Can You Get Paid to Care for a Spouse in Indiana? 2026 Rules Explained

Caring for a husband or wife after a stroke, a diagnosis of dementia or a serious injury often becomes a full-time job. Many spouses cut back on work or stop working entirely. It is natural to ask whether there is any way to be paid for the care you already give.

Yes, you can get paid to care for a spouse in Indiana. The main route is Structured Family Caregiving (SFC), a Medicaid waiver service that pays a daily rate to a spouse who lives with and cares for their partner.

This guide explains how SFC works for spouses, why attendant care is usually not an option, which waivers apply, what veterans can use, and how to get started. Vital Home Care is a family-owned agency in Fishers that supports paid spouse caregivers across Indiana.

Can you get paid to care for a spouse in Indiana?

Yes, when your spouse qualifies for an Indiana Medicaid waiver and you live together.

Indiana treats spouses and parents of minor children as legally responsible individuals. Many states do not pay them to give care. Indiana allows it through SFC, and since 2026 it also allows attendant care in limited extraordinary care cases. Payment always goes through an approved agency, which then pays the caregiver.

How does Structured Family Caregiving work for spouses?

Your spouse receives SFC as a waiver service, and you are the principal caregiver who lives in the home and provides daily care.

• Your spouse needs a Medicaid waiver: PathWays for Aging for age 60 and older, or the Health and Wellness Waiver for 59 and younger. The Traumatic Brain Injury (TBI) waiver also offers SFC.
• Nursing facility level of care: your spouse must need the level of help that would otherwise qualify them for a nursing home.
• You live together: SFC is a live-in service.
• An approved agency: the agency enrolls you, provides training, a caregiver coach and nurse visits, and pays you.
• Background check: agencies screen caregivers before they start.

What does a spouse caregiver actually get paid?

The state sets an SFC daily rate in three levels based on how much care your spouse needs. The agency receives that rate and pays the caregiver a large share of it, keeping the rest to fund coaching, nursing support, training and respite. Rates have changed several times since 2024, so ask any agency for its current caregiver pay at each level before you sign up. We share current numbers during a free call.

Can a spouse be paid for attendant care?

Usually not. Indiana stopped paying spouses for attendant care in July 2024, with one narrow exception.

Since January 1, 2026, an extraordinary care allowance lets a spouse be paid for attendant care when their partner has intensive nursing needs, such as continuous ventilator care, tracheostomy care or total parenteral nutrition. Even then, all legally responsible caregivers together can be paid for no more than 40 hours a week, the care must go through an agency rather than self-direction, and behavioral needs alone do not qualify. FSSA’s guidance on paid family caregivers and the state’s 2026 provider bulletin describe these rules.

For most couples who want to get paid to care for a spouse in Indiana, this means SFC is the realistic choice. Our guide to Structured Family Caregiving vs attendant care compares both programs side by side.

Which waivers allow paid spouse caregiving?

Waiver	Who it serves	Spouse options
PathWays for Aging	Hoosiers 60 and older, through Anthem, Humana or UnitedHealthcare	SFC; attendant care only for extraordinary care
Health and Wellness	Hoosiers 59 and younger with disabilities or medical needs	SFC; attendant care only for extraordinary care
Traumatic Brain Injury (TBI)	People with a qualifying brain injury	SFC; attendant care only for extraordinary care

Each waiver has its own care manager or health plan, and the rules for legally responsible individuals have changed more than once. Always confirm your situation with your care manager or a waiver provider before you make work or money decisions.

Are there options for veteran spouses?

Yes. If your spouse is a veteran, VA programs may offer another way to get paid to care for a spouse in Indiana, separate from Medicaid.

• Program of Comprehensive Assistance for Family Caregivers (PCAFC): pays a monthly stipend to an approved family caregiver, who can be a spouse. The veteran generally needs a service-connected disability rating of 70 percent or higher and a need for at least six months of continuous, in-person personal care. See the VA’s PCAFC page for details.
• Aid and Attendance: an add-on to a VA pension for wartime veterans or surviving spouses who need help with daily activities. The money goes to the veteran, who can use it toward care.
• Veteran-Directed Care: in some areas, eligible veterans get a budget to hire their own caregivers. Ask your VA social worker if it is offered near you.

VA and Medicaid programs have their own rules about combining benefits, so talk with a VA Caregiver Support Coordinator before you apply for both.

Do spouse caregivers pay taxes on SFC payments?

Often not. Under IRS guidance on Medicaid waiver payments, payments to a caregiver who lives in the same home as the person receiving care can usually be excluded from federal income. Because you live with your spouse, the SFC payments you receive when you get paid to care for a spouse in Indiana often qualify. Tax situations differ, so confirm with a tax professional.

How do you get started?

Most people who want to get paid to care for a spouse in Indiana follow the same five steps.

1. Check whether your spouse has Indiana Medicaid. If not, start the application. We can help.
2. Contact your Area Agency on Aging or, for PathWays members, the health plan to request a waiver and level of care assessment.
3. Ask for Structured Family Caregiving in the service plan and name the agency you want.
4. Complete the agency’s intake, background check and caregiver training.
5. Begin providing care and receive pay, with regular coach and nurse visits.

What if your spouse is not on Medicaid yet?

That is common. Many couples worry about the income and asset rules. Indiana has spousal protections that let the at-home spouse keep part of the couple’s income and assets. An agency or elder law attorney can explain how they apply to you. If you plan to get paid to care for a spouse in Indiana, start early. Waiver waiting lists are common, so apply even before care needs peak.

Conclusion

You can get paid to care for a spouse in Indiana, and Structured Family Caregiving is the main way to do it. Your spouse needs a Medicaid waiver and a nursing facility level of care, you must live together, and an approved agency pays you and supports you with training and nurse visits. Attendant care is open to spouses only in rare extraordinary care cases, and veterans may also qualify for VA caregiver programs. Learn more about our paid family caregiver program, or see how we provide home care in Indianapolis and across Central Indiana.