Who Pays Family Caregivers?

Quick Answer

A quick comparison before the details — each program below is explained in full in its own section.

Medicare

The single most common point of confusion: traditional Medicare pays Medicare-certified home health agencies for covered services — it does not enroll or pay an individual family member directly to provide that care.

What Medicare's home health benefit covers

• Skilled nursing care, on a part-time or intermittent basis
• Physical, occupational, and speech-language therapy
• Home health aide visits for personal care, but only alongside skilled nursing or therapy — not on their own
• Medical social services and certain medical supplies/equipment, when ordered as part of your plan of care

What it doesn't cover

• 24-hour care at home
• Custodial or personal care, when that's the only help someone needs
• Homemaker services (shopping, cleaning, laundry) and meal delivery

Source: Medicare.gov

Basic eligibility

• You must be homebound — leaving home takes considerable effort or the help of another person or device
• A doctor must certify the need for care and set up a plan of care, recertified regularly
• Care must come from a Medicare-certified home health agency

Some Medicare Advantage plans can offer expanded supplemental benefits beyond what traditional Medicare covers — what's included varies by plan, so it's worth asking your specific plan directly rather than assuming.

VA Benefits (PCAFC)

The VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) is the one program on this page built specifically to pay a family caregiver — but only for caregivers of eligible veterans.

Veteran eligibility

• A VA disability rating of 70% or higher for a qualifying service-connected condition
• Discharged from the U.S. military, or has a medical discharge date
• Needs at least 6 months of continuous, in-person personal care, and is enrolled in VA health care

Primary vs. Secondary Family Caregiver

A veteran can designate one Primary Family Caregiver (the main caregiver, who receives a monthly stipend and CHAMPVA health coverage) and up to two Secondary Family Caregivers (backup support, who receive training, counseling, and travel benefits but not a stipend).

How the stipend works

The stipend amount isn't a flat number — it's determined by a tiered structure tied to the veteran's level of need and geographic location, and it's reassessed over time rather than set once. Because it changes and varies by case, check VA.gov directly for current figures rather than relying on a number quoted elsewhere.

Caregivers also take part in periodic wellness check-ins — at least once every 120 days, including one annual visit to the veteran's home — to confirm the arrangement is still working for both of you.

Source: VA.gov

PCAFC's periodic reassessments ask caregivers to describe the day-to-day care they're providing — the same kind of detail Tutti's activity log already tracks as part of normal use, not as a special export.

Medicaid

There's no single national Medicaid program that pays family caregivers — instead, it's a patchwork of state-run options, and every state does it a little differently.

How it generally works

• Many states offer a "consumer-directed" or "self-directed" option, letting the Medicaid recipient hire and manage their own caregiver — sometimes including a family member
• These options are often run through Home and Community-Based Services (HCBS) waivers, which aren't guaranteed entitlements — some have caps or waiting lists
• A few states offer "Structured Family Caregiving," a distinct benefit for a caregiver who lives with and provides round-the-clock supervision to the person receiving care

Eligibility rules, which relatives can be paid, and how much the program pays all vary by state — there isn't one national answer, so the details above are deliberately general rather than specific to any one state.

Source: Medicaid.gov

FMLA

Basic eligibility

• You've worked for your employer for at least 12 months
• You've worked at least 1,250 hours during that 12-month period
• Your employer has at least 50 employees within 75 miles of your worksite

FMLA's family-care provision covers a spouse, child, or parent with a serious health condition — it generally doesn't extend to in-laws, siblings, or grandparents.

Separately from federal FMLA, a growing number of states run their own paid family leave programs that can provide actual wage replacement while you're out — worth checking whether yours is one of them, since that's a real source of pay FMLA itself doesn't provide.

Source: DOL.gov

Where to Start

Common Questions