qualify for Medicaid, but these are less common and often have long waitlists. You’ll find exceptions—like a few pilot programs, or options for veterans through the VA outside Medicaid—but Medicaid is still the main driver.
Which States Pay Family Caregivers?
It’s not an exotic club—you might even be surprised your own state is quietly offering money for these roles. States that pay family caregivers usually structure everything around Medicaid waivers or “self-directed” options. If you or your loved one have Medicaid, or are close to qualifying, check if your state is one of these:
- California: Through the In-Home Supportive Services (IHSS) program. Family caregivers—including adult children and sometimes even spouses—can get paid. Around 600,000 Californians used this as of 2024.
- New York: Has the Consumer Directed Personal Assistance Program (CDPAP). Family members, including most relatives, can get paid.
- Pennsylvania: Offers a few Medicaid waivers letting recipients direct their own care. Family can be paid, but not always spouses.
- Illinois: Its Community Care Program covers similar services. Adult children and even some spouses can be paid after proper paperwork and an assessment.
- Texas: The STAR+PLUS Medicaid Waiver in Texas lets eligible people pick family as caregivers (other than spouses).
- Florida: Programs like Consumer-Directed Care Plus (CDC+) let the care recipient hire almost anyone, even family, except for spouses.
- Massachusetts, Ohio, Colorado, Michigan:** All have Medicaid waivers supporting paid family caregivers, each with quirky eligibility.
And then you see states that really shine with short-term pilot projects or options for people not on Medicaid. For instance, New Jersey’s Personal Preference Program lets family get paid, Virginia allows some self-directed care under Medicaid, and Minnesota’s Consumer Directed Community Supports is widely used. There are exceptions: South Dakota and Alabama have tighter rules or fewer direct-pay options. Things get more flexible every year, as lawmakers respond to pressure from aging populations and families who want to keep loved ones at home.
Curious about the numbers? California’s IHSS pay rates in 2025 range from $16 to $20.50 an hour, depending on the county. New York pays between $15 and $21 per hour, depending on the area and whether you go through an agency. The average monthly pay for family caregivers nationally is about $1,500 to $2,500, but some folks managing 24/7 care report earning up to $4,500 per month in special high-need situations.
It’s not just Medicaid, though. The Department of Veterans Affairs helps veterans hire family as paid caregivers through its Veteran-Directed Care and Aid & Attendance benefits. Some states also use lottery funds or tobacco settlement money for state-level non-Medicaid programs, but these are smaller.
How to Qualify for Family Caregiver Payments
Now to the meat of the issue: It’s not just about being willing—it’s about meeting tricky paperwork and health eligibility. Most programs have two sides. First, the care recipient must qualify for Medicaid (or a specific waiver), which means strict income and asset limits. For example, in many places, Medicaid for seniors sets the income cap below $2,800/month, and assets under $2,000 (not counting a home you live in or a car). Then there’s the functional eligibility—a person must have significant trouble with activities like bathing, eating, or moving around, which is measured through assessments by social workers or nurses.
Once the person receiving care is approved, then the family member must pass a background check, fill out employment paperwork, and sometimes do basic training. Don’t expect a giant red bow and a ‘welcome’ packet. The process involves mounds of paperwork, and, yes, calling the county office more than once. States may require you to clock in and out using a phone app. Payments go through county or third-party agencies who might handle your taxes. And don’t forget: benefits like health insurance or retirement plans for paid caregivers are rare, so plan for that gap if you’re leaving a formal job.
Family members can usually cover most daily care tasks—help with personal hygiene, meals, medication reminders, errands, and housekeeping. Some states pay for basic nursing tasks too, if you do extra training. But professional medical treatment, like injections, often needs licensed nurses.
The choices of which relatives can be paid differ widely. Most programs let adult kids, siblings, or friends step in, but paying a spouse is less common—states like California allow it, but many others don’t. And if you have a minor child who needs care, most states won’t pay parents under 18. If you’re providing round-the-clock care for a loved one with dementia or severe disabilities, pro tip: document everything. Care logs help prove the level of need and fight for higher hours (and, yes, pay rates) at reassessment.
Most states conduct annual or semi-annual reviews to check continued eligibility. If the person’s health improves, the program may reduce the hours or even end payments. Some states limit the number of paid hours per week (e.g., 40 hours), while others allow more for people with higher needs.
