Parents as Paid Caregivers (PPCG)

AHCCCS received temporary authority from the Centers for Medicare and Medicaid Services (CMS) to allow parents of minor children with disabilities to be paid caregivers during the federal COVID-19 Public Health Emergency (PHE) on April 6, 2020. This temporary authority ensured children received services during the PHE. It also ensured services continued when direct care workers became ill or left the workforce. AHCCCS sent an 1115 Waiver amendment to the Centers for Medicare and Medicaid Services (CMS) requesting to make this authority permanent on September 27, 2023.

On February 16, 2024, AHCCCS received approval from CMS to permanently allow parents of minor children to get paid to provide attendant care and habilitation when it meets an “extraordinary” care definition. AHCCCS and DDD published a letter announcing they will collaborate to implement this change.

The Division and AHCCCS began working with a group including families, providers, and health plans on May 15, 2024. This group will provide input on the required policy and procedures. They will also help to create new tools for use in the assessment process.

Who qualifies as a “parent” to provide this service?

Parents who have formal physical and/or legal custody of their minor child. This includes guardians of minor children. Stepparents do not fall under the CMS definition of a legally responsible parent under the new authority.  Stepparents can provide paid care without the limitations of this new authority as family members.  DDD will update its policies in the future to align with AHCCCS policy.

What does “extraordinary care” mean in relation to this service?

AHCCCS defines “extraordinary care” as:

• Care for the member that exceeds the range of activities a parent would ordinarily perform in the household on the member’s behalf if they did not have a disability or chronic illness, and
• Care which is necessary to assist the member’s health and welfare to avoid institutionalization.

What will change as this flexibility becomes permanent in the months ahead?

• Tools will be revised and developed for use in the assessment process.
• Parents will be limited to 40 hours of paid care per week per child in the future if the member is assessed for more than 40 hours of service per week. The limitation will be phased in. The schedule will be communicated as it is developed. Support Coordinators continue to use the PHE guidance (English)/PHE Guidance (Spanish) to assess the need for this service.
  
  • When the limitation starts, the child can receive additional hours over the maximum 40 hours of authorized services being provided by a parent in a given week, through an alternate caregiver.
• Qualified Vendors will continue to hold quarterly supervisory visits with the parent(s) being paid to provide the service. During these visits, they will also help assess the needs of the family caregiver.

The AHCCCS website continues to be updated including their Frequently Asked Questions related to this topic with the most up-to-date information.