How to Get Paid by Medicaid to Care for a Family Member

Yes. Once your relative qualifies for Medicaid home care, they can hire you through a self-directed program, and a fiscal agent pays you by the hour for the hours in their service plan: in New York at least $18.65 to $20.65 an hour in 2026, in Texas at least minimum wage within the budget. Today, your relative (or you, with them) asks the state Medicaid agency for a home care assessment and the self-directed option, naming you as the worker. Adult children, siblings and friends qualify in New York, Texas and Minnesota; spouses and parents of minor children face the tightest federal limits.

Which Medicaid programs pay a family caregiver

Self-direction makes the person who needs care the employer: they recruit, hire, train and supervise their worker. A financial management service (a fiscal intermediary in New York, an FMSA in Texas) withholds taxes, processes timesheets and issues paychecks. Each federal authority sets who can be paid:

Program	Who gets it	Who can be the paid caregiver
State plan personal care	In states that cover it, Medicaid enrollees whose care a doctor's plan of treatment or a state-approved service plan authorizes; children under 21 get it when medically necessary (EPSDT)	Any qualified person except a legally responsible relative (a spouse, or a parent of a minor child)
1915(c) home and community-based services waiver	People in the waiver's target group who need an institutional level of care (nursing home, hospital or ICF/IID); the state caps the slots	Relatives when the state's waiver allows it; spouses and parents of minors only for extraordinary care, in states that choose to pay it
1915(k) Community First Choice	In states that offer it, people who need an institutional level of care and are in a Medicaid group covering nursing homes or have income at or below 150% of poverty	Family members or anyone else who meets the person's qualifications; spouses and parents of minors only where the state allows it (Minnesota does; Texas CDS and New York CDPAP do not)
1915(j) self-directed personal assistance	People getting state plan personal care or 1915(c) waiver services, in states that offer it	Legally liable relatives such as parents and spouses, when the state allows it; the state can also pay the budget in cash

Extraordinary care is CMS's term for care beyond what a spouse or parent ordinarily does for someone the same age without a disability, needed to keep the person safe and out of an institution. CMS leaves the parent of an adult child out of the legally responsible group unless state law adds them, so the state's line decides: under 21 in New York's program, under 18 in Texas, where a parent who is an adult child's legal guardian is also excluded.

Federal law requires electronic visit verification (EVV) for Medicaid personal care visits, so a caregiver who comes to the home clocks each shift in and out on an app or phone line. A caregiver who lives with the relative falls outside the federal rule, though the state can still require EVV.

Pay and rules in three states

New York: CDPAP

The Consumer Directed Personal Assistance Program lets a Medicaid member hire a friend or family member other than a spouse, the member's designated representative, or the parent of a member under 21. Since April 1, 2025, Public Partnerships LLC (PPL) is the only fiscal intermediary, and every caregiver registers with PPL at 1-833-247-5346. PPL's 2026 minimum base wage is $20.65 an hour for members in New York City, $20.05 in Nassau, Suffolk and Westchester, and $18.65 elsewhere, paid weekly on Thursdays. Before your first shift you complete a physical exam, show MMR immunity and take a TB test. Applicants 21 and older assessed since September 1, 2025 also need limited assistance with physical maneuvering for more than two daily activities, or supervision with more than one for dementia.

Texas: Consumer Directed Services

Under the CDS option, the employer is your relative, a parent for a child under 18, or the legal guardian for an adult who has one. CDS covers attendant care in STAR+PLUS, STAR Kids, Primary Home Care, Community Attendant Services, Family Care and waivers such as CLASS, HCS, TxHmL and MDCP. The paid worker cannot be the person's spouse (except in the CMPAS program), their legally authorized representative (a parent or stepparent of a child under 18, or a guardian at any age), the designated representative, or the spouse of either representative. You record time in EVV, get paid at least twice a month, and can expect up to three weeks from the first FMSA meeting to your first shift.

