Key takeaway
Minnesota offers some of the most flexible family-caregiver pay options in the country, with multiple consumer-directed programs that can compensate adult children and, in many cases, spouses.
- Medicaid: Elderly Waiver (EW), Community First Services and Supports (CFSS), and PCA Choice all allow paying family caregivers.
- Alternative Care (AC) supports older adults who are not yet on Medicaid but at risk of needing nursing-home care.
- CFSS and PCA Choice can pay spouses and parents of adult children under defined rules.
- Veterans Aid & Attendance and Veteran Directed Care add additional funding pathways.
Overview
Minnesota administers its home- and community-based services through the Department of Human Services (DHS) and local lead agencies (county or tribal). The state has invested heavily in self-direction models, allowing families to choose, train, and supervise the caregiver of their choice.
Whether you pursue the Elderly Waiver, Alternative Care, or the newer Community First Services and Supports (CFSS) program, the family caregiver is paid through a Financial Management Services (FMS) provider that handles payroll, taxes, and reporting. Spouses and certain legally responsible relatives can be paid under CFSS and PCA Choice, which is broader than most states.
Programs that pay family caregivers in Minnesota
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Elderly Waiver (EW) (Medicaid HCBS Waiver) | Age 65+, on Medical Assistance, meeting nursing-facility level of care. Income up to the special income standard and assets within Medical Assistance limits. | Funds in-home services including PCA, homemaker, and respite. Family caregivers can be hired under CFSS or PCA Choice service models tied to the waiver. |
| Community First Services and Supports (CFSS) (Medicaid State Plan (1915(k))) | Medical Assistance enrollees who need help with at least one ADL/IADL. Replacing the traditional PCA program. | Two models — Agency-Provider and Budget Model. Many family members can be paid; spouses and parents may be paid under defined exceptions. |
| PCA Choice (Medicaid Personal Care Assistance) | Medical Assistance enrollees needing help with ADLs/IADLs. Transitioning into CFSS over time. | Self-directed model that lets the care recipient hire and supervise a personal care assistant, often a family member. |
| Alternative Care (AC) (State-funded) | Minnesotans 65+ who would qualify for Medical Assistance within 135 days of receiving nursing-home services; income and asset rules apply. | Pays for home- and community-based services to delay or prevent Medicaid spend-down. Allows hiring family caregivers in many cases. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with daily activities and meets VA pension rules. | Increases the monthly VA pension; can be used to pay an adult child or relative caregiver. |
| Veteran Directed Care (VDC) (VA program) | Veterans in VA health care who need nursing-facility level of care and live within a participating VAMC service area. | Provides a self-directed monthly budget for personal care. Can pay spouses and other family caregivers. |
Minnesota Medical Assistance programs
Minnesota’s Medicaid program is called Medical Assistance (MA). It funds several pathways to pay family caregivers, primarily through the Elderly Waiver, Community First Services and Supports (CFSS), and PCA Choice. Each uses a self-directed service model where the participant chooses their caregiver.
Elderly Waiver (EW)
EW is a 1915(c) HCBS waiver for adults 65+ who need a nursing-facility level of care but want to remain at home or in an assisted-living setting.
- Open to MA-eligible Minnesotans age 65+.
- Requires a nursing-facility level of care assessment by the local lead agency.
- Pays for PCA, homemaker, respite, adult day, home-delivered meals, and more.
- Family caregivers can be paid under CFSS or PCA Choice within the waiver.
Community First Services and Supports (CFSS)
CFSS is replacing the traditional PCA program in Minnesota. It is a Medicaid state plan benefit (1915(k)) that gives participants two service models — Agency-Provider or Budget Model — with extensive self-direction.
- Agency-Provider: a CFSS agency employs the support worker chosen by the participant.
- Budget Model: the participant manages a flexible budget through a Financial Management Services (FMS) provider.
- Family caregivers, including some spouses and parents, may be paid under defined exceptions.
- Workers must complete CFSS training before billing for services.
PCA Choice
PCA Choice is Minnesota’s long-standing self-directed Personal Care Assistance option. It is being phased into CFSS but remains active for many participants.
