Paid Parent Caregiving Information

This page contains information about the availability of Paid Parent Caregiving in each state, focusing specifically on whether the parents of minors can be paid for personal or attendant care, home nursing, and other services. We recognize that this information is incomplete and may not be fully correct. This is an area of Medicaid that is rapidly changing, and many states are currently in the process of creating new programs or modifying pandemic-era programs that were created under emergency rules. Please Contact Us to let us know if the information we have is incorrect or outdated, or if you can add any additional information. Links to documentation are especially helpful.

Most of the information in this section has been taken either directly from Waiver Application Documents or state pages.

Alabama

Alabama’s Personal Choices program provides a monthly allowance to participants that can be spent on services, including some paid family caregiving. It is available to participants in the Elderly and Disabled Waiver, the Alabama Community Transition (ACT) Waiver, State of Alabama Independent Living (SAIL) Waiver, the Intellectual Disabilities (ID) Waiver, and the Living at Home (LAH) Waiver. We believe this program allows parents of minors to be paid. Please contact us if you have additional information on this program.

Alaska

Alaska amended its Children with Complex Medical Conditions, People with Intellectual and Developmental Disabilities, and Individual Supports Waivers as of 9/2024. These amendments allow a parent/guardian of a minor to be paid for care for a maximum of 40 hours per week of In-home Supports or Supported Living in a seven (7) day period, regardless of the number waiver participants that they have a legal duty to support. The following requirements must be met:
1. The service must be one that the LRI would not ordinarily provide in the household on behalf of a person without a disability of the same age and which is habilitative, documented in the support plan, and necessary to assure the health and welfare of the participant and avoid institutionalization; and
2. There is a lack of qualified providers who can furnish services at necessary times and place; or
3. The LRI has unique abilities necessary to meet the needs of the participant.

Arizona

Arizona offers a Licensed Health Aid (LHA) program, which allows parents who obtain an LHA certificate to be paid to care for minor children, including those with substantial medical technology like trachs and feeding tubes. More information is available here and through the AHCCCS Website.
As of February 2024, parents of minors under the age of 18 can be paid to provide attendant care and habilitation services when the care meets an “extraordinary care” definition. See this Paid Caregiver Information from the state, as well as this page of Paid Caregiver Documentation. Care is limited to 40 hours per week per child.
Parents/guardians of adult participants over the age of 18 can be paid to provide attendant care and habilitation hours up to the approved maximum.
Raising Voices Coalition works on paid parent caregiving in AZ and can be a helpful resource for the most up-to-date-information.

Arkansas

No information for this state at this time

California

Parents (and other family members or friends) can be paid for personal care services only through the In-Home Support Services (IHSS) program through a 1915(j) waiver.
Parents/guardians who are nurses can also be paid for RN, LPN, or LVN care for their own children through the state Medicaid plan.
In the Home and Community Based Alternatives program, legally responsible individuals, including parents and guardians of minors, may be paid for waiver personal care services (WPCS) or paramedical services. Another designee must sign timesheets. The following conditions must be met, as outlined in the waiver application approved 3/2023:
- The legally-responsible adult quit a full-time job or can’t get a full-time job because they must care for the disabled participant, AND
- If no other suitable care provider is available (willing and able), AND
- If services are not received, the participant will be at risk of out-of-home placement or inadequate care.
California also has a Family Certified Home Health Aide program that allows parents to be paid for unskilled tasked in the Home and Community Based Alternatives waiver.

Colorado

Parent CNA Program: allows parents/guardians to become certified as a CNA to care for their children, including giving tube feedings, and receive pay. For more information on that program, see this info from the Department of Public Health. The child must be enrolled in Medicaid, either through a waiver, categorical eligibility, or the Medicaid buy-in program.
IHSS Program: allows parents/guardians to be paid to provide personal care services for children in the Children’s HCBS program if the care is determined to be extraordinary. “Extraordinary care is determined by assessing whether a child who is the same age without a disability needs the requested level of care, the activity is one that a parent would not normally provide as part of a normal household routine and the activity is one that a parent is not legally responsible to provide.” Parent representatives may not be paid for services. In addition, adults in the Complementary and Integrative Health (CIH) waiver or the Elderly, Blind, and Disabled (EBD) waiver may also have a parent/guardian be paid for their personal care services through this program. This program is in the process of being moved into a 1915(k) program.
Brain Injury Waiver: Family members may provide up to 40 hours of Consumer-Directed Attendant Support Services (CDASS) in a seven-day period according to the waiver application.