Application Steps: How to Get Paid for Family Caregiving
Let’s get practical. If you want to start the process, here’s how the timeline usually unfolds, plus some tips from the trenches:
- Apply for Medicaid (if not already on it): You can often do this online through your state’s Medicaid website. Gather proof of income, assets, and expenses for the person who needs care.
- Request a care needs assessment: This tests if the care recipient needs ‘nursing home level’ help. A nurse or social worker will ask detailed questions and may visit your home. Be honest (don’t understate anything), and keep a symptom diary before the appointment to back up your answers.
- Choose a waiver or consumer-directed program: Once approved, pick ‘self-directed’ care if possible—it’s the option that most often pays family. Ask the assessor to explain all eligible waivers.
- Submit caregiver paperwork: You’ll need ID, a background check, and maybe TB testing or brief training. Sometimes you sign up with an agency as a formal employee, clock in/out, and get paid via direct deposit.
- Start providing care and tracking hours: Use any system required—many states now require electronic timecards. Track everything thoroughly for audits.
- Renew eligibility regularly: Rules change, and so do health needs. Mark reassessment dates on your calendar and keep records organized.
Pro tip: If the first application stalls, keep calling and don’t be shy about asking caseworkers to move things along. These offices are busy and mistakes happen, but persistent, polite follow-ups get results. And when you hit a roadblock? Look for a local Medicaid advisor or nonprofit for help. I personally talked to three before someone helped me with Larissa’s paperwork last year—that made all the difference.
Look for online support groups for caregivers in your state. People there can often share real-world tips about how long the process takes and where to find the fastest help. Sometimes you need to “escalate” your application by contacting a supervisor if the process drags past a couple of months.
Extra Perks and Challenges: What to Expect as a Paid Family Caregiver
There’s a real trade-off in taking this role. About 53 million adults in the U.S. provided unpaid care to someone in 2024, according to the National Alliance for Caregiving—and those who get paid are a fraction of that. So, while getting paid can really help, it doesn’t erase the stress, the long days, or the paperwork. Don’t expect to earn a nurse’s salary; payments help but rarely cover all household bills. For many, though, the value is not just the money—it’s the flexibility and the chance to keep loved ones out of institutions.
There are perks beyond pay. Some states offer small training stipends, counseling, or respite hours, which let you take short breaks while another worker steps in. If the care recipient qualifies for more complex care (like ventilators or Alzheimer’s), extra hours and higher pay may be approved. But don’t expect things to be seamless: sometimes paychecks get delayed, or you’ll have to stand your ground to get the hours you’re owed. One friend in Michigan told me she battled with a managed care company for three months to update her mother’s hours—persistence pays off here more than paperwork perfection.
Keep careful records—not just for Medicaid’s sake, but for your own. That doesn’t just mean timesheets, but also notes on health status changes, meds given, doctor visits, and problems resolved. Not only will this help at reassessments, but it’s useful if you need more hours or advocate for extra services like PT, OT, or meal deliveries.
Brush up on your state’s unique rules. For example, California lets caregivers earn workers’ comp; New York lets you unionize in some areas. If income from caregiving affects your own benefits (like SNAP or SSI), talk to a benefits specialist. And if your loved one gets Social Security Disability or Supplemental Security Income, the money you’re paid as a caregiver (if it’s through a “waiver” program) usually doesn’t count against that. But always double-check, as this stuff changes from year to year.
If you ever need extra help, programs like the Family and Medical Leave Act (FMLA) might let you take an unpaid leave from work to care for someone, without losing your job. Some states have paid leave, too—especially in California, New York, and New Jersey. Stack every available resource to stretch your sanity and protect your income.
| State | Main Program Name | Who Can Be Paid | Average Pay (2025 data) |
|---|---|---|---|
| California | IHSS | Relatives & Spouses | $16–$20.50/hr |
| New York | CDPAP | Most Family, Not Spouses | $15–$21/hr |
| Pennsylvania | Personal Assistance Services | Family, Not Spouses | $13–$19/hr |
| Texas | STAR+PLUS Waiver | Family, Not Spouses | $10–$14/hr |
| Illinois | Community Care | Family, Sometimes Spouses | $14–$20/hr |
So if you’re taking care of a relative, paying attention to these programs can lighten the financial load, even if it won’t solve every problem. Treat it like a part-time job, with all the communication, recordkeeping, and hustle that comes with it—but also the satisfaction that you get to be there for the people you love, on your own terms.