Key takeaway
North Carolina pays family caregivers mainly through Medicaid PCS and CAP waivers with self-direction options; veterans’ programs and AAA supports can complement these.
- PCS: In-home help via agencies; some may hire qualified family caregivers.
- CAP/DA & CAP/C: HCBS waivers with self-directed options to hire family (usually not spouses/legal guardians).
- No state paid family leave; use FMLA/employer leave if available.
- Veterans: PCAFC, A&A, and VDC can fund family caregiving support.
Overview
Family caregivers in North Carolina can leverage Medicaid benefits (PCS and CAP waivers), veterans’ programs, and private agreements to get paid for in-home care.
Programs that pay family caregivers in North Carolina
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Personal Care Services (PCS) (Medicaid) | Medicaid eligibility and medical need for hands-on help with daily living tasks. | Provided via agencies; some agencies may hire qualified family members; covered ADLs/IADLs include bathing, dressing, mobility, and housekeeping. |
| CAP/DA (Disabled Adults) (Medicaid HCBS Waiver) | Adults 18+ who need nursing facility-level care and meet Medicaid requirements. | Self-directed options allow hiring certain family caregivers (typically excluding spouses/legal guardians). |
| CAP/C (Children) (Medicaid HCBS Waiver) | Medically fragile children under 21; Medicaid and medical necessity criteria apply. | Supports in-home care; some services may be self-directed to hire family caregivers per program rules. |
| Self-Directed Care (various programs) (Medicaid self-direction) | Available within certain NC Medicaid programs when participant opts in. | Lets participants hire/train certain family members; payroll handled by a fiscal intermediary. |
| Veterans Programs (PCAFC, A&A, VDC) (Federal) | Eligible veterans; program-specific criteria apply. | PCAFC stipend/training; A&A increases pension; VDC funds a budget to hire family. |
| AAA/Respite & Local Supports (State/Local) | Varies by county and funding. | Training, respite, and support groups; no direct salary in most programs. |
| Private Pay / Long-Term Care Insurance (Private) | Policy coverage or private agreement. | Some policies reimburse family caregiving; otherwise use a written caregiver agreement. |
NC Medicaid: PCS, CAP waivers, and self-direction
North Carolina supports in-home care through PCS and CAP waivers, with self-direction enabling family caregivers under certain rules.
PCS basics
Medicaid-funded in-home assistance via agencies; some may hire family caregivers when qualified.
CAP/DA and CAP/C
Waivers to keep adults and children at home; self-directed options can allow hiring family caregivers (often not spouses/legal guardians).
Self-direction mechanics
Participant or representative manages hiring/scheduling; fiscal intermediary processes payroll.
Caregiver supports (AAA and state programs)
Family caregivers can access respite, education, and support through the NC Family Caregiver Support Program and local AAAs.
Short-term relief and support groups; availability varies.
Caregiver education and help finding programs like CAP or PCS.
Who qualifies
- Family caregivers of older adults or people with disabilities; criteria vary by county and program.
Veterans’ programs
Veterans and their families can use PCAFC, Aid & Attendance, and VDC to support in-home family caregiving.
PCAFC
Monthly stipend, training, and supports for a primary family caregiver of an eligible veteran.
Aid & Attendance
Adds to a veteran’s pension to offset care costs, often used to pay family caregivers (spouses typically excluded as direct pay).
Veteran-Directed Care
Flexible VA-funded budget to hire caregivers, including family.
Private pay and long‑term care insurance
If public programs do not apply, families can pay privately via caregiver agreements or use long‑term care insurance where policies allow family caregiving.
What to check in the policy
- Confirm policy covers in‑home personal care and whether benefits pay the policyholder.
How to apply in North Carolina (step-by-step)
- Choose the path: PCS, CAP/DA or CAP/C, self‑direction, VA programs, AAA supports, or private insurance.
- Gather documents: ID, Medicaid status, medical records, and provider contacts; income/assets if requested.
- Start with the right agency:
- PCS: contact your primary care provider for assessment; select an agency after approval.
- CAP waivers: request screening via your local DSS or NC Medicaid office.
- Self‑direction: ask your case manager about eligibility and enrollment steps.
- Veterans: apply via the VA Caregiver Support Program.
- AAA supports: use the NC Division of Aging and Adult Services directory to find your local AAA.
- Complete functional and financial assessments as required.
- If allowed, designate your family caregiver and complete enrollment/orientation and timesheets.
- Begin services; track hours/claims and keep documentation for renewals and audits.
North Carolina paid caregiver FAQs
Can a spouse be paid as a caregiver in North Carolina?
Generally no under self‑directed Medicaid options; other relatives may be eligible. Confirm rules for your program.
How much does PCS pay?
Rates vary by agency and contract; commonly around $10–$18 per hour.
How do I get into CAP/DA or CAP/C?
Contact your local DSS or NC Medicaid office to request a screening; waitlists may apply.
Is there paid family leave in NC?
No statewide paid family leave; use FMLA and any employer-provided leave if available.
