What the research says about paying family caregivers
Last checked 2026-10-15.
Every state that answered KFF's 2024 survey pays family or friends as caregivers through at least one Medicaid waiver; 40 states allow paying legally responsible relatives (such as spouses) through waivers, but only 6 through the state plan.
Source: KFF, How do Medicaid Home Care Programs Support Family Caregivers? (2024 survey; FL, IN, UT did not respond)KFF's 2025 update describes Medicaid's paid caregiving, self-direction, respite and training supports before most provisions of the 2025 reconciliation law take effect.
Source: KFF, Medicaid's Home Care Support for Family Caregivers in 2025 (Jan 5, 2026)In KFF focus groups, family caregivers paid by Medicaid said payments were lower than their earnings from other work, and some caregivers did not know payment was an option.
Source: KFF, Experiences of Direct Care Workers and Family Caregivers of HCBSAbout 38 million family caregivers provided 36 billion hours of unpaid care in 2021, worth an estimated $600 billion (about 18 hours a week at $16.59/hour).
Source: AARP Public Policy Institute, Valuing the Invaluable: 2023 Update (press release, Mar 8, 2023)In the randomized Cash and Counseling evaluation (Arkansas, Florida, New Jersey), people who could direct their own care budget, often hiring relatives, had fewer unmet care needs and were more satisfied with their care, without more adverse health outcomes.
Source: Carlson, Foster, Dale & Brown, Effects of Cash and Counseling on Personal Care and Well-Being, Health Services Research (2007)Of 58 Medicaid waivers serving older adults, 54 included some provision to pay family or friends.
Source: ADvancing States, Advancing Equity for Older Adults without Family Caregivers (Nov 2024)Indiana Structured Family Caregiving served over 4,300 families (2024 provider presentation); daily rates were $77.54 / $99.71 / $131.44 by level, and stipends are generally non-taxable under IRS Section 131.
Source: The Arc of Indiana, Introduction to Structured Family Caregiving (Apr 2024)