How to Get Paid as a Family Caregiver in Mississippi

You can get paid as a family caregiver in Mississippi through one of two main programs: a Mississippi Medicaid Home and Community-Based Services waiver (the Elderly and Disabled Waiver or the Independent Living Waiver) or, for veterans, the federal Veteran Directed Care program. Each has its own rules about which relatives qualify, what the person receiving care must show, and how payment is set up. The Medicaid path is stricter about family relationships; the VA path is more flexible about who can be hired.

Which Relatives Can Actually Be Paid

Start here, because this is where most families discover they don’t qualify the way they expected. Mississippi Medicaid waivers pay only “non-legally responsible relatives.” That means a relative by blood or marriage who is not the recipient’s legal guardian or legal representative.

The following people cannot be paid under the Elderly and Disabled Waiver:

A spouse of the person receiving care
A parent or stepparent of a minor child receiving care
A legal guardian, conservator, or representative payee for the recipient
Anyone holding power of attorney for the recipient
Anyone living in the same home as the recipient, for Home and Community Support and In-Home Respite services, regardless of relationship

An adult child, sibling, niece, or nephew who does not live with the recipient and is not their legal guardian generally can be paid. One more catch: if you were already providing the same care for free before your family member enrolled in the waiver, Medicaid will not start reimbursing you for that same task unless circumstances have changed and the service is newly documented in the care plan.

The Veteran Directed Care program is different. Spouses and adult children can be hired under a veteran’s budget, which is why many veteran families use this route when Medicaid rules would shut them out.¹

The Elderly and Disabled Waiver

The Elderly and Disabled Waiver is the primary paid-caregiver route for most Mississippi families. The name is misleading: the recipient does not need to be elderly. The program is open to anyone 21 or older who requires a nursing facility level of care as determined by a long-term services and supports assessment.² That assessment looks at whether the person needs hands-on help with daily activities like eating, bathing, dressing, and moving around.

The waiver uses a self-directed model. The recipient (or a designated representative) chooses the caregiver, sets the schedule, and supervises the work.³ Case management runs through local Planning and Development Districts, where a registered nurse and a licensed social worker coordinate the assessment and care plan.⁴

The family caregiver must sign a written agreement to follow the care plan and can only be paid for hours worked during the designated service window. The recipient or their representative has to sign off verifying the work was actually performed.³ The Division of Medicaid can remove a selected relative from the provider role at any time for compliance issues.

In-Home Respite services are capped at 60 hours per month.⁵ Personal Care Services hours have no fixed statewide cap; they’re set by the clinical assessment of what the recipient needs.

A separate Independent Living Waiver covers a narrower group: people 16 or older with severe orthopedic or neurological impairments who have reached maximum medical improvement and can direct their own care.⁶ The same family-member restrictions apply.

The Veteran Directed Care Program

Veterans enrolled in VA healthcare who are at risk of nursing home placement can use a separate route that sits outside Medicaid. The Veteran Directed Care program is run jointly by the Veterans Health Administration and community aging and disability agencies, and veterans of any age can participate.¹

The veteran receives a monthly budget and decides how to spend it, including hiring caregivers and setting their wages. Spouses and adult children living with the veteran can be paid under this program, which is the main structural difference from the Medicaid waivers.

In Mississippi, the Southern Mississippi Planning and Development District acts as the VDC super hub for both the VA Gulf Coast Healthcare System in Biloxi and the Jackson VA Medical Center.⁷ An options counselor helps the veteran build a care plan and set caregiver wages within the approved budget.

What the Care Recipient Has to Qualify For

For a Medicaid waiver, the care recipient (not the caregiver) must meet Medicaid’s income and resource limits and pass the clinical assessment for a nursing facility level of care.

For 2026, the federal SSI benefit rate is $994 per month for an individual.⁸ Mississippi uses 300 percent of the SSI rate as the special income level for waiver-level care, which comes to $2,982 per month in countable income for 2026. The resource limit for an individual is $2,000. These numbers change each year, so confirm the current thresholds with the Division of Medicaid before you apply.

How to Apply

Applications go to the Mississippi Division of Medicaid or a regional Planning and Development District. After receiving the paperwork, the Division schedules an in-home clinical assessment with a registered nurse and a licensed social worker, who evaluate the recipient’s physical and cognitive needs.⁴ The assessment decides whether the person meets the nursing facility level of care and how many service hours are appropriate.

If approved, the Division sends a formal notice with the authorized services, approved hours, and start date. The caregiver then completes employment paperwork through a financial management service that handles payroll, tax withholding, and payments.

For the Veteran Directed Care program, start with the veteran’s VA primary care team, who refers the case to the local aging and disability agency.