- Allows the care recipient (or responsible party) to recruit, hire, and supervise PCAs.
- Family members, including adult children and certain relatives, can be paid.
- Spouses and parents of minor children typically cannot be paid PCAs.
State-funded option: Alternative Care (AC)
Alternative Care is a Minnesota-funded program for older adults who would soon qualify for Medical Assistance if they received nursing-home services. It pays for in-home and community supports to delay or prevent that transition.
After a long-term care consultation, the participant’s lead agency authorizes services. AC can fund PCA, homemaker, respite, adult day, and home-delivered meals — often delivered by a family caregiver.
AC follows similar self-direction rules to the Elderly Waiver. Many family members can be paid through PCA Choice or CFSS while on AC.
Who qualifies
- Minnesotans age 65 or older.
- Would qualify for Medical Assistance within 135 days of nursing-home admission.
- Have a long-term care consultation showing nursing-facility level of care need.
Veterans’ programs
Minnesota veterans and surviving spouses can use VA benefits to fund in-home family caregiving. The two most common federal options are the Aid & Attendance pension benefit and Veteran Directed Care.
Aid & Attendance Pension
A&A increases a qualifying veteran’s or surviving spouse’s monthly VA pension to help cover care expenses. The payment goes to the veteran, who can use it to pay a family caregiver.
- Eligibility: wartime service, limited income and assets, and a need for help with daily activities.
- Adult children and relatives can be paid; spouses cannot be paid directly because household income is combined.
- Requires VA Form 21P-527EZ and supporting medical evidence.
Veteran Directed Care (VDC)
VDC is available through participating Minnesota VA Medical Centers (Minneapolis and St. Cloud have offered it). The veteran manages a flexible monthly budget to hire caregivers, including family.
- Open to veterans needing nursing-facility level of care in the VA system.
- Spouses can be paid caregivers under VDC.
- A financial management service handles payroll and taxes.
Long-term care insurance
A qualifying long-term care insurance policy may pay for in-home services delivered by a family caregiver. Confirm payment rules with the insurer before relying on it.
What to check in the policy
- Policy covers in-home personal care, not only nursing facilities.
- Benefits are paid as cash or indemnity to the policyholder, who can pay the caregiver directly.
When a policy only pays licensed agencies, the family caregiver can become a W-2 employee of a Minnesota-licensed home care agency that bills the insurer and routes pay through payroll.
How to apply in Minnesota (step-by-step)
- Identify the right path: Elderly Waiver, CFSS, PCA Choice, Alternative Care, or VA benefits.
- Gather documents: ID, Social Security number, proof of income and assets, medical records, and veteran service records if applicable.
- Contact the right entry point:
- EW, CFSS, PCA Choice, AC: call the Senior LinkAge Line (800-333-2433) or your county or tribal lead agency to request a long-term care consultation.
- VA paths: ask a VA social worker about Aid & Attendance and VDC eligibility.
- LTC insurance: call the insurer to confirm caregiver payment rules.
- Complete the in-person or telephonic functional assessment (MnCHOICES).
- Select your service model (Agency-Provider or Budget Model), choose your family caregiver, and enroll with a Financial Management Services provider.
- Complete required training and background study, then begin services and submit time sheets.
Minnesota paid caregiver FAQs
Can a spouse be paid as a caregiver in Minnesota?
Yes, in some cases. CFSS and Veteran Directed Care can pay spouses under defined rules. Traditional PCA Choice and the Elderly Waiver typically do not pay spouses.
What is replacing the PCA program in Minnesota?
Community First Services and Supports (CFSS) is replacing the traditional PCA Choice and PCA programs. Most participants will transition to CFSS over time.
What is MnCHOICES?
MnCHOICES is Minnesota’s integrated assessment used by lead agencies to determine eligibility for the Elderly Waiver, Alternative Care, CFSS, and other long-term care services.
Can I be paid to care for my parent in Minnesota?
Yes. Adult children are commonly paid under CFSS, PCA Choice, the Elderly Waiver, Alternative Care, and VA programs.
How long does approval take in Minnesota?
After the MnCHOICES assessment is completed, services typically begin within several weeks once the participant chooses a service provider and a financial management service.
