Can a Family Member Get Paid to Be a Caregiver in New York?

In New York, you can be paid to care for a family member, most often through a Medicaid program called the Consumer Directed Personal Assistance Program, or CDPAP. The program lets a Medicaid-eligible New Yorker choose their own personal assistant, and that assistant can be an adult child, a sibling, a grandchild, a cousin, or most other relatives. A few relationships are off-limits, and both the person receiving care and the caregiver have to meet specific requirements before the paychecks start.

Which Relatives Can Be Paid, and Which Cannot

Most family members qualify. Adult children caring for a parent, parents caring for a child who is 21 or older, siblings, grandchildren, nieces, nephews, and cousins can all be hired and paid through CDPAP.¹ Living in the same house as the person you care for does not disqualify you. The Department of Health has confirmed that a relative sharing the home can still be hired as the paid personal assistant.²

Three relationships are excluded:

A spouse cannot be the paid caregiver for their husband or wife.
A parent cannot be the paid caregiver for their own child under 21.³
The person officially directing the care (the designated representative) cannot also be the paid assistant.

Beyond those rules, a caregiver must be at least 18, legally authorized to work in the United States, and able to pass a pre-employment health screening.

What the Care Recipient Must Qualify For

CDPAP has two eligibility gates. The person receiving care must be enrolled in New York Medicaid, and they must have a documented medical need for help with daily activities.

Medicaid

The care recipient must be a New York State resident on Medicaid.¹ For applicants who are 65 or older, blind, or disabled, Medicaid has both income and asset limits, updated each January. In 2026, the resource limit for a single individual in this category is $33,038.⁴ Income limits differ by household size and by whether the applicant is seeking community-based Medicaid (which covers home care) or institutional Medicaid.

If income runs slightly over the limit, a pooled income trust can bring countable income back within range. Money deposited into a qualifying pooled trust each month is not counted for Medicaid purposes, and the trust pays the person’s bills directly.⁵ Trusts charge enrollment and monthly administrative fees that vary by organization.

Medical Need

The care recipient must have a chronic illness, physical disability, or similar condition that creates a need for help with tasks like bathing, dressing, eating, or moving around. A physician’s order is required. For adults 18 and older, the New York Independent Assessor (NYIA) performs a Community Health Assessment that confirms the level of care needed and recommends how many service hours to authorize.⁶ Those authorized hours are the cap on how much the family caregiver can work and earn.

The care recipient also has to be able to direct their own care, meaning they can tell the caregiver what to do and how. If cognitive impairment or another condition makes that impossible, a designated representative such as a legal guardian or family member takes on the management role instead.

How Much a Family Caregiver Earns

CDPAP personal assistants are paid hourly and must earn at least New York’s minimum wage. As of January 2026, that is $17.00 per hour in New York City, Long Island, and Westchester County, and $16.00 per hour in the rest of the state.⁷ Actual rates can run somewhat higher depending on the region and the fiscal intermediary’s pay schedule.

Monthly income depends entirely on the number of hours the NYIA assessment authorizes. A person approved for 40 hours per week produces far more caregiver income than one approved for 12. Working past the authorized hour cap is not an option; increasing hours requires a reassessment.

Because CDPAP is funded by Medicaid, the care recipient pays nothing. Wages, payroll taxes, and workers’ compensation are handled by the program’s fiscal intermediary.

How to Enroll

Enrollment involves both the care recipient and the caregiver, and it can take several weeks. The general sequence:

Confirm Medicaid coverage. If the care recipient is not already enrolled, apply through the local Department of Social Services or through a Managed Long-Term Care plan.
Request a Community Health Assessment by calling the New York Independent Assessor Program at 1-855-222-8350. The assessor decides whether home care is needed and how many hours to authorize.⁶
Register with Public Partnerships LLC (PPL), the statewide fiscal intermediary for CDPAP. The care recipient signs up first and must have a valid service authorization before the caregiver can register.¹
Create a PPL@Home account as the caregiver and submit the required documents: an offer letter, a Personal Assistant Agreement, IRS Form W-4, New York withholding form IT-2104-I, the federal I-9 with supporting ID, a payment method form, and a health assessment. PPL uses Mobile Health for the required medical screening.⁸
Download the Time4Care app and complete Electronic Visit Verification (EVV) training. EVV is required for all Medicaid-funded personal care hours in New York.⁹

Taxes on Caregiver Pay

The paycheck is taxable income by default, but a federal rule can shield much of it when the caregiver and care recipient share a home.