Be prepared to wait. Mississippi’s HCBS waivers have historically operated with backlogs, and if slots are limited you may be placed on a waiting list even when the recipient clearly qualifies.

Background Check Requirements

Any paid caregiver under a Medicaid waiver must pass a criminal background check. A conviction, guilty plea, or no-contest plea for certain felonies is disqualifying. Those offenses include murder, manslaughter, armed robbery, rape, sexual battery, drug possession or sale, child abuse, arson, grand larceny, burglary, aggravated assault, felonious abuse of a vulnerable adult, identity theft, and sex offenses listed in Mississippi Code Section 45-33-23(g).⁹ The rule also includes a catch-all for any job-related felony. A conviction reversed on appeal or pardoned does not count.

Electronic Visit Verification

Federal law requires states to use Electronic Visit Verification for in-home personal care and respite services, and Mississippi enforces this for waiver caregivers.¹⁰ Every visit must be electronically logged with the service type, date, location, caregiver name, recipient name, and start and end times.

Mississippi uses a mobile app that caregivers install on their phones. The app records clock-in and clock-out times with GPS coordinates and has an offline mode that stores records until the phone is back in cell range. If the app isn’t workable, the caregiver can call an automated telephone system from the recipient’s home phone to log the visit. Visits not recorded through EVV can go unpaid, so build the habit from your first shift.

What Family Caregivers Get Paid

Mississippi Medicaid sets reimbursement for personal care services through the Division of Medicaid’s fee schedule, published on the provider portal, rather than through a single easily accessible statewide hourly rate. Nationally, Medicaid personal care rates typically fall between $12 and $20 per hour, and Mississippi tends toward the lower end. What lands in your pocket depends on the service code, approved hours, and the financial management service’s administrative fees.

For Veteran Directed Care, the pay comes out of the veteran’s approved monthly budget. The veteran and options counselor set the caregiver’s hourly wage within that budget, which gives more control over compensation than the Medicaid fee schedule.

Taxes on Caregiver Pay

Paid caregiving is taxable work, but a significant federal exception can apply. Under IRS Notice 2014-7, Medicaid waiver payments may be excluded from the caregiver’s gross income if the caregiver lives with the care recipient and that shared home is the caregiver’s primary residence.¹¹ The IRS defines primary residence as the place where you regularly carry on the routines of your private life. If you keep a separate home and only stay at the recipient’s house during shifts, the exclusion doesn’t apply.

When it does apply, federal income tax should not be withheld from those payments. The payments may still be subject to Social Security and Medicare taxes unless another exemption applies.

Household employment taxes are a separate matter. For 2026, if a household employer pays a caregiver $3,000 or more in cash wages during the year, the employer owes Social Security and Medicare taxes. If total household wages reach $1,000 in any calendar quarter, federal unemployment tax also applies.¹² If the caregiver is the employer’s spouse or child under 21, employment taxes may not be owed, though the wages still need to be reported on a W-2.¹³ In most consumer-directed setups in Mississippi, the program’s financial management service handles withholding and reporting for you.

If You’re Denied

A denial isn’t final. The applicant or beneficiary has 30 days from the postmark date of the denial notice to request a local or state hearing.¹⁴ That deadline can be extended for good cause, but the Division of Medicaid decides whether your reason qualifies. If it doesn’t, the hearing request is rejected.

Denials usually come from a clinical finding that the recipient doesn’t need a nursing facility level of care, income or resources over the limits, or incomplete paperwork. If the problem is missing documents, you can often resubmit a full application rather than appealing. For clinical denials, the hearing is your chance to put additional medical evidence of the recipient’s actual needs in front of the decision-maker.

1
Administration for Community Living (ACL). Veteran-Directed Care Program
2
Cornell Law School. 23 Miss Code R 208-1.2 – Beneficiary Eligibility
3
Mississippi Division of Medicaid. Administrative Code Title 23 Part 208 – HCBS Long Term Care
4
Mississippi Division of Medicaid. Elderly and Disabled Waiver
5
Mississippi Secretary of State. Home and Community-Based Services (HCBS) Elderly and Disabled Waiver
6
Cornell Law School. 32 Miss Code R 1-10.0 – Independent Living Waiver Eligibility
7
Administration for Community Living (ACL). VDC Super Hub Fact Sheet
8
Social Security Administration. SSI Federal Payment Amounts for 2026
9
Cornell Law School. 15 Miss Code R 16-1-43.3.2 – Criminal History Record Checks
10
Mississippi Division of Medicaid. EVV for Members/Caregivers
11
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
12
Internal Revenue Service. Publication 926 (2026) – Household Employer’s Tax Guide
13
Internal Revenue Service. Family Caregivers and Self-Employment Tax
14
Cornell Law School. 23 Miss Code R 300-2.8 – Time Limit for Filing a Hearing Request