Updated September 4, 2026. Quick answer: yes, through Personal Choice Program, Rhode Island’s Cash and Counseling self-direction model. Most adult family members can be hired and paid to provide the care. A spouse cannot be the paid caregiver; the federal rule against paying a “legally responsible relative” still applies here.
How Rhode Island pays a family caregiver
| Program | Personal Choice Program, Rhode Island’s Cash and Counseling self-direction model |
|---|---|
| Can a family member be paid? | Yes. “Participants can hire friends, neighbors, family members, advertise for a PCA, or use the registry.” |
| Can a spouse be paid? | No. “Spouses, legal guardians, financial powers of attorney, or participants’ representatives cannot be a PCA.” |
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
Rhode Island’s Personal Choice Program, EOHHS’s Cash-and-Counseling-model self-directed Medicaid LTSS option, gives an eligible participant a monthly budget based on an ADL/IADL assessment. The participant, or a representative if needed, hires, trains, supervises, and can fire their own Personal Care Attendant, including friends and most family members, while a Fiscal Agent handles payroll, taxes, and required PCA background checks.
What this doesn’t answer
The current PCA rate is not published as a specific dollar figure; EOHHS’s 2025 PCA orientation states only that PCAs are paid a wage decided by the participant that is within a range set by EOHHS. A 2015 program manual gives a worked wage example based on that era’s CNA reimbursement rate, but that figure is outdated and was not used as a current rate.
Sources
- Rhode Island EOHHS: Personal Choice PCA Orientation (dated July 2025)
- Rhode Island EOHHS: Personal Choice Program Participant/Representative User Manual (December 8, 2015)
Read September 4, 2026.
Same question, other states: South Carolina · South Dakota.
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.