That heavily depends on the laws in your country. In my country, yes, you have to register a kind of simplified one-person mini company when above a certain limit, something like more than 400€ per year. Its essentially just a form you have to fill out, vaguely state what kind of work you are doing (programming....digital art...something something....they don't care about details, just how they need to tax it) but in the end the requirement is that you have to properly track your income and expenses related to the company in an official way...and of course you have to pay income taxes on the difference between income and expenses. Obviously it goes into your yearly tax statement. Because I have a well paying real job and Patreon is just on top, its taxed rather heavily with like 30-40%.
While you can get payed from Patron via Paypal, Patron still needs your actual name, address and you have to sign a digital statement that states you don't need to pay taxes in the US, because you tax it properly yourself in your home country. (I guess its easier if you are in the US.)
Note that the VaM community is too small to make "decent cash". If you are in any kind of western high-wage country, you won't make enough per hour for it to make sense. If you just want money, there are certainly easier and less time consuming ways. It makes only sense if you do what you do anyway because you LIKE to do it. You just take a bit of extra time to polish, package stuff properly and present it in a nicer way with screenshots/video/etc.