Minnesota: CFSS

Community First Services and Supports, Minnesota's Community First Choice program, is replacing personal care assistance (PCA). Since October 1, 2024, spouses and the parents and stepparents of minor children can be paid PCA and CFSS workers. A spouse, or a parent who is the only parent on the payroll, can work up to 60 hours of Medicaid home care in seven days; when both parents are paid, each gets up to 40, for 80 combined. Workers pass a background study and a standardized training and test.

In California, use In-Home Supportive Services, which pays spouses and parents too; see the California IHSS guide.

What to do today

Find the right office. New applicants pick their state on Medicaid.gov's state contact page; the Eldercare Locator (1-800-677-1116) connects older adults to local help. Already on Medicaid? In Texas, tell the case manager or service coordinator you want CDS; in New York, call the managed care plan, or the Local Department of Social Services if your relative has no plan.
Apply for Medicaid now if your relative is not enrolled. The state has 45 days to decide, or 90 when the application is based on disability.
Request the home care assessment. List each task, how long it takes and how often, nights included; the Medicaid home care guide covers the visit.
Choose self-direction by its state name (CDPAP, CDS, CFSS, participant-directed) and name yourself as the worker.
Enroll with the fiscal agent: tax and employment forms, a background check, any required training or health screening, and EVV setup.

Where it splits

If your relative can't manage the hiring, another family member becomes the designated representative (in Texas, an adult's guardian is the employer), and that person can't be the paid worker in New York, Texas or Minnesota. Settle the roles before the assessment.
If you are the spouse or the parent of a child under 18, ask waiver intake whether the waiver pays legally responsible relatives for extraordinary care and whether the state offers 1915(j). If not, a sibling, adult child or friend takes the paid role and you stay the backup.
If the waiver has a waiting list, get on it today. Slots open through turnover or new legislative funding, and the state's written selection policy decides who goes next. States can reserve slots for people leaving an institution, moving from another waiver, or in a crisis; tell intake if one fits. Meanwhile, apply for state plan personal care or Community First Choice where offered: states cannot cap CFC enrollment.
If the person is a veteran rated 70% or higher who needs at least six months of continuous in-person care, VA pays the primary family caregiver a monthly stipend; see the PCAFC guide.

Your leverage

Regular Medicaid, no health plan: request a fair hearing by the deadline on the denial or cut notice, at most 90 days from mailing. Cut notices come at least 10 days ahead; ask before the effective date and services continue until the decision. If the state wins, it can recover what it paid meanwhile.
Medicaid through a health plan (such as New York MLTC or Texas STAR+PLUS): appeal to the plan within 60 days of its notice, and within 10 days or by the effective date to keep services. If the plan upholds the cut, request the state fair hearing by the deadline in its decision letter, 90 to 120 days out; file within 10 days to keep services running until the hearing.
A stalled application: once the decision deadline passes, your relative can request a fair hearing over the delay.
Taxes: if you live with your relative and the pay comes through a 1915(c) waiver, IRS Notice 2014-7 excludes it from income; moving into your parent's home counts if you have no other home. Pay from CDPAP, CFSS and other programs can qualify, depending on the program's design. Give the fiscal agent a signed live-in statement so it leaves excluded pay out of box 1 of your W-2.

Call your local legal aid office when a waiver denial or an hour cut has a hearing date set.

What to say when you call

"I'm calling for [name], born [date of birth], Medicaid number [number] (or: applying now). [Name] needs daily help with [bathing, dressing, meals, medications] and wants care at home. Please schedule a home care assessment, screen [him/her] for personal care, Community First Choice and every waiver that fits, and add [him/her] to any waiting list. [Name] wants to self-direct and hire me, [your name], [his/her] [daughter/son/sister]. Which fiscal agent enrolls workers, and what is today's reference number?"

Today

Make the call and write down the date and reference number.
Start the Medicaid application if your relative is not enrolled.

Next: the eligibility decision, an assessment visit, and a notice with the approved hours or budget. Then the fiscal agent's enrollment packet arrives, and pay follows its schedule: weekly in New York, at least twice a month in Texas.