Connecticut

Legislative committees recently approved paid family caregiving for three developmental disability waivers.
The state lists the following information in various waiver applications: “For parents with school age children approved to provide IHS, respite, individualized day, personal supports and/or senior supports under this waiver, all supports that can be provided by such parent have a combined cap of 800 awake hours of support annually with the ability to request a prior approval exception for hours over the cap. For parents with school age children requesting to provide such support and be compensated, an assessment to determine age-appropriate dependency that meets the criteria of extraordinary care is required. This assessment will be done through a form that utilizes a rating scale that reflects support or assistance a child needs that exceeds the typical standard of care for any child. The state has finalized this form. For legal guardians approved to provide IHS, respite, individualized day, personal supports and/or senior supports under this waiver, all supports that can be provided by such legal guardian have a combined cap of 2100 awake hours of support annually with the ability to request a prior approval exception for hours over the cap.”
Connecticut also uses a 1915(k) amendment to allow family members to provide personal care services; however, guardians and legally responsible individuals are not eligible.

Delaware

Delaware’s Medicaid Demonstration Waiver allows parents, guardians, and other family members to be paid for providing personal care to children. Parents can work up to 40 hours per week, and another adult must be responsible for and sign paperwork. See pp. 27-29 of this document.

District of Columbia

No information at this time

Florida

Florida passed legislation creating a parent caregiver Family Home Health Aide for Medically Fragile Children program. The information be seen here. The program will allow parent caregivers to be paid for complex skilled services, including tube feedings and trach care, after completing a training program. There have been numerous delays in setting up this program, and more information will be available soon.
Through a 1915(j) amendment, Florida allows parents of minor children in the iBudget Waiver and categorical Medicaid to be paid for personal care services that are self-directed.

Georgia

We have reports that Georgia is considering continuing its pandemic flexibilities to allow paid parent caregivers of minors in the New Options and Comprehensive Supports waivers. We will post information when it becomes available.
The pandemic provisions for the GAPP program have been extended as of 11/15/2024 through an amendment to Georgia’s Healthy Babies 1115 Demonstration Program. See this document. “The state will provide payment for PCS rendered by an LRI, which could be inclusive of legally responsible family caregivers, for beneficiaries eligible to receive 1905(a) personal care services through the Georgia requirements. The requested LRI must meet all qualifications to become a direct care worker to provide PCS as authorized in the Medicaid state plan, including abiding by all oversight requirements from the hiring agency and DCH. All PCS must be deemed medically necessary and reviewed through the standing prior authorization process. Beneficiaries must require medically necessary nursing care and/ or PCS to be considered for GAPP.”

Hawaii

No information for this state at this time, though we have been informed programs exist. Waiver language for the HCBS waiver states parents of minors cannot be paid.

Idaho

Idaho allows parents who are nurses to be paid for providing care to their own children.
Idaho received approval in 2023 for an amendment to its Behavioral Health Transformation demonstration to allow spouses and parents of minor children to be reimbursed for providing personal care services to eligible individuals. However, as of 12/2024, Idaho is considering eliminating or changing these provisions due to increased costs and possible fraud. See this article, Citing growing costs, Idaho seeks to end parental disability care worker program, for more information.

Illinois

Illinois allows parents/guardians who are RNs or LPNs to be paid to care for their own minor children. This has been permitted during the public health emergency and is now approved for all children receiving private duty nursing in Illinois (waiver or non-waiver).
Legislation was passed in June 2024 to create a parent CNA program for parents of children and adults who receive home nursing through the MFTD Waiver or DSCC Home Care (non-waiver) programs. This program is anticipated to begin in 2025 and will allow parents who have a CNA license to be paid for care.
The Home Services Program, particularly the Persons with Disabilities (DRS Waiver) and Brain Injury Waiver, now allow parents to be paid to provide personal care to minor children.
Illinois is also attempting to develop a paid family caregiver program for unlicensed parents.

