Table of Contents
The Basics: Getting Paid to Care for a Family Member
Understanding the Broader Landscape of Family Caregiver Programs
FreedomCare Allows You to Choose Who Provides Your Care
Can Spouses Get Paid as Family Caregivers?
Paid Family Leave for Caregivers
Every day, family members across the country step up to care for the people they love most. Whether it’s helping with meals, managing medications, or simply offering comfort and companionship, caregiving is a full-time job—one that often goes unpaid.
But what if you could get compensated for the care you already provide? For many families, that financial support can make a world of difference. The good news is that many states allow family members, including spouses, to be paid caregivers through Medicaid programs and waiver services.
At FreedomCare, we’re proud to help families across the U.S. navigate these programs and access the benefits they deserve. This guide will explain:
- Which states pay family caregivers (including spouses, children, and other relatives)
- How these programs work
- Where FreedomCare can support your family directly
- Additional federal and state programs that offer support
Let’s dive in.
The Basics: Getting Paid to Care for a Family Member
Yes, it’s possible, and more common than you might think.
Across the country, state Medicaid programs and waiver-based services allow family members—including adult children, siblings, and even friends—to receive compensation for providing care to a loved one. These options are especially accessible under self-directed care models, which put the choice of caregiver in the hands of the person receiving care.
Many of these programs fall under Home and Community-Based Services (HCBS) waivers, such as the 1915(c), 1915(j), and 1115 demonstration waivers. Others operate as part of state-funded initiatives or federal programs like Veterans Affairs caregiver support. Some states even offer unique programs like Structured Family Caregiving or Adult Foster Care that provide stipends for live-in care.
Eligibility varies based on factors like Medicaid status, level of care needed, and caregiver relationship to the recipient. Not all states allow every type of family member to be paid—for example, spouses or legal guardians are still restricted in some areas—but the national trend is moving toward broader inclusion.
At FreedomCare, our mission is to make this process simple and supportive. We help:
- Navigate state-specific rules and eligibility criteria
- Complete assessments and documentation
- Provide training where required
- Handle payroll processing and taxes
- Offer InstaPay4Care, so caregivers can receive their pay the same day they work
Whether you’re a family member who’s been helping out for years or someone just stepping into a caregiving role, FreedomCare can help you get compensated for the vital work you do every day.
Read more about state-by-state programs offered by FreedomCare.
Understanding the Broader Landscape of Family Caregiver Programs
There are several types of government-supported programs available for family caregivers. FreedomCare currently operates in select states, so please visit freedomcare.com to confirm if your state is eligible to work with us.
- Medicaid Self-Directed Care Programs (e.g., LHCSA in NY, IHSS in CA)
- Structured Family Caregiving (offered in IN, GA, LA, etc.)
- Adult Foster Care Programs (e.g., MA, TX)
- Veterans Directed Care Programs (VDC)
- Federal and State Paid Family Leave Laws (available in 13+ states)
- State-Specific Medicaid Waivers (e.g., PASSPORT in OH, HSP in IL)
Each program has unique eligibility requirements and benefits, but they all share a common goal: empowering families to care for their loved ones at home—with financial support.
FreedomCare Allows You to Choose Who Provides Your Care.
FreedomCare helps people in the following states become paid caregivers for family or friends. Here’s a breakdown of whether spouses can also be paid in each state and what you can expect from the program.
How Much Do Family Caregivers Get Paid?
Caregiver pay rates vary by state, waiver program, and service hours. Here’s a general range:
Most FreedomCare programs also offer:
- InstaPay4Care: Get paid right after your shift
- Benefits: Some states offer insurance options
- Training Support: Free CPR/First Aid where required
Can Spouses Get Paid as Family Caregivers?
Historically, spouses have often been excluded from Medicaid caregiver compensation programs due to regulations that classified care between spouses as a familial duty rather than reimbursable labor. The assumption was that spousal support, even when intensive and around-the-clock, should not qualify as paid employment. But in recent years, that mindset has been shifting.
Thanks to growing advocacy, research on caregiver burnout, and the evolving structure of Medicaid waiver programs, many states are re-evaluating or reversing restrictions that exclude spouses from compensation. Today, a number of states—including New York, Arizona, Illinois, and Oregon—allow legal spouses to be paid for the care they provide through self-directed models or specific waiver programs.
