Can I Get Paid to Care for a Family Member in North Carolina?

Quick answer

A family member may be paid to care for someone in North Carolina, but usually only through a specific program. The strongest Medicaid route to check is CAP/DA. CAP/DA is for adults who need a nursing-home level of care but can stay at home with supports.

CAP/DA has a consumer-directed option that can let the person receiving care hire a worker. NC Medicaid policy also says a spouse, parent, step-parent, child, sibling, or other relative can be hired for some CAP/DA services when the person receiving care is age 18 or older and the worker meets the rules.

For older adults without Medicaid, Home Care Independence may help in some counties. For veterans, VA Aid and Attendance, PCAFC, and Veteran Directed Care may help, depending on VA rules and local access.

NC Medicaid CAP/DA is the main Medicaid route to check first

CAP/DA means Community Alternatives Program for Disabled Adults. It is a North Carolina Medicaid home and community-based services waiver. A waiver is a Medicaid program that can pay for services at home or in the community instead of a nursing home.

CAP/DA is for adults age 18 or older with serious health needs. The person must meet a level of care like nursing facility care. They must also need at least one CAP/DA service.

NC Medicaid says CAP/DA members must be enrolled in NC Medicaid Direct. Some people may have a Medicaid deductible or spend-down. If income or assets are the problem, read our guides on Medicaid spend-down and the Medicaid look-back period.

CAP/DA services that may matter to caregivers

CAP/DA can include in-home aide services, personal assistance, respite, meal delivery, home changes, personal emergency response systems, supplies, case management, financial management, consumer-directed services, and coordinated caregiving.

For a broader plain-English guide to waivers, see Medicaid HCBS waivers explained.

CAP/DA has more than one service model

• Provider-led: an agency provides the aide or home care worker.
• Consumer-directed: the person receiving care, or a representative, acts as the employer of record and hires workers.
• Coordinated caregiving: a live-in caregiver provides care with support from a health care agency and a care plan.

Ask about the exact model. A family member who can be paid under one model may not fit another model.

CAP/DA consumer-directed services

Consumer direction means the person receiving care has more choice and control over who provides care. In CAP/DA, the person or their representative may recruit, hire, train, supervise, and dismiss the personal assistant.

NC Medicaid policy says a family member can be hired in some CAP/DA service situations. This can include a spouse, parent, step-parent, child, sibling, or other relative when the person getting CAP/DA is age 18 or older and the worker meets the rules.

The worker may need to be at least 18, meet skill or competency rules, pass background and registry checks, and keep other jobs from getting in the way of the approved care plan.

The person directing care cannot always be the paid worker. NC DHHS says a person who directs the care, or is involved in the decision-making for the care recipient, cannot also be the person paid to provide care under its listed self-directed programs. CAP/DA policy also has limits for representatives, guardians, powers of attorney, and legally responsible people, unless special rules apply.

CAP/DA coordinated caregiving and live-in caregiver pay

North Carolina does not appear to use the public name “Structured Family Caregiving” for its main adult Medicaid caregiver-pay route. The similar CAP/DA service to ask about is called coordinated caregiving.

Coordinated caregiving is for some CAP/DA members. The caregiver lives in the same home as the waiver participant, or the participant lives in the caregiver’s home. The service is meant to help the person stay in the community and avoid a facility when safe.

NC Medicaid policy says the live-in caregiver is paid a stipend for oversight and supervision needed to keep the person in the community. The policy also says the caregiver must meet rules such as being at least 18, being in good health, following instructions, and passing criminal and registry checks.

This is not automatic. It must fit the assessment and the care plan. Ask the CAP/DA case manager this exact question: “Could coordinated caregiving be considered for a live-in family caregiver?”

NC Medicaid Personal Care Services may help, but it is not usually a direct family-pay route

Personal Care Services, or PCS, helps people with daily tasks. These tasks can include eating, dressing, bathing, toileting, and moving around.

NC Medicaid says PCS is provided by trained helpers who work for licensed home care agencies or adult care homes. That means PCS may help your loved one get hands-on care, but it is not the same as consumer direction.

If your goal is to be paid as the family caregiver, ask about CAP/DA consumer direction, CAP/DA coordinated caregiving, and Home Care Independence. Still ask about PCS if the person needs hands-on help now.

Home Care Independence may help some older adults

Home Care Independence is a North Carolina Division of Aging program. It can let an older adult hire family, friends, or others as a caregiver or personal assistant.

The person must usually be age 60 or older, live at home, and need help with daily living or home tasks. The person must be able to direct their own care or have someone who can do that for them.

This program is not in every county. It also may not provide enough help for someone who needs ongoing nursing care, supervision, or monitoring.

Important rule: the person who directs the care cannot also be the paid caregiver. Ask the provider how this rule works before you plan on payment.

