Respite Care: The Five Ways It Gets Paid For, and What It Costs in Your State

You have not slept through the night in weeks. Your mom cannot be left alone, and the one sibling who helps is three states away. You need a few days off, and you need to know who will pay for someone to take over while you take them.

That is respite care. I'm an occupational therapist who has worked in home health, and this is one of the questions families ask me most. The answer is spread across five different programs with five different rulebooks, so I have put them in one place.

Below, a rule means a federal rule, and I'll cite the paragraph. A price comes from a named survey or a government data file, and I'll say which one. Anything labelled "my advice" is my own opinion, not a rule.

What Respite Care Is, and Where It Happens

Respite care is a substitute caregiver for a short time so the regular caregiver can rest. The federal aging agency defines it as services "which offer temporary, substitute supports or living arrangements for care recipients in order to provide a brief period of relief or rest for caregivers" (ACL, Older Americans Act Title III 2020 Program Results).

The same definition lists the three places it happens:

Which kind you can get, and who pays, depends on which of the five doors below your parent fits through.

Door 1: Medicare

Medicare has exactly one respite benefit, and it is not in home health.

Medicare home health does not cover respite

Home health is skilled, part-time visits. There is no respite service in the benefit, and Medicare's home health booklet lists "24-hour-a-day care at home" among the things Medicare doesn't pay for. Our guide to what home health does not cover goes through the rest of that list.

What home health does allow is for you to arrange your own break alongside it. The Medicare Benefit Policy Manual gives the example of a patient whose family hires a licensed practical nurse for nights so the family can sleep. It says that care, "as respite to the family members," has "no impact" on whether Medicare pays for the home health visits (MBPM ch. 7, §20.2). So a paid caregiver in the house does not cost your parent their home health.

Medicare hospice does cover respite, for five days at a time

If your parent is on hospice, or qualifies for it, Medicare pays for respite. The rule defines it narrowly: "Respite care is short-term inpatient care provided to the individual only when necessary to relieve the family members or other persons caring for the individual" (42 CFR §418.204(b)(1)).

Three limits come with it:

• Inpatient only. The stay has to be in a hospice inpatient unit, a hospital, a skilled nursing facility, or a Medicare- or Medicaid-certified nursing facility that meets the hospice standards, and the facility "must provide 24-hour nursing services" (42 CFR §418.108(b)). Hospice respite is not an aide coming to your house.
• Five days at a time. "Respite care may be provided only on an occasional basis and may not be reimbursed for more than five consecutive days at a time" (§418.204(b)(2)). You can use it more than once, but not back to back.
• A small coinsurance. The hospice may charge coinsurance "equal to 5 percent of the payment made by CMS for a respite care day" (42 CFR §418.400(b)). From October 1, 2026, Medicare pays hospices that report quality data $545.98 for an inpatient respite day (FY 2027 hospice rule, CMS-1851-F), so 5% is about $27 a day before the hospice's geographic adjustment. Over the whole hospice election, your respite coinsurance "may not exceed the inpatient hospital deductible applicable for the year in which the hospice coinsurance period began," which is $1,736 in 2026 (CMS, November 14, 2025).

Hospice is a different choice from home health, for a different situation. Our guide to home health vs home care vs hospice explains the line between them.

Medicare Advantage plans vary

Since plan year 2019, CMS guidance has let Medicare Advantage plans offer caregiver support, including short periods of respite, as an extra benefit (CMS memo of April 27, 2018, on supplemental benefits). Not every plan does, and the ones that do set their own hours and rules. The place to check is the plan's Evidence of Coverage, under supplemental or extra benefits, or a call to the plan. If your parent is on an Advantage plan, our guide to Medicare Advantage and home health covers what the plan must still do.

Door 2: Medicaid

If your parent has, or could qualify for, Medicaid, this is the door most likely to pay for respite in the home.

States pay for care at home through home and community-based services (HCBS) waivers. The federal rule that lists what a waiver may cover names "Respite care services" directly (42 CFR §440.180(b)(7)). Medicaid.gov lists respite care among the standard waiver services and says "about 257 HCBS Waiver programs are active nationwide," with nearly every state and DC running at least one.

