Can a Spouse Get Paid for Taking Care of a Disabled Spouse?

A debilitating injury or illness is life-changing. Families seek comfortable, convenient ways to get needed care for the disabled person, and daily assistance from a spouse may be the best way to achieve this.

In some cases, a spouse may be paid for taking care of a disabled spouse. In this guide, we'll outline the important limitations and restrictions you need to know.

Can a Husband Be a Caregiver for His Wife?

Some programs pay a person to care for their disabled husband or wife. However, the availability of these programs depends on many factors, including: 

• Geographic region and state of residence
• The couple's income level
• Assets
• Types of insurance held by the disabled person
• Whether the disabled spouse is a veteran

Unfortunately, these programs are limited and not available to all couples. 

Medicaid and State Programs

Medicaid is a federally mandated program administered by the states. Each state can decide many of its own rules, including whether to pay people to care for disabled partners. 

There are three main types of state programs that may pay a person to care for their spouse: 

• Medicaid Home and Community Based Services (HCBS) Waivers 
• Medicaid personal care programs 
• State programs not associated with Medicaid, such as Oregon's Family Caregiver Program

Medicaid HCBS Waivers allow a beneficiary to apply for in-home care instead of being cared for in an institution. Most states also pay for in-home care through personal care or attendant programs. However, not all states will pay a spouse as the caregiver.

Some states allow self-directed services, also called consumer direction of services. Beneficiaries in these states have more control over the services they receive and may be able to select their spouse as a care provider. 

Who Qualifies for Medicaid Based Spousal Pay

For a spouse to become a paid caregiver, the couple must reside in a state where spousal caregivers are allowed under Medicaid guidelines. The spouse must also meet the state's requirements for caregivers.

The beneficiary must meet requirements for Medicaid in their state, which can include:

• Income limits
• Asset limits 
• Disability or chronic illness if required by the state of residence 

Some states have imposed additional limits on who qualifies for in-home care and may only cover these services for beneficiaries with specific conditions, such as HIV or Parkinson's disease. Couples should check their state's Medicaid guidelines to determine if a spouse can be paid for taking care of a disabled spouse. 

Caring for a Disabled Veteran Spouse 

There are two VA programs that may pay the spouse of a disabled veteran for care:

• Veterans Directed Home and Community Based Services (VD-HCBS)
• VA Caregiver Support 

However, the following VA programs don't offer any pay for caregiver spouses: 

• Aid and Attendance
• Housebound
• Basic Pensions 

These VA programs calculate income for the veteran based on the household income, so paying the spouse as a caregiver would offset the benefit. 

Veterans Directed Home and Community Based Services 

The VD-HCBS program allows veterans to manage their care and choose certain providers. The program can vary by state and may not be available everywhere. Additionally, not all veterans are eligible for these benefits. A local VA office can help veterans determine whether they qualify for this program. 

VA Caregiver Support

This program is also known as the Program of Comprehensive Assistance for Family Caregivers. To qualify, a veteran must: 

• Have been injured in duty on or after September 11, 2001, or before May 7, 1975 
• Have a disability rating of at least 70% 
• Require help with daily activities and need assistance on a daily basis 

 This program will pay a stipend to the spouse of a qualifying veteran. 

Will Disability Pay for a Caregiver? 

Neither Social Security Disability Insurance (SSDI) nor Supplemental Security Income (SSI) will pay for a caregiver. Both programs may provide an increased benefit to married couples, but the benefit isn't related to whether the spouse provides caregiving services to the disabled person. 

Private long-term care insurance may pay a spouse for caregiving if the policyholder becomes disabled. Whether this is an option depends on the terms of the policy. Some policies require the spouse to be licensed or registered as a non-medical home care provider with their state. 

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Other Sources of Support

There are other sources and programs people often look to when they become sick or disabled. Most of these don't pay a spouse for caregiving services but may help the family in other ways. 

Life Insurance 

Some life insurance policies pay a benefit during life if the policyholder becomes disabled or terminally ill. The benefit may include paying for a spouse or another person to provide care. 

Paid Family Leave Laws 

Paid family leave laws allow a person to temporarily take time off work to care for a spouse while still collecting a percentage of their salary. Currently, only six locations have these laws: 

• Washington D.C.
• New Jersey 
• Rhode Island 
• New York
• California 
• Washington State 

The Family Medical Leave Act (FMLA), a federal law, protects a person's job and health insurance if they take time off to care for a family member. However, it does not ensure any pay for the person taking time away from work and only applies to those working for larger employers. 

Will Medicare Pay a Spouse to Care for Their Disabled Husband or Wife?

Medicare won't pay a person to care for their elderly or disabled spouse. Although Medicare may pay a person who is a medical professional to provide medical care for their spouse, the program doesn't pay spouses to provide personal care or assist with daily living needs. 

Medicare may pay for a non-spouse caregiver for housebound beneficiaries who also require home health services, such as skilled nursing care or physical therapy.