Updated September 4, 2026. Quick answer: yes, through Services My Way (Participant-Directed Community Supports) under the Elderly and Persons with Physical Disabilities (EPD) Waiver. 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 District of Columbia pays a family caregiver
| Program | Services My Way (Participant-Directed Community Supports) under the Elderly and Persons with Physical Disabilities (EPD) Waiver |
|---|---|
| Can a family member be paid? | Yes. “Participant-Directed Community Supports are similar to Personal Care Aide (PCA) services in the larger EPD Waiver program. When using this service the participant or his/her authorized representative is the common law employer of their Participant-Directed Worker (PDW).” |
| Can a spouse be paid? | Not clearly addressed in the materials reviewed this session. |
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
EPD Waiver participants who choose Services My Way become the common law employer of their own Participant-Directed Worker (PDW) and pick who provides personal care and community support. DHCF contracts with Consumer Direct DC as the financial management services (FMS) vendor, which runs payroll, bill payment, and Support Broker services on the participant’s behalf.
What this doesn’t answer
DHCF’s own EPD Waiver Participant Handbook and the underlying 1915(c) waiver application PDFs would not extract as readable text this session, so no primary-source sentence could be found that explicitly states whether a spouse specifically can or cannot be a paid PDW. Multiple non-primary caregiver sites describe a spousal exclusion, but that could not be used as the basis for a fact, so spouse eligibility is marked Unclear rather than No. The hourly PDW rate is not published on the pages read this session.
Sources
- DC Department of Health Care Finance (DHCF): EPD Waiver Services page
- DHCF press release: DHCF Awards Services My Way Program Contract to Consumer Direct DC
- DC Department of Aging and Community Living (DACL): EPD Waiver service page
Read September 4, 2026.
Same question, other states: Nebraska · Nevada.
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.