Get Paid to Care for Your Elderly Parent in North Carolina
North Carolina lets family members get paid through the Community Alternatives Program for Disabled Adults (CAP/DA) using its consumer-directed (CAP/Choice) self-direction option, for adults at risk of nursing-facility placement.
This guide covers what North Carolina family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
North Carolina pays family caregivers $12–$18 per hour through the Community Alternatives Program for Disabled Adults, Consumer-Directed option (CAP/Choice) option within the CAP/DA 1915(c) HCBS waiver. Your parent must meet a nursing-facility level of care but prefer to remain at home.
North Carolina's Main Program: Community Alternatives Program for Disabled Adults, Consumer-Directed option (CAP/Choice)
Community Alternatives Program for Disabled Adults, Consumer-Directed option (CAP/Choice) is a self-directed option within North Carolina's CAP/DA 1915(c) HCBS waiver, which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant, and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across North Carolina
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Charlotte / Mecklenburg (urban) | $14–$18/hr | Higher metro rates; final rate set by assessed need |
| Raleigh-Durham / Triangle | $13–$17/hr | Set through the CAP/DA care plan and FMS provider |
| Rural Eastern & Western NC | $12–$15/hr | Lower-cost areas; rate tied to assessed hours |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
North Carolina is relatively flexible, the CAP/DA consumer-directed (CAP/Choice) option lets a participant hire an adult child, and in some cases even a spouse, as a paid caregiver. Always confirm the current rules with NC Medicaid (NC DHHS, Division of Health Benefits) before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full North Carolina Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the CAP/DA 1915(c) HCBS waiver (or its self-directed option)
- Live in North Carolina in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through a Financial Management Services (FMS) provider
How to Apply: Step-by-Step
- Apply for North Carolina Medicaid. Apply online at epass.nc.gov or call 1-888-245-0179. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the CAP/DA 1915(c) HCBS waiver.
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the CAP/DA 1915(c) HCBS waiver and assigned a case manager or care coordinator.
- Request the self-directed (CAP/DA) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with a Financial Management Services (FMS) provider. Complete enrollment paperwork, W-4, I-9, and background authorization, so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for North Carolina's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay North Carolina Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable, and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, North Carolina's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 1-800-662-7030.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing, see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided, date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What North Carolina Caregivers Are Actually Earning
At 30 hours per week and about $15 per hour, you would earn roughly $1,950 per month. At 40 hours per week and $18 per hour, earnings reach about $3,120 per month, around $37,440 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- NC Medicaid (NC DHHS, Division of Health Benefits): medicaid.ncdhhs.gov | 1-888-245-0179
- Apply for Medicaid: epass.nc.gov
- State aging services: www.ncdhhs.gov/divisions/division-aging | 1-800-662-7030
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Through CAP/DA's consumer-directed option, family caregivers are typically paid about $12–$18/hr depending on the participant's assessed need and region. The exact wage is set in the participant's CAP/DA care plan and paid through a Financial Management Services provider.
CAP/DA (Community Alternatives Program for Disabled Adults) is a NC Medicaid 1915(c) home and community-based waiver for adults who would otherwise need nursing-home care. Its consumer-directed (CAP/Choice) option lets the participant hire and direct their own caregiver, including a relative.
North Carolina is relatively unusual in that the CAP/DA consumer-directed (CAP/Choice) option can allow a participant to hire a spouse or an adult child. A Financial Management Services agency handles payroll and tax withholding. Confirm current rules with NC Medicaid.
The Community Alternatives Program for Disabled Adults (CAP/DA) waiver. Choosing its consumer-directed (CAP/Choice) model lets the participant employ a friend or relative to provide personal care.
First enroll in NC Medicaid (apply at epass.nc.gov or call 1-888-245-0179). Then request a CAP/DA referral through a CAP/DA case management agency in your county; a case manager assesses eligibility and helps you choose consumer direction.
Yes. Dementia-related needs can qualify a parent for CAP/DA if they meet the nursing-facility level-of-care and Medicaid rules. Once approved, you can be hired as the paid caregiver under the consumer-directed (CAP/Choice) option.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county, confirm details with NC Medicaid (NC DHHS, Division of Health Benefits). Sources: medicaid.ncdhhs.gov · epass.nc.gov.