Indiana

As of January 2024, Indiana has suspended their paid parent caregiver program. A structured family caregiving program is still available. This program pays a daily stipend for care. More information is available here.

Iowa

As of June 2024, parents/guardians of minors, as well as parents/guardians of adults are allowed to be paid to care for their children in the AIDS/HIV, BI, HD, ID, and PD waivers. They can provide Supported Community Living (SCL), Consumer Directed Attendant Care (CDAC), and Consumer Choices Option (CCO) services. More information is available in INFORMATIONAL LETTER NO. 2588-MC-FFS.
Iowa has also added a new service to waivers, Medical Day Care for Children, which will allow parents of minors to be paid for care in the home. It is limited to children who are medically fragile or have complex behavioral issues. Information is available here.

Kansas

Kansas’ Technology Assisted Waiver has added provisions to make paid family caregiving allowable on a permanent basis. This includes paid personal care services up to 12 hours per day provided by a legally responsible person, as well as nursing care provided by parents who are LPNs or RNs up to 8 hours per day. Parents can only work 40 hours per week and cannot work overnight respite hours. See their waiver application for more information.

Kentucky

In the Home and Community Based Services Waiver, parents/guardians may be paid to provide attendant care for their minor children in Kentucky under special circumstances. See this manual on Participant Directed Services. Typically, parents must have a specific skillset or the child must not have another option for care. Parents are limited to 40 hours per week and must complete CPR training, among other requirements.
In the Michelle P. Waiver, personal care services may be provided by parents, limited to 40 hours per week (combined between parents).
We also have reports that parents who are nurses (RN or LPN) can provide services to minor children.

Louisiana

Parents/guardians may be paid for care in the New Opportunities, Children’s Choice and adult developmental disability waivers. While the language is not entirely clear in the waiver documentation, it appears this policy applies to parents of minors as well. See these slides for providers and these more general slides about the process. Each family caregiver can provide up to 40 hours per week and cannot also serve as the representative/employer. See also this information about the Monitored In-Home Caregiving Program, which provides a per diem payment to a caregiver who lives in the home. Additional information is available in this webinar.

Maine

Maine recently created a new Family Home Health Aide program that allows parents to be paid for home health care for minor children. LD 258, PART GGG Sec. GGG-1. 22 MRSA §2149-B is enacted to read: §2149-B. Home health aide services to minors: Notwithstanding section 2147, subsection 2, a parent of a child who is eligible for home health aide services under the MaineCare program may receive reimbursement for providing those services to the child pursuant to this section and according to department rule….No later than July 1, 2024, the Department of Health and Human Services shall apply to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services for a state plan amendment to allow for qualifying parents of children and youth with in-home personal care needs who are eligible for the MaineCare program to be reimbursed for providing home health aide services under the Medicaid home health benefit. (Will be codified within Section 40.)
Parents who are nurses are able to be paid to provide care for their own children in Maine if they meet exceptional circumstance criteria, including the following:

1. Have resigned from full-time or part-time employment specifically to provide PDN services to the Member; or
2. Have changed from full-time employment to part-time employment resulting in less compensation in order to provide PDN services to the Member; or
3. Have taken a leave of absence without pay from employment in order to provide PDN services to the Member;
4. Have incurred substantial expenses by providing PDN services to the Member; or
5. Be needed to provide an adequate number of qualified nurses to meet the Member’s plan of care because of labor conditions or intermittent hours of care.

Further information is available through the MaineCare manual, section 96, with the relevant section downloadable here (p.21).