Two rules shape who gets in:

• Level of care. The state has to evaluate "the need for the level of care provided in a hospital, a NF, or an ICF/IID" and find that the person, "but for the provision of waiver services, would otherwise be institutionalized in such a facility" (42 CFR §441.302(c)). In plain words: your parent has to need enough help that a nursing home would be the alternative. Each state writes its own test for that.
• Enrollment caps and waiting lists. A state "must indicate the number of unduplicated beneficiaries to which it intends to provide waiver services in each year," and that number "will constitute a limit on the size of the waiver program" (42 CFR §441.303(f)(6)). Medicaid.gov puts it plainly: "States choose the maximum number of people that will be served." When the cap is full, the state keeps a waiting list, and the same rule requires it to report on that list.

What this means for you. Respite is a covered service in most waivers, but the waiver decides the hours, the setting and whether a family member can be paid to provide other care around it. Financial eligibility for Medicaid is the first gate, and it is a state question. Ask two places: your state Medicaid agency, and your Area Agency on Aging (the Eldercare Locator below will find it), which usually knows which waiver fits and how long the wait is.

Door 3: The VA

If your parent is a veteran enrolled in VA health care, VA runs its own respite program and a caregiver program with respite built in.

VA Respite Care. VA describes it as "a program that pays for care for a short time when family caregivers need a break." It comes in the three forms above. "Home Respite Care is a service that pays for a person to come to a Veteran's home" or for the veteran to attend adult day health care, and "Nursing home respite may take place in a VA Community Living Center or a community nursing home." Eligibility: "All enrolled Veterans are eligible for Respite Care IF they meet the clinical criteria for the service and it is available." You start with the VA social worker or case manager and the Application for Extended Care Benefits (VA Form 10-10EC). VA's respite page does not state a number of days per year.

What it costs. VA says "A copay for Respite Care may be charged based on your VA service-connected disability status and financial information." The regulation sets the amounts: "Non-institutional respite care—$15" a day and "Institutional respite care—$97" a day, and "A veteran has no obligation to pay a copayment for the first 21 days" of extended care in a 12-month period (38 CFR §17.111(b)(1)). Many veterans owe nothing at all because of their disability rating or income, which is what the 10-10EC works out.

The caregiver program. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) is for veterans with a VA disability rating of 70% or higher who need at least six months of continuous in-person personal care. For the primary caregiver it includes a monthly stipend and respite: "Respite care will be available for at least 30 days per year and may exceed 30 days per year if clinically appropriate and if requested by the Primary Family Caregiver," and it "shall be medically and age-appropriate and include in-home care" (38 CFR §71.40(c)(2)). The VA Caregiver Support Line is 1-855-260-3274.

Our guide to VA home health aide care covers the rest of VA's home care programs and how they fit with Medicare.

Door 4: The Older Americans Act

This door is open to almost every family, and most have never heard of it.

The National Family Caregiver Support Program. Under Title III-E of the Older Americans Act, the federal government gives grants to states "based on their share of the population age 70 and over," and the states fund five kinds of help for caregivers. Respite is the fourth: "temporary relief from caregiving responsibilities—at home or in an adult day care or institutional setting" (ACL).

Who it is for, in ACL's words:

• "Adult family members or other informal caregivers providing care to individuals 60 years of age and older"
• Caregivers "providing care to individuals of any age with Alzheimer's disease and related disorders"
• "Older relatives (not parents) age 55 and older providing care to children under the age of 18"
• "Older relatives, including parents, age 55 and older providing care to adults ages 18-59 with disabilities"

There is no income test in those four lines. How much you get depends on your area's budget. In 2020, ACL reports, Title III programs supported "over 186,000 caregivers serving elderly individuals, delivering more than 5 million hours of respite care to these caregivers." The exact count was 5,028,432 hours, measured in one-hour units.

How to reach it. The program runs through your Area Agency on Aging. The Eldercare Locator, 1-800-677-1116 (call or text) or eldercare.acl.gov, is the federal line that finds yours.

