What Family Caregivers Actually Earn — And Where the Money Comes From

Most family caregivers are not paid at all, but some states and programs do pay relatives for care work

If you are caring for a parent, spouse, or adult child, you may not receive any payment — many people provide care without compensation. But depending on where you live, what program covers the person you care for, and your relationship to them, you might be paid as a formal caregiver. Payment ranges from nothing to roughly $15 to $25 per hour in most states, though some programs pay more and others pay less. The money comes from Medicaid, Veterans benefits, or state-funded aging programs, not from the person you care for directly.

The key difference is whether the person you care for is enrolled in a program that allows relative caregiving. A parent on Medicaid waiver services might have money available to pay you; that same parent on standard Medicaid might not. A spouse receiving Veterans Aid and Attendance benefits might be able to pay you; one receiving only Social Security cannot. This section explains what the actual payment looks like and where it comes from.

Key Takeaways

• Payment to family caregivers comes from Medicaid waivers, Veterans programs, or state aging agencies — never directly from the person you care for.
• Medicaid waiver programs in most states pay family caregivers $12 to $20 per hour, though rates vary by state and by specific program.
• Veterans Aid and Attendance benefits can reimburse a spouse or adult child for caregiving, but the amount depends on the veteran's income and assets.
• You will need to be formally hired, complete background checks, and sometimes complete training before any payment begins.
• Not all programs allow family members to be paid caregivers — some require you to hire an unrelated person or use an agency.

Medicaid waiver programs: the most common source of caregiver pay

If the person you care for receives Medicaid through a home and community-based services waiver (sometimes called an HCBS waiver or simply "waiver"), that program often has money budgeted for paid caregiving. The person you care for has a care plan that lists the hours of care they need each week. If the plan includes paid family caregiver hours, the state pays you directly for those hours.

Payment rates vary by state. In some states, family caregivers earn $12 to $15 per hour. In others, the rate is $18 to $25 per hour. A few states pay more; a few pay less. The rate also depends on the specific waiver program — a state might have one rate for elderly care, another for people with developmental disabilities, and a third for people with physical disabilities. You can find your state's rates by contacting your state Medicaid office or asking the case manager for the person you care for.

Before you are paid, you will need to be formally hired. This means completing an employment application, providing references, passing a background check, and sometimes completing a training course on topics like safety or medication handling. The hiring process typically takes two to four weeks. During that time, you can still provide care, but you will not be paid until the paperwork is complete.

Veterans Aid and Attendance benefits for spousal and adult child caregivers

If you care for a veteran, the Aid and Attendance benefit may include money to pay you. This is a monthly payment to the veteran that can be used to pay for care, including care from a spouse or adult child. The veteran applies through the Department of Veterans Affairs, not through you.

The amount varies based on the veteran's income, assets, and living situation. In 2024, the maximum monthly payment for a veteran with a spouse or adult child providing care ranges from roughly $1,000 to $3,500, depending on whether the veteran lives alone, with family, or in a facility. That money goes to the veteran, who then pays you. There is no set hourly rate — you and the veteran (or their family) decide what payment makes sense.

The veteran's VA caseworker does not oversee how much you are paid or how many hours you work. This is a private arrangement between you and the veteran's family. However, the VA does require that the veteran's care needs are actually being met, so if the veteran's health declines, the VA may review whether the current arrangement is still working.

State aging programs and other funding sources

Some states have programs specifically for older adults that pay family caregivers. These programs are often run by the state unit on aging or the department of elder services. They typically pay lower rates than Medicaid waivers — often $10 to $15 per hour — but they may have fewer restrictions on who can be hired or what training is required.

A few states also have programs for people with specific conditions, such as Alzheimer's disease or traumatic brain injury, that include caregiver payment. These are less common and vary widely by state. Your local area agency on aging can tell you whether your state has programs beyond Medicaid waivers.

Some employers also offer paid family leave or caregiver benefits that let you take time off work to provide care, though this is separate from being paid by a government program. This is worth asking about if you work for a large employer.

What you need to do to be hired and paid

The process differs slightly depending on the program, but the basic steps are the same. First, the person you care for (or their legal representative) must request that you be hired as their paid caregiver. This request goes to their case manager or care coordinator. The case manager will verify that the care plan includes paid family caregiver hours and that you meet the program's requirements.

