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Spouses

States that pay spouse caregivers

Some states pay spouses, many do not, and rules change by program. Where it is allowed, there are usually conditions, like "extraordinary care" or a 40 hour weekly cap. The VA program pays spouses of eligible Veterans.1

  • Official sources
  • Last verified Oct 20, 2026
  • Independent site, not a government agency
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Spouse rules by state

Can a spouse be the paid caregiver? (source on each state page)
StateProgramSpouse
AlabamaPersonal Choices (self-directed waiver services)Not stated on the official page
AlaskaConsumer-Directed Personal Care Services (CDPCS) and Community First ChoiceYes, through Community First Choice PCS
ArizonaALTCS Self-Directed Attendant Care (SDAC) and spouse attendant careYes, through an agency, max 40 hrs per week
ArkansasIndependentChoicesNo
CaliforniaIn-Home Supportive Services (IHSS)Yes, under program rules
ColoradoConsumer-Directed Attendant Support Services (CDASS)Yes, for extraordinary care
ConnecticutCommunity First Choice (CFC)No
DelawareSelf-Directed Attendant Care (DSHP Plus)Yes, up to 40 hrs per week
District of ColumbiaEPD Waiver: Services My WayNo
FloridaSMMC Long-Term Care Participant Direction Option (PDO)Check with your LTC plan
GeorgiaStructured Family Caregiving (CCSP and SOURCE waivers)No
HawaiiQUEST Integration self-direction (Personal Assistance)Yes, in extraordinary circumstances
IdahoMedicaid Personal Care and Attendant CareNo (ended July 2025)
IllinoisHome Services Program (HSP), Personal AssistantYes, extraordinary care only
IndianaStructured Family Caregiving (SFC)Not stated on the state fact sheet
IowaConsumer Choices Option (CCO)Possibly, under the Elderly Waiver
KansasKanCare HCBS self-directionVaries by waiver
KentuckyParticipant Directed Services (PDS)Yes, with DAIL approval
LouisianaCommunity Choices Waiver Self-Direction OptionYes, extraordinary care only
MaineMaineCare Consumer Directed Attendant ServicesCheck with OADS
MarylandCommunity First Choice (CFC) self-directed personal assistanceNot stated on the official page
MassachusettsMassHealth PCA program and Adult Foster Care (AFC)No
MichiganHome Help programNo (Home Help)
MinnesotaPCA Choice and Community First Services and Supports (CFSS)Yes, since Oct 2024
MississippiElderly and Disabled Waiver, relatives as direct care workersNo
MissouriConsumer Directed Services (CDS)No
MontanaSelf-directed Community First Choice and Personal CareYes, under CFCS rules
NebraskaMedicaid HCBS waiver independent providers and LRI Personal CareYes, LRI Personal Care only
NevadaPersonal Care Services, self-directed through an ISONo
New HampshireChoices for Independence (CFI) participant-directed servicesGenerally no
New JerseyPersonal Preference Program (PPP)Not stated on the state page
New MexicoSelf-Directed Community Benefit (SDCB)Yes, with MCO approval
New YorkConsumer Directed Personal Assistance Program (CDPAP)No
North CarolinaCAP/DA consumer directionNot stated on the official page
North DakotaFamily Personal Care and Family Home CareYes
OhioPASSPORT Participant DirectionYes, under OAC 5160-44-32
OklahomaADvantage Consumer-Directed Personal Assistance (CD-PASS)Only by exception
OregonIn-Home Services (homecare worker) and Spousal Pay ProgramYes, Spousal Pay Program
PennsylvaniaCommunity HealthChoices (CHC) participant-directed servicesNo
Rhode IslandPersonal Choice ProgramNo
South CarolinaCommunity Choices Waiver participant-directed Attendant CareCheck with SCDHHS
South DakotaHOPE Waiver Structured Family CaregivingNot stated on the official page
TennesseeTennCare CHOICES Consumer DirectionNo (consumer direction)
TexasConsumer Directed Services (CDS) optionOnly in CMPAS
UtahAging Waiver self-administered servicesExtraordinary care only
VermontChoices for Care self-directed servicesYes, for personal care
VirginiaConsumer-Directed ServicesYes, since July 2025
WashingtonIndividual Provider (DSHS long-term services)No (Medicaid LTSS)
West VirginiaAged and Disabled Waiver Personal OptionsNo
WisconsinIRIS Self-Directed Personal CareYes
WyomingCommunity Choices Waiver participant directionYes, with conditions