Maryland

Legally responsible individuals, including parents and guardians, are able to provide up to 40 hours a week of Community Development Services or Personal Supports in the Family Supports Waiver, according to the most recently approved Waiver Application. These are also available in the Community Pathways and Community Supports Waivers. This may include delegated nursing tasks, as well as nursing by a parent who is an RN, LPN, or CNA. Parents/guardians are limited to 40 hours per week and cannot also be the participant’s Support Broker

Massachusetts

Massachusetts recently created a Complex Care Assistant provider type that will allow parents/guardians to be paid to care for their children. This care can include personal care as well as some enhanced services, including tube feedings and oxygen delivery.
Parents/guardians who are RNs or LPNs can be paid to care for their own children in Massachusetts.

Michigan

No information for this state at this time

Minnesota

CAC and CADI Waivers – Nursing Services: Parents/guardians who are nurses may be paid for care of minor children per the regulations in the Waiver Application-CAC and Waiver Application-CADI. “Spouses, legal guardians, family foster parents (not corporate foster parents) and parents of minor children may receive a hardship waiver to be paid to provide extraordinary services that require specialized nursing skills when the following criteria are met: 1) The service is not legally required of the parent, spouse, or legal; 2) The service is necessary to prevent hospitalization of the participant; and 3) One of the following hardship criteria are met: (i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to provide the service; or (ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with less compensation to provide the service; or (iii) the parent, spouse, or legal guardian takes a leave of absence without pay to provide the service; or (iv) because of labor conditions, special language needs, or intermittent hours of care needed, the parent, spouse, or non-paid legal guardian is needed in order to meet the medical needs of the participant. The home care nursing hardship waiver is not available when a participant is using consumer directed community supports. The spouse, legal guardian, family foster parent or parent of a minor must be a nurse licensed in Minnesota and pass a criminal background study in accordance with Minnesota Statutes, Chapter 245C. Individuals must have a current RN or LPN license with the State of Minnesota and be employed by a home health care agency….The number of hours shall not exceed 50 percent of the total approved nursing hours, or eight hours per day, whichever is less, up to a maximum of 40 hours per week. The service shall not be covered if the home health agency, case manager, physician, advanced practice registered nurse, or physician assistant determines that the home care nursing care provided by the spouse, legal guardian, or parent of a minor is unsafe.”
CAC, CADI, DD, and BI Waivers – Personal Care Services: Minnesota will pay parents/guardians of minors through its Consumer Directed Community Supports. This program pays parents to care for their children in the home, along with others chosen by the family. See also this page for more information on regulations. Parents/guardians may be paid for providing personal care services only through the Consumer Directed Community Support program per the regulations in their respective waiver applications. “The parents (as defined above) of minor children and spouses may not provide more than 40 hours of service in a seven-day period. For parents of minor children and spouses, 40 hours is the total amount per family regardless of the: number of parents (as defined above), combination of parent(s) of minors and spouse, or number of children who receive CDCS.”
Beginning October 1, 2024, parents of minors can be paid to provide personal care services. See this documentation on the new Paid Personal Care benefit.

Mississippi

Mississippi allowed some parent caregivers to be paid during the pandemic; however, language in their updated waivers does not allow paid caregivers who are parents/guardians or other legally responsible individuals.

Missouri

Per its waiver applications, Missouri does not allow parents/guardians of minors to be paid for personal care.

