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 Please Contact Us to let us know if the information we have is incorrect or outdated, or if you can add any additional information.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.
- 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:
- Have resigned from full-time or part-time employment specifically to provide PDN services to the Member; or
- Have changed from full-time employment to part-time employment resulting in less compensation in order to provide PDN services to the Member; or
- Have taken a leave of absence without pay from employment in order to provide PDN services to the Member;
- Have incurred substantial expenses by providing PDN services to the Member; or
- 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).
- 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 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.
- No information for this state at this time
- 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.”
- Paid parent caregiver for those over 18 is widely available in most programs in Minnesota.
- 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.
- Per its waiver applications, Missouri does not allow parents/guardians of minors to be paid for personal care.
- 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.