How to check for your spouse

  1. Open your state page and read the official source.
  2. Ask the case manager if a spouse can be the paid worker.
  3. Get the answer in writing.
Can a spouse be the paid caregiver? Yes, at least with conditions: 20. No: 17. Not stated or depends on plan: 14.
Source: 51 official state sources (see state pages), Oct 20, 2026

Frequently asked questions

What states pay spouse caregivers?

Based on the official sources we reviewed, 20 of 51 jurisdictions allow a spouse to be paid in at least one program, usually with conditions such as extraordinary care or hour caps. See the table for each state.

Why do some states exclude spouses?

Spouses are legally responsible relatives. Federal rules let each state decide when they can be paid.

Does the VA pay spouses?

Yes. A spouse can be a Primary Family Caregiver under VA PCAFC if eligibility rules are met.

Steps to apply: 1. Open your state page and read the official source. 2. Ask the case manager if a spouse can be the paid worker. 3. Get the answer in writing.
Source: usa.gov

Sources

  1. VA.gov, PCAFC: https://www.va.gov/family-and-caregiver-benefits/health-and-disability/comprehensive-assistance-for-family-caregivers/Official
  2. Alabama: https://medicaid.alabama.gov/content/6.0_LTC_Waivers/6.3_Other_LTC_Programs/6.3.3_Personal_Choices.aspxOfficial
  3. Alaska: https://health.alaska.gov/en/services/pcs/Official
  4. Arizona: https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/1300/1320-A.pdfOfficial
  5. Arkansas: https://humanservices.arkansas.gov/divisions-shared-services/aging-adult-behavioral-health-services/self-direction-independent-choices/Official
  6. California: https://www.cdss.ca.gov/in-home-supportive-servicesOfficial
  7. Colorado: https://hcpf.colorado.gov/consumer-directed-attendant-support-servicesOfficial
  8. Connecticut: https://wp.cga.ct.gov/apa/wp-content/cgacustom/reports/performance/PERFORMANCE_Department%20of%20Social%20Services-Community%20First%20Choice_20220601.pdfOfficial
  9. Delaware: https://dhss.delaware.gov/services/attendant-services/Official
  10. District of Columbia: https://dhcf.dc.gov/page/epd-waiver-servicesOfficial
  11. Florida: https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care/long-term-care-program/long-term-care-plans-participant-direction-option-pdo.htmlNon-official
  12. Georgia: https://dch.georgia.gov/document/document/structured-family-caregiving/downloadOfficial
  13. Hawaii: https://medquest.hawaii.gov/api/media/file/Health%20Plan%20Manual%20-%20Part%20II%20Operational%20Guidance%2024.1.pdfOfficial
  14. Idaho: https://healthandwelfare.idaho.gov/providers/home-and-community-based-long-term-care/long-term-care-provider-enrollment-and-generalOfficial
  15. Illinois: https://www.dhs.state.il.us/page.aspx/?item=158178Official
  16. Indiana: https://www.in.gov/fssa/ompp/files/Structured-Family-Caregiving.pdfOfficial
  17. Iowa: https://secureapp.dhs.state.ia.us/IMPA/Information/ViewDocument.aspx?viewdocument=808e5ae2-e204-4ca6-ae1d-bfe553a5eba4Official
  18. Kansas: https://www.kdads.ks.gov/services-programs/long-term-services-supports/ltss-training-resources/self-directionOfficial
  19. Kentucky: https://www.chfs.ky.gov/agencies/dms/dca/Pages/cdo.aspxOfficial
  20. Louisiana: https://www.ldh.la.gov/medicaid/self-directionOfficial
  21. Maine: https://www.maine.gov/dhhs/oads/get-support/older-adults-disabilities/home-careOfficial