Montana

According to its 2023 Waiver Application, the DD Waiver allows parents/guardians of minors to be paid for care. “A legally responsible individual is a biological or adoptive parent of a recipient under 18, or a spouse of an adult recipient. The services legally responsible individuals may provide include: Residential Habilitation, Supported Employment-Follow Along Support, Companion Services, Personal Care, Personal Supports, Supported Employment-Co-Worker Support, Supported Employment-Individual Employment Support, and Supported Employment- Small Group Employment Support. For a legally responsible person to be paid for the provision of any of the aforementioned services all of the following authorization criteria and monitoring provisions must be met. The service(s) must: 1) Meet the definition of a service/support as outlined in the federally approved waiver plan; 2) Be necessary to avoid institutionalization; 3) Be a service/support that is specified in the member service and support plan; 4) Be provided by a parent or spouse who meets the provider qualifications and training standards specified in the waiver for that service; 5) Be paid at a rate that does not exceed what is allowed by the department for the payment of similar services; and 6) Not be an activity that the family would ordinarily perform or is responsible to perform. Extraordinary care means care exceeding the range of activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the participant and avoid institutionalization.”
In the Waiver Application for Big Sky, parents/guardians may be paid for personal care. “For a legally responsible individual, including biological and adoptive parents of recipients under 18, spouses of adult recipients, and court appointed guardians to be paid for the provision of HCBS services all of the following authorization criteria and monitoring provisions must be met. The service must: 1) meet the definition of a service/support as outlined in the federally approved waiver plan; 2) be necessary to avoid institutionalization; 3) be a service/support that is specified in the member service and support plan; 4) be provided by a parent or spouse who meets the provider qualifications and training standards specified in the waiver for that service; 5) be paid at a rate that does not exceed what is allowed by the department for the payment of similar services; and 6) not be an activity that the family would ordinarily perform or is responsible to perform. The family member who is a service provider will comply with the following: 1) for self-directed personal assistance the family member must maintain and submit time sheets and other required documentation for hours paid; and 2) married individuals must be offered a choice of providers. If they choose a spouse as their care provider, it must be documented in the service plan.”
Montana recently approved a Pediatric Complex Care Assistant Program. View the legislation here. Parents/guardians will be able to provide tube feedings, trach care, medications, and personal care services. More information will be provided when it becomes available.

Nebraska

According to Nebraska’s Waiver Applications, parents/guardians of minors cannot be paid for personal care services. However, Nebraska does allow parents to train non-legally responsible individuals to be paid for “childcare” in the Aged and Disabled Waiver, including skilled nursing tasks, while they work.

Nevada

In the Physical Disabilities Waiver, parents/guardians of minors may be paid for certain waiver tasks. “[Legally Responsible Individuals] may provide the following waiver services: Attendant Care – bathing, dressing, grooming, toileting, skilled services; Homemaker – up to 2 hours/week if the LRI is a live-in caregiver and for LRI non-live-caregiver – will be based on the case manager’s assessment of the recipient’s living condition e.g., living alone and risk level; Respite; Chore – this will be based on case manager’s assessment and only if the primary caregiver (live-in) needs assistance and that the LRI is a non-live-in caregiver.”
The Developmental Disabilities Waiver is in the process of adding the ability for some parents/guardians of minors to be paid for some waiver services.
We have also received reports that Nevada will soon allow parents who are nurses to be paid for the care of minors.

New Hampshire

New Hampshire has a Family Licensed Nursing Assistant program that allows parents/guardians to be paid for providing personal assistance and some limited skilled care, including tube feedings and medication administration. More details will be forthcoming.
In the In Home Supports Waiver for Children with Developmental Disabilities, parent/guardians of children may be paid for some services. “Payment for provision of In Home Residential Habilitation shall be available to the parent or legal guardian of a child with a developmental disability when the following extraordinary conditions are met: (1)The child has at least one of the following factors: a. The child’s level of dependency in performing activities of daily living, including the need for assistance with toileting, eating or mobility, exceeds that of his or her developmentally disabled peers as determined by the Functional Screen; b. The child requires support for a complex medical condition, including airway management, enteral feeding, catheterization or other similar procedures; or c. The child’s need for behavioral management exceeds that of his or her developmentally disabled peers, as determined by a nationally recognized standardized behavioral assessment tool, and the child’s destructive or injurious behavior represents a risk for serious injury or death; and (2) The parent has at least one of the following factors: a. The parent has exhausted all options for obtaining in home support assistance due to the lack of availability of qualified providers; or b. The child’s need for care has an imminent, negative effect on a parent’s ability to maintain paid employment. Examples of lack of availability of qualified providers include the following: (1) A family lives in a rural or remote area and cannot secure providers; (2) The extensive medical or behavioral needs of the child prevent the recruiting and maintaining of providers; (3) A family whose cultural background is different from the culture of the overall pool of providers cannot secure providers who are culturally competent; (4) A family’s work schedule requires that providers be available during evening, overnight, weekend and holiday hours, thus making it impossible to retain providers; (5) A family’s needs are such that no provider agency can be identified or is available to provide the required service; and (6) Any other circumstance or condition of a parent or child or of local provider agencies that results in a family being unable to obtain in-home support assistance.”

