Can I Get Paid to Care for a Family Member as an HHA?

Yes — in most states. Through Medicaid's consumer-directed care programs, family members (including adult children, siblings, and other relatives) can become certified HHAs and receive Medicaid payments for caring for a loved one at home. Spouses are excluded in many states, but most other family relationships are allowed.

The short version: Your family member must be on Medicaid and meet care needs criteria. You must complete HHA training and pass your state exam. The program pays you — like any HHA job — but you work only for your family member.

How the Program Works

Consumer-directed care (also called self-directed care or participant-directed care) lets Medicaid recipients choose their own caregiver instead of using an agency. When they choose a family member, that family member gets paid through the state Medicaid program.

40+

States with programs

Most states have some form

$13–$22/hr

Typical pay rate

Varies by state and region

Care plan

Hours covered

Set by Medicaid assessment

Step-by-Step: How to Get Approved

Verify your family member qualifies for Medicaid

Your family member (the person needing care) must be enrolled in Medicaid and meet medical eligibility requirements — typically a functional assessment showing they need help with ADLs.

→ Contact your state Medicaid office or call 1-800-MEDICARE to check eligibility.

Find your state's self-directed or consumer-directed care program

Most states run these programs under different names (CDPA, IHSS, CDS). They allow the care recipient to choose their own caregiver — including family members.

→ Search "[your state] consumer directed Medicaid" to find the specific program name.

Get enrolled as an approved provider

You'll need to complete a background check, provide identification, and in most states, complete HHA training and pass the competency exam to become an approved caregiver.

→ Contact the program's fiscal intermediary (the agency that processes your paycheck).

Complete HHA training and certification

Most states require family caregivers to meet the same training requirements as agency-hired HHAs — typically 75–120 hours of training and a state competency exam.

→ Enroll in an approved HHA training program near you.

Develop a care plan with a nurse or care coordinator

A care coordinator will visit and document your family member's needs. This creates an authorized care plan that specifies hours and tasks — which determines your pay.

→ Schedule an intake assessment with the program's care coordinator.

Start providing care and submitting timesheets

Once approved, you provide care according to the plan, track your hours, and submit timesheets through the fiscal intermediary. Pay arrives like a paycheck — with taxes withheld.

→ Set up electronic visit verification (EVV) if required in your state.

Family Caregiver Programs by State

These are the most common programs. Contact your state Medicaid office for the most current rules — eligibility details change frequently.

State	Program Name	Family Allowed?	Notes
New York	Consumer Directed Personal Assistance (CDPA)	✓ Yes	Spouses excluded in most cases; adult children and other relatives allowed
California	In-Home Supportive Services (IHSS)	✓ Yes	Spouses and parents of minor children allowed
Pennsylvania	Participant-Directed Services	✓ Yes	Family members allowed; legal guardians excluded
Florida	Medicaid Waiver / Agency for Health Care Administration	✓ Yes	Allows relatives with restrictions on legally responsible parties
Texas	Consumer Directed Services (CDS)	✓ Yes	Most family members allowed; spouses case-by-case
Illinois	Home Services Program (HSP)	✓ Yes	Adult children and relatives commonly approved
Ohio	PASSPORT Medicaid Waiver	✓ Yes	Spouses and parents of minors typically excluded
Arizona	Arizona Long Term Care System (ALTCS)	✓ Yes	Family members allowed under self-directed option

Don't see your state? Search "[your state] Medicaid consumer directed care family caregiver" — most states have programs not listed above.

Common Questions

Q: Can a spouse be paid to care for their partner?

It depends on the state. New York and Ohio generally exclude spouses. California's IHSS allows it. Most states exclude "legally responsible relatives" — meaning spouses and parents of minor children. Adult children caring for parents are almost always allowed.

Q: How much can I earn caring for a family member?

Pay rates are set by the Medicaid program — typically the same as agency HHA rates in your area. This ranges from $13–$22/hour depending on your state. Hours are limited by the care plan (the number of hours approved per week based on your family member's needs).

Q: Do I still need to pass the HHA exam?

Yes, in most states. Even when the care recipient chooses you, you must still meet the state's HHA training and certification requirements. Some programs offer an exemption for family caregivers who complete a shorter training, but this varies.

Q: Will being paid affect my family member's Medicaid?

No. The payments go to you as the caregiver, not your family member. This does not affect your family member's Medicaid eligibility or benefit amount.

Q: What if I already care for my family member but it's not official?

You can apply retroactively in most programs. The care must be documented going forward, but past unpaid care does not disqualify you. Start the application process — many families find they were eligible for years without knowing.

Q: Is this the same as being a paid family caregiver outside of Medicaid?

No. Some states have non-Medicaid programs (like the VA Caregiver Support Program for veterans' families). This guide focuses on Medicaid-funded programs, which are the most widely available. If your family member is a veteran, the VA program may offer different benefits.

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