This is particularly important because spousal caregivers often shoulder the greatest emotional and physical burden. Unlike paid home health aides, spouses typically live full-time with the person receiving care, which means their caregiving responsibilities don’t stop at the end of an 8-hour shift. They may assist with bathing, dressing, toileting, meal preparation, medication management, transportation, and companionship. And yet, in states where spousal compensation is not permitted, these contributions go unrecognized financially.
FreedomCare works to close that gap. In the states where spouses are eligible, we help:
- Determine your eligibility based on Medicaid status, care level, and state-specific criteria
- Handle enrollment and assessments, including paperwork and scheduling
- Provide caregiver support, including training and resources
- Offer instant payments through our InstaPay4Care system, helping spouses get paid immediately after completing care shifts
In states that still prohibit spousal pay, we provide:
- Guidance on alternative caregiving arrangements, such as having an adult child or sibling serve as the paid caregiver while the spouse remains involved informally
- Notification tools that alert families if their state’s policies change
- General support navigating other available benefits, such as paid family leave or respite services
Examples of where spouses can be paid include:
- Arizona – under ALTCS with the Agency with Choice option, where spouses are eligible if they meet care and training requirements
- Illinois – through the Home Services Program (HSP), which explicitly includes spouses as eligible personal assistants
- Oregon – where Medicaid’s self-directed care model permits spousal caregivers under certain conditions
Examples of where spouses are still excluded:
- Nevada – Medicaid PCS program does not allow spouse compensation
- Pennsylvania – spousal caregivers are excluded, along with parents of minors and legal guardians
- Georgia – the Structured Family Caregiving (SFC) program excludes spouses, guardians, and conservators
It’s worth noting that even in states that don’t currently allow spouse pay, pressure is mounting to revise those rules. States are recognizing that excluding spouses may undermine care quality, cause unnecessary financial hardship, and discourage families from keeping loved ones at home.
Whether you’re already caring for your spouse or considering taking on the role, FreedomCare is here to support you, with clarity, compassion, and tools to help you navigate your options.
Veteran Caregiver Programs
If your family member is a U.S. veteran, you may be eligible for compensation under VA caregiver programs, such as:
- Veterans Directed Care (VDC): Veteran-managed budget for home care, including family caregivers
- Program of Comprehensive Assistance for Family Caregivers (PCAFC): Monthly stipend for primary caregivers
- Aid and Attendance / Housebound Benefits: VA pension supplements for in-home care support
FreedomCare does not directly manage VA benefits, or support veteran waivers, but we can guide you toward trusted resources.
Paid Family Leave for Caregivers
Thirteen states and D.C. offer paid family leave laws, allowing caregivers to receive income replacement during time off to care for a loved one. These include:
- California
- Colorado
- Connecticut
- Delaware
- Massachusetts
- Maryland
- Maine
- Minnesota
- New Jersey
- New York
- Oregon
- Rhode Island
- Washington
Most FreedomCare programs operate in addition to paid leave protections, helping you stay financially stable while providing care.
Challenges Faced by Family Caregivers
Caregiving is rewarding—but also incredibly demanding. Common challenges include:
- Emotional burnout from round-the-clock care
- Reduced work hours and lost income
- Lack of respite services or breaks
- Administrative complexity in navigating Medicaid
FreedomCare helps by:
- Handling paperwork and enrollment
- Offering caregiver coaching and support
Providing tools and mobile apps to track hours and get paid faster
What If Your State Doesn’t Pay Certain Family Members Yet?
Even if your state currently excludes certain relatives (like spouses or legal guardians), here are steps you can take:
- Explore other caregiver options: Child, sibling, or friend may qualify
- Use state Paid Family Leave: If you work a W-2 job
- Advocate: Many states are reconsidering outdated caregiver eligibility rules
- Join FreedomCare’s waitlist: Get notified if policies change
FreedomCare: Empower Your Caregiving Journey
Caring for a loved one is a profound act of love, and you shouldn’t have to do it alone or unpaid.
If you live in a state that allows family caregiver compensation, FreedomCare is here to help:
- Navigate complex Medicaid rules
- Handle assessments and paperwork
- Get paid quickly and reliably
- Receive ongoing caregiver support
Ready to check your eligibility? Start your application now!