New Jersey

New Jersey recently approved a new Family Home Health Aide program. View the legislation here. Parents/guardians will be able to provide personal care services as well as skilled care, including tube feedings, trach care, and medications. More information will be added as it becomes available.
Those who are eligible for nursing or personal care services through Medicaid may be paid to provide personal care services to their children through the Personal Preference Program. At this time, some parents of children who are minors report being paid by this program.

New Mexico

In the Mi Via Waiver, parents/guardians of minors may be paid for some waiver services. “Legally responsible individuals may be paid for waiver services under extraordinary circumstances in order to assure the health and welfare of the participant and avoid institutionalization, and provided that the State is eligible to receive federal financial participation. Extraordinary circumstances include the inability of the legally responsible individual to find other qualified, suitable caregivers when the legally responsible individual would otherwise be absent from the home and, thus, must stay at home to ensure the participant’s health and safety. Legally responsible individuals may not be paid for any services that he or she would ordinarily perform in the household for individuals of the same age who did not have a disability or chronic illness. Legally responsible individuals who may receive payment for the provision of services through Mi Via include biological or adoptive parents of recipients under eighteen (18) and legal spouses of adult participants. Legally responsible individuals may be paid to provide all Mi Via Waiver services, except for transportation of a minor, consultant services, and customized group supports services, and individual directed goods and services….A parent of a minor, a spouse, or other legally responsible individual may not provide more than forty (40) hours of services in a seven (7)-day period.”

New York

In the OPWDD waiver, parents/guardians of adult children over age 21 may provide personal care services as long as they are not the individual’s designated representative. Under extraordinary circumstances, parents/guardians may provide respite or habilitation services for those over 18. See this clarification for more information.
A bill pending in the legislature would create a Complex Care Assistant Program, allowing parents to be paid caregivers for children who are medically fragile.

North Carolina

In the CAP/C Waiver, parents of minor children can be paid to provide a number of services. This overview from Advocates for Medically Fragile Kids NC is exceptionally helpful.
- For those requiring a nursing level of care, parents who are nurses (RN/LPN) may be paid for care to minors through the Attendant Nurse Care waiver provision and can also be paid through the regular Medicaid state plan.
- For those requiring a nurse aide (PNA/CNA) level of care, parents who have the appropriate CNA/PNA training may be paid to care for minors through an agency.
- For those requiring a nurse aide (PNA/CNA) level of care and choose consumer direction, parents who are not the employer of record may be paid to provide personal care or aide services.
- The Coordinated Caregiving waiver service program allows parents who live with the child to be paid for supportive care beginning approximately 11/2023. Parents receive a stipend and this service is expected to replace the need for nursing or CNA/PNA services.
- Children with unfilled private duty nursing hours may transfer those hours to CNA/PNA level care when a nurse is unavailable, and those hours can be paid to a certified parent.
- With the exception of Coordinated Caregiving, the child must have extraordinary circumstances to allow the parent to be paid. These include one of the following: no available provider, child requiring isolation, 24-hour supervision required, or specialized health care needs.
- Parents may be paid for up to 40 hours per week.
The Innovations Waiver now allows for parents of minor children to provide Community Living and Supports up to 40 hours per week (with overttime approved on a case-by-case basis) if they meet the “Extraordinary Needs” criteria. See this information on Paid Parent Caregiving in the Innovations Waiver.

North Dakota

North Dakota created a Family Paid Caregiver Pilot Program beginning 4/1/2024. This program allows for caregivers to be paid a lump sum five days per week for care. Those who qualify include: Autism Spectrum Disorder Birth Through 17 Waiver, Children with Medically Fragile Needs Home and Community-Based Services Waiver, Children’s Hospice Home and Community-Based Services Waiver, and Traditional Individual with Intellectual Disabilities and Developmental Disabilities Home and Community-Based Services Waiver. Eligible participants ages 0 through 17 will receive an authorization for $77.45 per day and participants ages 18 and older for $154.89 per day. More information is available on ND’s Family Paid Caregiver Pilot page.

