Updated September 4, 2026. Quick answer: yes, through Personal Options, the self-directed model of the Aged and Disabled Waiver (ADW). 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 West Virginia pays a family caregiver
| Program | Personal Options, the self-directed model of the Aged and Disabled Waiver (ADW) |
|---|---|
| Can a family member be paid? | Yes. “Staff hired by you cannot be a spouse or legal guardian to you.” |
| Can a spouse be paid? | No. “Staff hired by you cannot be a spouse or legal guardian to you.” |
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
Under West Virginia’s Aged and Disabled Waiver, the Personal Options self-directed model lets a participant act as employer to hire, train, supervise, and terminate their own attendant, including most relatives (adult children and other family members), with BMS contracting a Fiscal/Employer Agent to handle payroll and employment paperwork; participants who need help exercising employer authority can designate a representative.
What this doesn’t answer
West Virginia’s official ADW rate documents could not be extracted as readable text this session, so no verified Personal Options hourly pay rate or cap is reported; a secondary source claims a floor of state minimum wage with a Medicaid-regulation ceiling, but that was not confirmed against the primary rate chart. The exact statutory or policy-manual citation for the spouse/guardian exclusion was not independently located in readable form, only the plain-language statement on the ADW program’s own website.
Sources
Read September 4, 2026.
Same question, other states: Wisconsin · Wyoming.
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.