The Live-In Exclusion

IRS Notice 2014-7 treats certain Medicaid waiver payments as “difficulty of care” payments that can be excluded from gross income under Section 131 of the Internal Revenue Code. The exclusion applies only when the care recipient lives in the caregiver’s home.¹⁰ Payments for care provided outside the caregiver’s home do not qualify.¹¹ The exclusion applies whether the caregiver is a family member or not.

Payments excluded from gross income can still count as earned income when claiming the Earned Income Tax Credit. For lower-income caregivers with little other reportable income, that can be a meaningful benefit.

When the Exclusion Does Not Apply

If the care recipient does not live in the caregiver’s home, wages are fully taxable. PPL withholds federal and state income tax, Social Security (6.2%), and Medicare (1.45%) from each paycheck. In 2026, household employers generally must withhold Social Security and Medicare taxes once cash wages to a household worker reach $3,000 in a year.¹²

Some family relationships carry FICA exemptions. Wages paid to your child under 21 for domestic work, or to your parent under certain conditions involving a dependent child in the home, are generally exempt from Social Security and Medicare taxes.¹³ Because CDPAP payroll runs through PPL rather than directly through the care recipient, whether these exemptions get applied depends on how PPL handles the withholding. Confirm your status with PPL if a family exemption might fit your situation.

Keeping the Job: Reassessments and Timekeeping

Care authorizations last no more than six months. Before each one expires, the Managed Care Organization starts a fresh assessment to decide whether services should continue and whether the authorized hours should stay the same, increase, or decrease.¹⁴ If the care recipient’s condition changes between reassessments, notify the Managed Care Organization or local district promptly. Reductions or denials come with a formal notice of action and the right to appeal.

Caregivers log every shift through the Time4Care app for Electronic Visit Verification, a federal requirement under the 21st Century Cures Act.⁹ Missed or sloppy clock-ins delay paychecks and cause compliance problems. Build the habit early.

Other Ways to Get Paid for Family Caregiving

CDPAP is the most widely used route in New York, but a few alternatives exist.

Veterans Affairs Programs

If the person needing care is a veteran, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to an eligible primary family caregiver. The amount is based on the General Schedule pay rate for a GS-4, step 1 federal employee in the veteran’s geographic area, divided by 12. Caregivers at the lower tier receive 62.5% of that monthly figure; caregivers for veterans who cannot live independently receive the full amount.¹⁵ Depending on locality, that works out to roughly $1,500 to $3,000 per month. The VA also runs a Veteran Directed Home and Community Based Care program, which gives veterans a budget to hire their own caregivers on a model similar to CDPAP.

Long-Term Care Insurance

Some private long-term care insurance policies cover care provided by family members, and many do not. Policies that distinguish between formal caregivers (licensed agency staff) and informal caregivers (friends and relatives) may only pay for formal care. When family care is covered, the payment usually comes as a cash benefit to the policyholder, who then pays the caregiver. Whether that money is tax-free depends on whether the policy is tax-qualified under federal rules. The policy language, or a call to the insurer, is the only way to know.

1
New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP)
2
New York State Department of Health. Clarification to the New Law in Relation to the Consumer Directed Personal Assistance Program
3
New York State Department of Health. Clarification to the New Law in Relation to the Consumer Directed Personal Assistance Program
4
NYC.gov. 2026 NYS Income and Resources Standards and Federal Poverty Levels
5
New York State Department of Health. Explanation of the Effect of Trusts on Medicaid Eligibility
6
New York State Department of Health. New York Independent Assessor Process Overview for Initial Assessments for Immediate Need
7
NY.gov. New York State’s Minimum Wage
8
PPL. NY Consumer Directed Personal Assistance Program (CDPAP)
9
New York State Department of Health. NY Medicaid Electronic Visit Verification (EVV)
10
Internal Revenue Service. Internal Revenue Bulletin 2014-4 – Notice 2014-7
11
Internal Revenue Service. Notice 2014-7 – Treatment of Qualified Medicaid Waiver Payments Under Section 131
12
Internal Revenue Service. Employment Taxes for Household Employees
13
Internal Revenue Service. Family Employees
14
New York State Department of Health. Guidelines for Consumer Directed Personal Assistance Services
15
Department of Veterans Affairs. The Program of Comprehensive Assistance for Family Caregivers