Can a Spouse Be Paid as a Caregiver in New York?

No. A spouse cannot be paid as a caregiver in New York under the Consumer Directed Personal Assistance Program (CDPAP), the state’s main Medicaid-funded path for hiring a family member to provide home care. Section 365-f of New York’s Social Services Law defines who can serve as a paid “personal assistant” and specifically excludes the consumer’s spouse from that role.¹ The bar applies no matter how many hours of care the spouse actually provides, and there is no waiver or appeal process inside CDPAP that overrides it. Other relatives can be paid, and a spouse still has options outside CDPAP.

What the Statute Says

The exclusion is written into the program’s founding statute rather than a regulation or agency policy, which is why it cannot be waived. Section 365-f bars three categories of people from being paid as a personal assistant:

The consumer’s spouse.
The consumer’s designated representative, meaning the person chosen to manage care decisions when the consumer cannot self-direct.
A legally responsible parent of a CDPAP consumer under age 21.²

The reasoning behind these exclusions is that spouses and legally responsible parents already have a duty of care toward the family member. Medicaid pays for services the individual would otherwise lack, not for care that a family member is already legally obligated to provide.

What Role a Spouse Can Play

While a spouse cannot be the paid personal assistant, a spouse can serve as the consumer’s designated representative. In that role, the spouse handles hiring, training, and supervising whoever does provide the hands-on care. The designated representative role is unpaid, but it gives the spouse full control over the arrangement.³ One person cannot fill both roles at once, so a spouse acting as designated representative has to accept that the paid caregiver will be someone else.

Family Members Who Can Be Paid Through CDPAP

CDPAP flips the usual home care model. Rather than an agency assigning an aide, the consumer picks their own caregiver, trains them, and directs the care. That caregiver, called a personal assistant, does not need a license or certification, and can be almost any adult in the consumer’s life. The requirements for the caregiver are that they be at least 18, legally authorized to work in the United States, and not the consumer’s spouse or designated representative.²

That leaves a wide field. An adult child, grandchild, sibling, cousin, niece, nephew, or close friend can all be hired and paid through CDPAP. For a married couple, this often means an adult child steps into the paid role while the well spouse handles day-to-day management. Payroll runs through Public Partnerships LLC (PPL), which as of 2025 is the sole Statewide Fiscal Intermediary for CDPAP across New York and handles wages, tax withholdings, and employment records for every personal assistant in the program.⁴

Paid Caregiving Options for Spouses Outside CDPAP

The CDPAP bar does not extend to every program. Two pathways can compensate a caregiving spouse depending on the couple’s circumstances.

VA Program of Comprehensive Assistance for Family Caregivers

If the person needing care is a veteran with a serious service-connected disability, the spouse can be paid through the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC). This program explicitly allows spouses to serve as primary family caregivers.⁵

Eligibility requires the veteran to have a service-connected disability rated at 70 percent or higher (individually or combined) and to need at least six continuous months of in-person personal care services. The caregiver must be at least 18 and complete VA caregiver training, and there must be no finding of abuse or neglect.⁵

The primary family caregiver receives a monthly stipend based on the federal pay scale. The VA takes the annual GS-4, Step 1 salary for the veteran’s geographic area, divides it by 12, and multiplies by either 62.5 percent (Tier 1) or 100 percent (Tier 2, for veterans unable to sustain themselves in the community).⁶ The primary caregiver may also qualify for health insurance through CHAMPVA if they lack other coverage, mental health counseling, and at least 30 days per year of respite care for the veteran.⁷

Private Personal Care Agreements

Outside of any government program, families sometimes use a written personal care agreement, also called a caregiver contract, to compensate a caregiving spouse from the couple’s own funds. These agreements establish a fair market rate for the services provided and create a documented record of payments. Done correctly with an elder law attorney, payments can be structured as compensation for services rendered rather than transfers of assets, which matters because Medicaid penalizes asset transfers made within a lookback period before an application. To withstand Medicaid scrutiny, the agreement must be in writing, executed before services begin, and pay a reasonable market rate. A New York elder law attorney can draft one that fits the couple’s situation.

Financial Protections That Still Apply to the Spouse

Even if a spouse cannot be paid, federal and state rules protect the well spouse’s finances when the other spouse receives Medicaid-funded long-term care. These protections often matter more to a family’s bottom line than the caregiver question itself.

Spousal Impoverishment Rules

When one spouse enters Medicaid-funded care, the healthy spouse, called the community spouse, is not required to spend down every asset the couple owns. As of 2025 in New York, the community spouse can retain up to $157,920 in countable resources and a minimum monthly income allowance of $2,643.75.⁸ These figures are adjusted annually. If the couple’s resources exceed the community spouse’s protected share, the excess must be spent down before the ill spouse qualifies for Medicaid, but the protected share itself stays with the community spouse.

Estate Recovery Is Deferred During the Spouse’s Lifetime

Federal law requires New York to seek reimbursement from the estates of Medicaid recipients who were over 55 or permanently institutionalized. Recoverable costs include nursing facility services, home and community-based services, and related hospital and prescription drug costs.⁹

For married couples, recovery is deferred as long as the surviving spouse is alive. New York will not pursue a Medicaid claim against the estate while the spouse survives.¹⁰ Deferred is not forgiven, though. The state may review potential recovery from the surviving spouse’s own estate after they pass away. Recovery is also deferred when the recipient is survived by a child under 21 or a child of any age who is blind or disabled.⁹ An elder law attorney can help a couple map their exposure before filing a Medicaid application.

1
New York State Senate. New York Social Services Law 365-F – Consumer Directed Personal Assistance Program
2
New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP)
3
New York State Department of Health. Clarification to the New Law in Relation to the Consumer Directed Personal Assistance Program
4
New York State Department of Health. CDPAP Update
5
Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers Eligibility Criteria Fact Sheet
6
U.S. Department of Veterans Affairs. Monthly Caregiver Stipend Fact Sheet
7
U.S. Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers (PCAFC)
8
Medicaid.gov. Updated 2025 SSI and Spousal Impoverishment Standards
9
Medicaid.gov. Estate Recovery
10
New York State Office of the Medicaid Inspector General. Casualty and Estate Recovery