The Lifespan Respite Care Program. A smaller federal program, created in 2006, funds state systems for respite across all ages and conditions. ACL says that since 2009 it has made grants in "39 states and the District of Columbia," and that Congress appropriated $10 million for it in fiscal 2025. Whether your state has a Lifespan Respite program, and what it offers, is a state-by-state question. The ARCH National Respite Network, which ACL funds for technical assistance, runs a free National Respite Locator that lists respite providers by state.

My observation, not a rule: these programs are funded by grant, so hours are limited and some areas keep their own waiting lists. Ask early, and ask what the yearly cap is.

Door 5: Paying for It Yourself

If your parent has long-term care insurance, read the policy. ACL describes these policies as covering "long-term services and supports, including personal and custodial care" in "a variety of settings such as your home, a community organization, or other facility," paying "a daily amount (up to a pre-selected limit)." Whether respite counts, and how many days, is written in the policy.

Without insurance, you pay the going rate. The best national price survey I know is CareScout's Cost of Care Survey, run "July through November 2025." Its 2025 national medians:

Those are medians across the whole country, and CareScout itself warns that any one provider "may differ significantly" from the median. A weekend off at $35 an hour for 48 hours is $1,680, before any overnight premium. Our guide to 24-hour home care costs goes through that arithmetic in detail.

What Respite Costs in Your State: The Floor Under the Price

CareScout's state figures are its own copyrighted survey, so I built the table below from two government files instead. It will not give you a quote, but it tells you what is underneath one.

• Aide median hourly wage is what home health and personal care aides earn in your state, all industries, from the Bureau of Labor Statistics' Occupational Employment and Wage Statistics for May 2025 (occupation 31-1120). An agency's price has to cover this plus payroll taxes, insurance, supervision, travel and margin. In my experience the hourly price is usually around double the wage, but that is a rule of thumb, not a rule.
• Middle agency spend per aide visit is what Medicare-certified home health agencies in your state paid, in wages and contract fees, per home health aide visit in their 2024 Medicare cost reports, divided by visits. It is the median agency, with the usual range being the 25th to 75th percentile. These are our own calculations from CMS's HCRIS file, the same ones behind our pay per visit by state guide. In my experience a home health aide visit runs an hour or two, not a shift, so read it as a per-visit cost, not an hourly one. States with fewer than 5 reporting agencies are left blank, and where the count is under 10 the range is wide and should be read loosely.

Nationally, the middle agency spent $36 per aide visit, with the usual range $25 to $51, across 3,424 agencies with a usable figure.

A few things stand out to me. Aide wages run from $10.83 an hour in Louisiana to $22.95 in Washington, more than a two-to-one spread, and the private-pay prices you are quoted will follow that spread. The states where agencies spent the most per aide visit, North Dakota, Delaware, New York and Maine, include three with fewer than ten reporting agencies, so read those loosely; New York's $76, from 55 agencies, is the solid one. And the lowest-wage states, Louisiana, Mississippi and Texas, are also near the bottom on what agencies spend per aide visit, with Louisiana's $22 the lowest in the country.

My Advice on the Order to Call

This is my opinion, from watching families do it in the wrong order and burn a week.

1. If your parent is on hospice, call the hospice first. Inpatient respite is a covered benefit, the team arranges the bed, and the coinsurance is small. Ask for it by name.
2. If your parent has Medicaid, or might qualify, call your Area Agency on Aging and the state Medicaid agency the same day. Ask which waiver covers respite for your parent's situation, whether there is a waiting list, and how long it is. Get on the list even if you are not sure you will need it. Coming off a list is easy; getting on it late is not.
3. If your parent is a veteran, call the VA social worker and the Caregiver Support Line. Ask about Respite Care, the 10-10EC, and whether PCAFC fits. The 21 copay-free days reset every 12 months, so find out when your parent's clock started.
4. Everyone else, and everyone in the meantime: the Eldercare Locator, 1-800-677-1116. The National Family Caregiver Support Program has no income test for caregivers of someone 60 or older, or of anyone with dementia. Ask for respite, ask what the yearly cap is, and ask about the Lifespan Respite program if your state has one.
5. While you wait, price it yourself. Use the table above as the floor and CareScout's medians as the national middle. A home care agency will quote by the hour with a minimum shift; adult day programs quote by the day. Ask whether overnight hours cost more.