Next, you will complete an employment application and provide personal references. You will need to pass a background check, which typically includes a criminal history check and a check of the state abuse and neglect registry. Some programs also require fingerprinting. This step usually takes one to three weeks.

Many programs require you to complete training before your first paid shift. Common training topics include personal care assistance, infection control, recognizing signs of abuse or neglect, and emergency procedures. Training can be online or in-person and typically takes four to eight hours. Some programs waive training if you already work as a caregiver elsewhere.

Once you are hired, you will receive a contract or employment agreement that lists your hourly rate, the number of hours per week you are scheduled to work, and how you will be paid (usually by direct deposit or check). You will also receive information about how to report your hours and how to contact your supervisor if you have questions.

Restrictions on who can be paid and how much

Not every family member can be paid. Some programs do not allow spouses to be paid caregivers, on the theory that spouses already have a legal obligation to support each other. Other programs allow spouses but not adult children, or vice versa. A few programs allow any relative. The rules depend on the specific program and the state.

Some programs also have rules about how many hours per week a family caregiver can work. A program might allow up to 40 hours per week, or it might cap family caregiver hours at 20 per week and require that additional care come from an unrelated paid caregiver or a family member providing unpaid care. These limits exist to prevent one person from being the sole source of care and to ensure that the person receiving care has backup support.

If you work as a paid caregiver, you are typically classified as an employee of the state program or a contractor hired by the program. This means taxes are withheld from your pay, and you may be may be able to access for benefits like workers' compensation insurance. You will receive a W-2 or 1099 form at the end of the year for tax purposes.

How payment compares to other caregiver jobs

Family caregivers paid through government programs typically earn less than unrelated caregivers hired through agencies. An agency caregiver in the same state might earn $18 to $30 per hour, while a family caregiver on the same Medicaid waiver earns $12 to $20 per hour. This difference exists because government programs have fixed budgets and because family members are sometimes seen as having a pre-existing relationship with the person they care for.

However, family caregivers have advantages that agency caregivers do not. You already know the person you care for, so there is no adjustment period. You can often set your own schedule within the hours approved by the program. And you may have more flexibility if the person's needs change unexpectedly.

If you are not paid through a government program, you might negotiate payment directly with the family. Rates for this kind of informal arrangement vary widely — from $12 per hour to $25 per hour or more, depending on your experience, the intensity of care needed, and what the family can afford. This arrangement is simpler to set up but offers no legal protections, no workers' compensation, and no tax withholding.

Frequently Asked Questions

Can I be paid if I already live with the person I care for?

Yes. Most programs do not require you to live separately from the person you care for. However, some programs have rules about how many hours per week you can be paid for if you live in the same home, on the assumption that you are already present and some care happens naturally. Ask the case manager whether living together affects your pay rate or the number of hours you can work.

What happens to my payment if the person I care for goes into the hospital?

This depends on the program. Some programs pause your pay while the person is hospitalized, on the theory that they do not need your care during that time. Others continue to pay you for a limited number of days. Ask your supervisor or case manager what the policy is before this situation arises, so you know what to expect.

Do I have to report caregiver income to Social Security or other benefits?

If you receive Social Security, Supplemental Security Income, or other means-tested benefits, caregiver income may affect your benefits. Report the income to the program that provides your benefits. In some cases, earned income is partially excluded from the calculation, which means your benefits may not decrease dollar-for-dollar with your caregiver pay. Contact your local Social Security office to understand how your specific situation works.

Can I be paid if the person I care for is on regular Medicaid, not a waiver?

Regular Medicaid does not typically include payment for family caregivers. Only Medicaid waiver programs (home and community-based services) usually have this option. If the person you care for is on regular Medicaid, ask their case manager whether they are may be able to access for a waiver program, which might open up the possibility of paid caregiving.

What if I want to be paid but the program says family caregivers are not allowed?

Some programs require that care come from an unrelated paid caregiver or a family member providing unpaid care. If this is the case, you have a few options: you can ask the case manager whether an exception is possible, you can explore whether a different program or waiver might allow family caregiving, or you can negotiate informal payment directly with the family outside of any government program.