Ohio

Parents who are RNs or LPNs can be paid to provide home nursing care for their own children in Ohio.
The three developmental disability waivers (Individual options, Level One, and SELF) all have pending amendments (as of 10/2023) that would allow parents/guardians of minors to be paid to provide personal care services. During the pandemic, this included medication administration and some skilled tasks for those providing personal care through a waiver. However, those who receive nursing through the state plan are ineligible. These amendments can be found here.
View the administrative rules governing paid parent caregiving in Ohio. Note that these rules currently require parents/guardians to work for an agency, be the provider of last resort, ban parents from caring for anyone else (such as siblings) while being paid, ban foster parents from being paid for care, and state that any parent can be denied without appeal rights.

Oklahoma

We have reports that Oklahoma allows parents who are nurses to be paid to care for their minor children.

Oregon

As of 7/2024, Oregon has received approval for a new 1915(c) waiver, Children’s Extraordinary Needs Waiver, which will allow for paid parent caregivers. The waiver is targeted to children under age 18 with high levels of medical or behavioral needs. Currently, the program only can serve 155 families, who can receive up to 20 hours of paid caregiving (from one parent or split between two parents). This paid caregiving is for attendant care only. See Children’s Extraordinary Needs Waiver for more information.
Parents of ADULT children over the age of 18 may be paid for services.

Pennsylvania

Pennsylvania has recently implemented a Family Home Health Aide program, which allows parents to be paid for providing care to their own children as a licensed home health aide. Parents can only provide unskilled care. As this is a new program, limited information is available at this time. Some information is available in this memo.
In the Consolidated Waiver, Person/Family Directed Support Waiver, and Community Living Waiver, parents/guardians may be paid for personal care. “The only two waiver services legally responsible individuals can provide that have personal care components are In- Home and Community Support and Life Sharing. A legally responsible individual is a person who has legal obligation under the provisions of law to care for another person, including parents of minor children (under the age of 18) and legally-assigned relative caregivers of minor children. These individuals may be paid to provide In-Home and Community Support and Life Sharing services when the following conditions are met: The service is considered extraordinary care. A legally responsible individual is legally responsible to meet the needs of a minor child, including the need for assistance and supervision typically required for children at various stages of growth and development. A legally responsible individual can, however, receive payment for In-Home and Community Support or Life Sharing when this support goes beyond what would be expected to be performed in the usual course of parenting, and when needed support exceeds what is typically required for a child of the same age; The service would otherwise need to be provided by a qualified provider of services funded under the Waiver; The legally responsible individual is not the common law employer or managing employer for the participant that they will provide the service to; The service is provided by a legally responsible individual who meets the qualification criteria that are established by ODP in Appendix C-3 of the approved Waivers. The service definition for In-Home and Community Support outlines limits for the number of hours that legally responsible individuals, relatives or legal guardians may provide the service.”
In the waivers, parents/guardians may also be paid for some other services, including Transportation.

Rhode Island

No information for this state at this time

South Carolina

Some waivers, including the Head and Spinal Cord Injury Waiver, are allowing parents/guardians who are not legally responsible to provide self-directed services.
The Medically Complex Children Waiver has a pending amendment to allow paid parent caregiving as a part of self-directed attendant care. It will be limited to those who meet the definition of extraordinary care. Targeted start date is 10/1/2024. Information is available on this MCC page.

South Dakota

Waivers allow parent/guardian caregivers of ADULTS to be paid for some services, such as Personal Care or Habilitation. Parents of minors cannot be paid.

Tennessee

A small group of individuals who receive services through the Employment and Community First CHOICES waiver can receive a small monthly stipend; however, this is not truly paid parent caregiving, but rather just a stipend more similar to SSI.

Texas

In the CLASS waiver, parents/guardians of minors may be paid to provide non self-directed services, including residential habilitation, respite, minor home modifications, and nursing.

Utah

In the Waiver for Technology Dependent, Medically Fragile Individuals and also the Medically Complex Children’s Waiver, parents/guardians may elect to replace respite care with attendant care up to 13 hours per month and be paid to provide this service.
During the pandemic, caregivers, including spouses and parents of minors, were allowed to be paid for up to 40 hours of care per week through the five other waivers run by the Division of Services for People with Disabilities (DSPD). A bill was passed in 2023 to continue this program. More information is available here.