Two more things. Respite does not change home health. Your parent keeps their visits, and the manual says a paid caregiver in the house for the family's relief has no effect on coverage. And if you are reading this because you are past empty, our guide to caregiver burnout lists the people to call tonight, not next week.

Frequently Asked Questions

Does Medicare pay for respite care?

Only under hospice. Medicare's hospice benefit pays for short-term inpatient respite care, for no more than five consecutive days at a time, with a 5% coinsurance (about $27 a day at the October 2026 rate). Medicare home health has no respite service, and Medicare's home health booklet lists 24-hour-a-day care at home as something it does not pay for.

Does Medicaid pay for in-home respite care?

In most states, yes, through a home and community-based services waiver. Federal rules list respite care as a waiver service, but each state decides who qualifies, how many people it serves and how many hours it covers. Many waivers have waiting lists. Your state Medicaid agency or Area Agency on Aging can tell you which waiver fits and whether there is a wait.

How many days of respite care does the VA give?

VA's respite page does not state a yearly limit for its general respite program. For caregivers enrolled in the Program of Comprehensive Assistance for Family Caregivers, the rule guarantees respite care for at least 30 days a year, including in-home care. Copays for respite can apply after the first 21 days of extended care in a 12-month period: $15 a day at home, $97 a day in a facility.

How much does respite care cost if I pay for it myself?

CareScout's 2025 survey puts the national median for a non-medical caregiver at $35 an hour, adult day health care at $95 a day, and a private duty nurse at $90 an hour. Prices vary a lot by state. Our state table shows what aides earn and what home health agencies spent per aide visit in each state, which is the floor under any price you are quoted.

Where do I start if I need a break right now?

Call the Eldercare Locator at 1-800-677-1116. It connects you to your Area Agency on Aging, which runs the National Family Caregiver Support Program's respite services and knows your state's Medicaid waivers. If your parent is a veteran, call the VA Caregiver Support Line at 1-855-260-3274. If your parent is on hospice, ask the hospice team for inpatient respite.

Sources

• 42 CFR §418.204, Special coverage requirements, hospice (Cornell LII), paragraph (b), respite care
• 42 CFR §418.108, Condition of participation: Short-term inpatient care (Cornell LII), paragraph (b)
• 42 CFR §418.400, Individual liability for coinsurance for hospice care (Cornell LII)
• FY 2027 Hospice Payment Rate Update Final Rule (CMS-1851-F), rate tables as summarized by HFMA
• 2026 Medicare Parts A & B Premiums and Deductibles, fact sheet of November 14, 2025 (CMS)
• Medicare & Home Health Care, CMS Product No. 10969 (Medicare.gov)
• Medicare Benefit Policy Manual, Chapter 7, Home Health Services, §20.2 (CMS)
• Reinterpretation of "Primarily Health Related" for Supplemental Benefits, CMS memo of April 27, 2018 (HHS guidance portal)
• 42 CFR §440.180, Home and community-based waiver services (Cornell LII)
• 42 CFR §441.302, State assurances (Cornell LII), paragraph (c)
• 42 CFR §441.303, Supporting documentation required (Cornell LII), paragraph (f)(6)
• Home & Community-Based Services 1915(c) (Medicaid.gov)
• Respite Care (VA Geriatrics and Extended Care)
• 38 CFR §17.111, Copayments for extended care services (Cornell LII)
• 38 CFR §71.40, Caregiver benefits (Cornell LII), paragraph (c)(2)
• National Family Caregiver Support Program (ACL)
• Older Americans Act Title III Programs, 2020 Program Results (ACL), Exhibit 9 and the service definitions
• Lifespan Respite Care Program (ACL)
• National Respite Locator (ARCH National Respite Network)
• What is Long-Term Care Insurance? (ACL)
• Cost of Care Survey, 2025 national medians (CareScout)
• Occupational Employment and Wage Statistics, May 2025, state data, occupation 31-1120 (BLS)
• Home Health Agency cost report data, HHA20FY2024 (CMS HCRIS)