  22. Maryland: https://health.maryland.gov/mmcp/ltss/Pages/community-first-choice.aspxOfficial
  23. Massachusetts: https://www.mass.gov/info-details/masshealth-adult-foster-care-program-fact-sheetOfficial
  24. Michigan: https://www.michigan.gov/mdhhs/adult-child-serv/adults-and-seniors/independentOfficial
  25. Minnesota: https://content.govdelivery.com/accounts/MNDHS/bulletins/3abc52cNon-official
  26. Mississippi: https://www.sos.ms.gov/adminsearch/ACCode/00000235c.pdfOfficial
  27. Missouri: https://health.mo.gov/providers/manuals/home-and-community-based-services-manual/300-available-home-and-community-13Official
  28. Montana: https://dphhs.mt.gov/assets/sltc/CommunityFirst/CFCSelfDirect/AccessingCommunityFirstChoiceServices.pdfOfficial
  29. Nebraska: https://dhhs.ne.gov/Pages/HCBS-Prospective-Provider.aspxOfficial
  30. Nevada: https://www.nevadamedicaid.nv.gov/resources/medicaid-services-manual/chapter-3500-personal-care-services-program/Official
  31. New Hampshire: https://www.dhhs.nh.gov/programs-services/adult-aging-care/home-and-community-based-careOfficial
  32. New Jersey: https://www.nj.gov/humanservices/dmahs/individuals-families/njppp.shtmlOfficial
  33. New Mexico: https://www.hca.nm.gov/wp-content/uploads/Paid-caregivers_Explainer_240708-1.pdfOfficial
  34. New York: https://health.ny.gov/health_care/medicaid/program/longterm/cdpap/Official
  35. North Carolina: https://medicaid.ncdhhs.gov/providers/programs-and-services/long-term-care/community-alternatives-program-disabled-adults-capdaOfficial
  36. North Dakota: https://www.nd.gov/dhs/policymanuals/52505/Content/525_05_30_32.htmOfficial
  37. Ohio: https://dam.assets.ohio.gov/image/upload/aging.ohio.gov/Participant_Direction_Provider_Application_User_Guide.pdfOfficial
  38. Oklahoma: https://oklahoma.gov/okdhs/services/aging/cdpass.htmlOfficial
  39. Oregon: https://www.oregon.gov/odhs/home-care-consumers/pages/default.aspxOfficial
  40. Pennsylvania: https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/contact/dhs-offices/documents/oltl/oltl-waivers/2026-chc-waiver/2026-01-28-chc-1915c-appendix-e.pdfOfficial
  41. Rhode Island: https://eohhs.ri.gov/consumer/healthcare/long-term-services-and-supports/personal-choice-programOfficial
  42. South Carolina: https://www.scdhhs.gov/sites/dhhs/files/pdf/links/Approved%20Community%20Choices%20Waiver%20Amendment_1_Jacob%20Chorey.pdfOfficial
  43. South Dakota: https://www.dhs.sd.gov/en/ltss/paid-family-caregiverOfficial
  44. Tennessee: https://www.tn.gov/tenncare/long-term-services-supports/choices.htmlOfficial
  45. Texas: https://www.hhs.texas.gov/providers/long-term-care-providers/consumer-directed-services-cdsOfficial
  46. Utah: https://medicaid.utah.gov/ltc-2/ag/Official
  47. Vermont: https://asd.vermont.gov/sites/asd/files/documents/Choices%20for%20Care%20Eligibility%20At-A-Glance.pdfOfficial
  48. Virginia: https://www.dmas.virginia.gov/for-members/benefits-and-services/waivers/consumer-directed-services/Official
  49. Washington: https://www.dshs.wa.gov/adult-and-aging-services/caregiving-resources/becoming-paid-caregiverOfficial
  50. West Virginia: https://adwprogram.wv.gov/Official
  51. Wisconsin: https://www.dhs.wisconsin.gov/iris/sdpc.htmOfficial
  52. Wyoming: https://health.wyo.gov/healthcarefin/hcbs/participants/participant-direction/Official

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