Can a Family Member Get Paid to Be a Caregiver in Arizona?

Yes, a family member can get paid to be a caregiver in Arizona. The main route is the Arizona Long Term Care System (ALTCS), the state’s Medicaid long-term care program, which lets an eligible person hire a relative to provide care at home instead of entering a nursing facility. Veterans’ families have separate federal options through the VA. Pay typically starts near Arizona’s 2026 minimum wage of $15.15 per hour, and the rules differ depending on which family member is providing care and who is receiving it.¹

The Two ALTCS Pathways That Pay Relatives

ALTCS, administered by the Arizona Health Care Cost Containment System (AHCCCS), funds two service models that let the care recipient hire a family member directly.

Self-Directed Attendant Care (SDAC) puts the care recipient in charge. They choose the caregiver, set the schedule, and direct the daily work. A Fiscal Employer Agent runs payroll, tax withholding, and paychecks, so the family does not have to manage that side.² Legally, the care recipient is the employer and the family member is their employee.

Agency with Choice is a co-employment model. The family still selects the caregiver and manages day-to-day care, but a home care agency shares the employer role and handles scheduling, compliance, and payroll. It suits families who want control over who provides care without the paperwork burden.

Both models cover attendant care, homemaker services, and personal care tasks like bathing, dressing, and eating.

Does the Person Needing Care Qualify for ALTCS?

No family member gets paid until the care recipient is approved. ALTCS has two eligibility gates, and both must be met.

Financial Eligibility

In 2026, a single applicant’s gross monthly income must be at or below $2,982, and countable assets must be $2,000 or less.³ The primary home, one vehicle, and prepaid irrevocable funeral and burial expenses do not count toward the asset limit. Married couples get additional spousal protections so the healthy spouse is not impoverished.

The $2,000 asset ceiling is low, and many families need to spend down excess assets before applying. Legitimate spend-down options include home modifications like ramps and roll-in showers, vehicle adaptations, prepaying funeral costs, and paying off debt. Gifting assets or selling them below fair market value will not work; Arizona enforces a look-back period and will delay eligibility. Keep receipts.

If income is over the limit, the applicant is not automatically disqualified. Arizona permits a Qualified Income Trust (sometimes called a Miller Trust) that captures excess income and directs it toward care costs.³

Approved members often owe a share of cost, which is a portion of care expenses the member pays from their own income after allowable deductions.⁴ That share effectively reduces the amount the state pays toward the family caregiver’s wages.

Medical Eligibility

After financial approval, a medical assessor conducts a Pre-Admission Screening interview with the applicant and any current caregivers and reviews medical records. For an elderly or physically disabled applicant, a score of 60 or more indicates immediate risk of institutionalization and meets the medical threshold.⁵ The person does not have to actually live in a nursing facility, only to need that level of care.

Which Family Members Can Be Paid

Being a relative is not enough on its own. Every paid caregiver in Arizona must:

Be of legal working age and authorized to work in the United States.
Pass a criminal background check before providing paid care.
Complete Arizona’s Principles of Caregiving training, including Level I Fundamentals and the appropriate Level II course, with competency tests.⁶
Hold current First Aid and CPR certification. Combined courses generally run about $70 to $125.

Spouses

Spouses are not flatly excluded, but they cannot simply be hired through SDAC. Under Arizona’s Section 1115 Waiver, a spouse can be paid if they work through a provider that subcontracts with the member’s ALTCS Program Contractor. For members with developmental disabilities, a spouse can alternatively register with AHCCCS as an independent provider. The spouse must meet the same training requirements as any other caregiver.⁷

Legal Guardians

Under the Agency with Choice model through the Division of Developmental Disabilities, the Individual Representative, including a legal guardian, cannot be the member’s paid caregiver.⁸ Families in that situation should ask the ALTCS case manager about alternative service models.

What Family Caregivers Actually Earn

Under SDAC, pay is typically at or near Arizona’s 2026 minimum wage of $15.15 per hour.¹ When care runs through an agency, ALTCS reimburses the agency at $25 to $35 per hour, but agencies typically pass along $14 to $18 per hour to the caregiver and keep the rest for overhead. Self-direction usually leaves more money in the caregiver’s hands because no agency takes a cut.

For adult care recipients, there is no weekly hour cap on paid family care. Authorized hours come from the care plan the ALTCS case manager builds around the member’s assessed needs. The share of cost, if any, reduces the total state payment accordingly.

Parents Paid to Care for a Minor Child

Arizona’s Parents as Paid Caregivers (PPCG) program began as a pandemic measure and became permanent in February 2024 when CMS approved it under the state’s 1115 Demonstration Waiver.⁹ It allows a parent to provide attendant care, personal care, homemaker, and habilitation services to their disabled minor child, but only for “extraordinary care” that goes beyond typical parenting.

