Updated September 4, 2026. Quick answer: yes, through Choices for Care, Flexible Choices participant-directed option. Most adult family members can be hired and paid to provide the care. Whether a spouse specifically qualifies is not clearly stated in the materials reviewed this session.
How Vermont pays a family caregiver
| Program | Choices for Care, Flexible Choices participant-directed option |
|---|---|
| Can a family member be paid? | Yes. “Flexible Choices is a participant or surrogate directed home and community based option which converts a participant’s Home Based Service Plan into a cash allowance.” |
| Can a spouse be paid? | Partial. “A spouse or civil union partner shall not be paid to provide assistance with Instrumental Activities of Daily Living (IADLs) as a part of Personal Care Services.” |
Why the spouse question is different
Federal Medicaid rule treats a spouse (and a parent paying for a minor child) as a “legally responsible relative”, someone already assumed to owe the care for free, so paying them is barred by default. A state has to build an explicit exception into its waiver or state-plan option to pay a spouse at all; the rule for any other relative (an adult child, a sibling, a grandchild) is looser and usually allowed. That is why the two rows above can carry different answers on the same page.
The going rate
Not published by the state in the materials reviewed this session.
How it works
A Choices for Care participant (or a surrogate acting for them) can elect Flexible Choices, converting their approved service plan into a cash allowance and becoming the employer of their own workers, with a Fiscal Intermediary Services Organization running payroll and a Consultant Agency helping build the budget. Workers, including most relatives and even a spouse or civil union partner for hands-on personal care (ADLs), can be hired and paid an hourly wage the participant sets within legal minimum-wage and prevailing-wage limits, but a spouse or civil union partner cannot be paid for instrumental activities of daily living, respite, or companion care, and a court-appointed legal guardian cannot be paid at all.
What this doesn’t answer
No specific published dollar wage rate was found; DAIL policy only requires pay to meet legal minimum wage and not be out of line with prevailing regional wages, with the actual rate negotiated between the participant and worker. The manual does not contain one single affirmative sentence stating that non-spouse family members may be hired, so the Yes for family here is inferred from the self-directed employer structure plus the narrow, explicit exclusions that name only spouses, civil union partners, and legal guardians rather than family generally.
Sources
- Vermont DAIL: Choices for Care, High/Highest Needs Group Program Operations Manual
- Vermont DAIL: Choices for Care Long-Term Care Medicaid Program Manual, Section IV.10 Flexible Choices, revised August 2013
Read September 4, 2026.
Same question, other states: Virginia · Washington.
Related: the private-pay caregiver-agreement rule · the household-employee tax rules once you’re being paid · what family caregiving actually costs unpaid.
General information drawn from each state’s own Medicaid agency and public program materials, not legal, tax or financial advice. Medicaid self-direction programs are administered state by state and change by budget cycle and waiver renewal; this page cannot see your own state’s current program status or your family’s eligibility. We are not a law firm, a benefits counselor, or a fiduciary, and this is not personalized advice. We sell nothing on this page and earn nothing from it.