Vermont

Parents/guardians of minor children who receive Personal Care Services (CPCS) through Medicaid were able to be paid during the pandemic, and this program will continue with minor changes. See this document for more information.
Parents/guardians of minor children who are Nurses can be paid to provide High Tech Nursing through Medicaid if their child has a medical need for home nursing. Parents may be paid for up to 12 hours per day or 40 hours per week. See this information for additional guidelines.

Virginia

Parents/guardians of minors were able to be paid for personal care in all waivers during the pandemic. Virginia is in the process of making these changes permanent. Virginia passed several pieces of legislation to remove some of the original requirements of the program. These include HB1318, which eliminated the requirement that a parent be the caregiver of last resort, and HB909/SB488, which modifies the 40-hour work week requirement. As of fall 2024, amendments are pending for the Family and Individual Support Waiver, Community Living Waiver, and Commonwealth Coordinated Care Plus Waiver. More information is available here.

Washington

The language in the current waivers excludes parents/guardians of minors from being paid; however, Washington has a study beginning in 2023 to determine the feasibility of adding a paid parent caregiving program.
In January 2024, House Bill 2184 was filed. This bill, if passed, will require the state to create a paid parent caregiving program by October 2024.

West Virginia

In the Intellectual and Developmental Disabilities Waiver, “The legally responsible adult may only provide services that have been identified as necessary in the Extraordinary Care Assessment which is completed initially and at the annual reevaluation of eligibility by the UMC. For individuals who self-direct through Personal Options, a program representative cannot serve in the dual role as the program representative and a paid service provider. The rural nature of the state of West Virginia also makes it problematic for behavioral health agencies to recruit appropriate staff so legal guardians may be paid employees, but someone else will have to serve as the program representative for purposes of self-direction. For children eligible to receive public education services/home schooling/other education alternatives, person-centered support services cannot exceed 7,320 15-minute units per IPP year. The legal guardian of a person who is not eligible for public education services/home schooling/other educational alternatives, is limited to 11,680 15-minute units of person- centered support services. A spouse is not allowed to provide person-centered support services….Any qualified relative/legal guardian living in the person’s home except for a person’s spouse may provide Family Person-Centered Support services, both through the Traditional Option and the self-directed program, Personal Options. Any qualified relative except for a person’s spouse or legal guardian may provide respite as long as they do not reside in the home with the person and are not the individual’s parent or step-parent. Any qualified relative/legal guardian may provide transportation provided they meet qualifications in the IDDW policy manual.”

Wisconsin

Parents/guardians of adult participants over age 18 may be paid for some personal care and respite services.
Parents/guardians of minors may be paid for transportation only through the Children’s Waiver, and only when there are extraordinary circumstances.

Wyoming

For the Supports and Comprehensive Waivers: Wyoming State Statute 42-4-102(a)(ii) provides the statutory authority to allow payments to legally responsible individuals. “Children under the age of 18 may receive personal care services from a legally responsible individual for services that are deemed extraordinary care, if the legally responsible individual is the biological, adoptive, or step parent of a minor child, or the legally authorized representative of a minor child. Criteria for extraordinary care shall meet the requirements specified below, and shall be documented in the participant’s IPC: the participant’s Adaptive Behavior Quotient is 0.35 or lower on the ICAP assessment; and the participant needs assistance with ADLs or IADLs exceeding the range of expected activities that a legally responsible individual would ordinarily perform in the household on behalf of a person of the same age without a disability or chronic illness, and which are necessary to assure the health and welfare of the participant and avoid institutionalization; or the participant requires care from a person with specialized medical skills relating to the participant’s diagnosis or medical condition as determined appropriate by the participant’s licensed medical professional and DHCF. Personal care services for extraordinary care paid to a legally responsible individual shall not exceed four (4) hours per day per participant. Additional units needed beyond 4 hours a day shall only be approved by the Extraordinary Care Committee (ECC).”