Family Caregiver Support Program helps caregivers, but does not pay ongoing wages

The Family Caregiver Support Program can help unpaid caregivers with information, help finding services, counseling, support groups, training, short-term respite, and limited extra services.

NC DHHS says this program does not pay caregivers to provide ongoing care for loved ones. It can still be worth calling if you need respite, local names, or help finding a program.

For more help with breaks, read respite care for caregivers.

Can a spouse be paid?

Sometimes, under CAP/DA. NC Medicaid policy says a spouse can be hired as an employee for some CAP/DA services when the person receiving CAP/DA is age 18 or older and the spouse meets the service rules.

But there are limits. If the spouse is also the person who directs the care, acts as representative, guardian, power of attorney, or health care power of attorney, the rules may block payment unless a special rule applies.

Do not assume approval. Ask the CAP/DA case manager or financial manager these questions:

• Can a spouse be hired for this service?
• Is the spouse also listed as the representative, guardian, or power of attorney?
• Would that role stop payment?
• Does this need an exception or a different service model?

Can an adult child be paid?

Yes, an adult child may be able to be paid through CAP/DA if the program approves the service and the adult child meets worker rules. The same may be true for a sibling or another relative.

Under CAP/DA, the worker may need to be at least 18, pass checks, meet skill rules, and follow the approved care plan. The person receiving care must qualify for CAP/DA first.

An adult child may also be paid through Home Care Independence in counties where the program is offered. The adult child cannot be the person who directs the care if that rule applies.

Start with the bigger guide here: Can I get paid to be a caregiver? You can also use the caregiver pay quiz to sort the likely path.

What about a sibling, other relative, or live-in caregiver?

A sibling or other relative may be paid under some CAP/DA service rules if they meet the worker rules and the service is approved. The same is true for some live-in caregivers.

NC Medicaid policy defines a paid live-in caregiver as someone who lives in the same household as the waiver participant and is hired and paid by an in-home aide agency, home health agency, or through consumer direction to help with daily living tasks.

Paid live-in status may need proof of the shared address. Ask what documents the agency or financial manager needs.

What if the person is a veteran?

Check VA routes before you stop at Medicaid. The VA has several paths that may help a family caregiver.

VA Aid and Attendance

VA Aid and Attendance can add money to a VA pension for a qualified veteran or survivor who needs help with daily activities or is housebound. It does not pay the caregiver directly. The payment goes to the veteran or survivor.

The VA usually needs medical information. VA Form 21-2680 is the Aid and Attendance medical exam form.

PCAFC

PCAFC is the VA family caregiver stipend program. The caregiver must be at least 18. The veteran must meet VA rules, including VA health care enrollment, a VA disability rating of 70% or higher, and a need for at least 6 months of in-person personal care services.

Only an approved Primary Family Caregiver gets the monthly stipend. Secondary caregivers may get some supports, but not the stipend.

Veteran Directed Care

Veteran Directed Care, or VDC, can let some veterans manage a service budget and hire workers. Those workers may include family members, friends, or neighbors. It must be offered through the local VA medical center or partner agency.

For more detail, see VA Aid and Attendance.

Common reasons for delay or denial

• The person does not yet have the right Medicaid category.
• The person is not in NC Medicaid Direct, which CAP/DA requires.
• The assessment does not show a nursing-home level of care.
• The file does not show enough help with ADLs or safety needs.
• The person needs services, but not a CAP/DA waiver slot.
• The family caregiver is also the representative, guardian, or decision-maker and the rule blocks payment.
• The worker has not passed background or registry checks.
• The county does not have a Home Care Independence provider.
• A doctor, agency, or plan did not send records.
• The request used the wrong program name.

If you are told no

Ask for the reason in writing. A phone answer is not enough when Medicaid services are denied, reduced, stopped, or delayed.

If you get a written denial, read the appeal deadline right away. The notice should tell you how to appeal. If services are being cut, ask whether you must appeal quickly to keep services during the appeal.

What to say

“Please send the denial or decision notice in writing. Please tell me the appeal deadline, what rule was used, what records were missing, and who can help me file the appeal.”

Who may help

• The county DSS caseworker listed on the notice
• The Medicaid health plan, if the person has one
• The CAP/DA case manager or case management entity
• The NC Medicaid Ombudsman if the person has Medicaid and cannot solve the issue with the plan or provider
• Legal Aid of North Carolina or another qualified legal help source if the issue is serious

Do not give up after one phone call. Ask for the exact program rule and the next step.

Other money and work issues to check

Caregiver pay may affect taxes, benefits, Medicaid eligibility, and household income. Keep pay records, timesheets, and tax forms.

Do not count on a state paid leave check as the caregiver-pay route. Some workers may have unpaid job-protected leave under FMLA or paid leave through an employer. Ask your employer before you quit or cut hours.

Use these next if money is tight:

• Caregiver tax deductions
• Care cost calculator
• Caregiver checklists