Updated September 3, 2026. Quick answer: yes, through Community Choices Waiver, Self-Direction (SD) option. Most adult family members can be hired and paid to provide the care. A spouse can also be the paid caregiver.
How Louisiana pays a family caregiver
| Program | Community Choices Waiver, Self-Direction (SD) option |
|---|---|
| Can a family member be paid? | Yes. “After determining the participant is eligible and appropriate for the Self-Direction (SD) option… Self-Directed PAS in the POC and budget sheet.” |
| Can a spouse be paid? | Yes. “”OAAS has determined that extraordinary care is met and [Participant’s Spouse’s Name], LRI/spouse of [Participant’s Name] is authorized to serve as the DSW effective [enter date approved].” … If not approved, the SC will: Contact the DSP or SD employer to ensure their understanding that the spouse CANNOT be the DSW.” |
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
Applicants join the Community Choices Waiver Request for Services Registry (a waitlist, prioritized for certain referral categories); once enrolled, the Support Coordinator refers the participant to a Fiscal Employer Agent to set up Self-Direction, and the participant becomes the legal employer of their chosen Direct Service Worker, who can be a relative. A spouse specifically can only become the paid DSW after the OAAS Service Review Panel approves an “extraordinary care” request.
What this doesn’t answer
No published hourly rate was found on an official Louisiana source this session.
Sources
- LDH/OAAS: Community Choices Waiver (CCW) Waiver Procedures Manual, Ch. R (incl. R-100.9 LRI/Spouse as DSW, R-100.14.4 Self-Directed PAS)
- LDH/OAAS: Community Choices Waiver Fact Sheet
Read September 3, 2026.
Same question, other states: Maine · Maryland.
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.