Specific rules apply:

A parent cannot be paid for more than 40 hours per child per week. If both parents provide paid care for the same child, their combined hours cannot exceed 40.
Each parent must work through only one agency, and two parents caring for the same child must use the same agency.
A “parent” is someone with formal physical or legal custody, including a legal guardian. Step-parents do not qualify unless they have legally adopted the child.
Parents must meet all Direct Care Worker requirements, including Level I competency testing, and comply with Electronic Visit Verification.

The 40-hour cap applies only to this program. Family caregivers of adult children face no equivalent weekly limit.⁹

Taxes: Two Breaks Most Families Miss

IRS Notice 2014-7 lets caregivers who live in the same home as the person they care for exclude their Medicaid waiver payments from federal income tax entirely. The IRS treats these as “difficulty of care” payments under Section 131, and the exclusion applies whether or not the caregiver is related.¹⁰ The eligible individual must live in the caregiver’s home. A relative who visits to provide care but lives separately does not qualify for the exclusion.

Separately, when the care recipient is the employer (as under SDAC), employment taxes may not apply to certain family relationships. The employer does not owe Social Security and Medicare taxes when the caregiver is their spouse, their child under 21, or their parent, with limited exceptions. Wages still get reported on a W-2.¹¹ A live-in adult child caring for a parent through SDAC can potentially owe no federal income tax and no FICA on the caregiver pay.

VA Programs for Veterans’ Families

Veterans have federal options outside ALTCS. Some can be combined with state benefits, and none require Medicaid eligibility.

Veteran Directed Care

This program gives veterans of any age a flexible budget to manage their own home care. The veteran can hire a family member or neighbor, set the schedule, and direct how the budget is spent.¹² It requires enrollment in VA health care and a clinical determination that the veteran needs home and community-based services. There is no separate application beyond the clinical assessment.

Program of Comprehensive Assistance for Family Caregivers

PCAFC pays a monthly stipend directly to a family caregiver based on the veteran’s care needs. Eligibility is tighter: the veteran must have a service-connected disability rated at 70% or more (individually or combined) and need in-person personal care for at least six continuous months, and the injury must have been incurred or aggravated during active military service.¹³ Approved caregivers also receive CHAMPVA health insurance, mental health counseling, and respite care.

Aid and Attendance Pension

Veterans who qualify for a VA pension and need regular help with daily activities can receive an enhanced pension through the Aid and Attendance benefit. The 2026 maximum annual rate is $29,093 for a veteran with no dependents and $34,488 for a veteran with at least one dependent.¹⁴ The money goes to the veteran, who may use it to pay a family member. Spouses and dependent children cannot be paid caregivers through this benefit.

If ALTCS and the VA Don’t Fit

Private options exist, but they draw on private funds. Some long-term care insurance policies pay family caregivers; coverage terms vary and the policy may require specific certifications or a doctor’s statement of need. A personal care agreement is a private contract between the care recipient and the family caregiver that documents duties, hours, and pay. It formalizes the arrangement and, if the care recipient later applies for ALTCS, shows that payments were compensation for services rather than gifts, which matters because gifts trigger look-back penalties.

How to Start

The application starts with the person who needs care, not the family caregiver. Apply through the Health-e-Arizona Plus online portal or call ALTCS at (888) 621-6880. Another person can act on the applicant’s behalf.³ Expect to submit bank statements, income records, and proof of assets, and to complete a financial interview in person or by phone. The Pre-Admission Screening follows financial approval.¹⁵

Once ALTCS approves the care recipient, they pick SDAC or Agency with Choice. Under SDAC, the family caregiver enrolls with the Fiscal Employer Agent, submits timesheets, and receives paychecks through that agent.² From that point, the paid caregiving arrangement is underway.

1
Industrial Commission of Arizona. New 2026 Minimum Wage
2
AHCCCS. Self Directed Attendant Care (SDAC)
3
AHCCCS. Filing an Application for the Arizona Long Term Care System (ALTCS)
4
AHCCCS. Calculating the Amount You Must Pay For Your Medical Services
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AHCCCS. 1003 Preadmission Screening Criteria for an Applicant or Member who is Elderly or Physically Disabled (EPD)
6
AHCCCS. Training and Testing Info
7
Cornell Law Institute. Ariz. Admin. Code R9-28-506 – Requirements for Spouse as Paid Caregiver
8
Arizona Department of Economic Security. DDD-1658A – Agency with Choice Individual Representative
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AHCCCS. Parents as Paid Caregivers of Minor Children – Frequently Asked Questions
10
Internal Revenue Service. Notice 2014-7 – Treatment of Qualified Medicaid Waiver Payments Under Section 131
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Internal Revenue Service. Family Caregivers and Self-Employment Tax
12
VA.gov. Veteran-Directed Care
13
Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Eligibility Criteria Fact Sheet
14
VA.gov. Current Pension Rates For Veterans
15
AHCCCS. 1303 ALTCS Application Process