Medicaid Paid Parent Caregiving Across States

Paid parent caregiving programs vary widely across the country, and the details matter just as much as the availability. Some states have long-standing pathways that allow parents to be paid under Medicaid waivers, while others are newly expanding these options — or narrowing them. To make sense of this patchwork system, here are examples of how different states structure paid parent caregiving, including states that limit paid parent caregiving, plus recent expansions in HCBS programs, and some cases where states have reduced or ended these benefits.

Please note that the following information is for guidance only based on the current waivers — please check with your state agencies to verify what is available in your state.

For more up-to-date and general information on this topic, head to our article Paid Family Caregiving Through Medicaid HCBS Waivers. The website Kids' Waivers also has great information on waivers and services (but laws and policies in each state are always changing, so the page might not be up to date).

It's worth noting that in every state where legally responsible adults can be paid for caring for their children or adults, there are strict limits on the kinds of tasks they can be paid for, the number of hours they are paid for, and complicated application processes that prevent waste, fraud, and abuse.

Alaska

Updates: In Alaska, the state amended its Children with Complex Medical Conditions, People with Intellectual and Developmental Disabilities, and Individual Supports Waivers in September 2024, allowing parents to be paid for care for a maximum of 40 hours per week of in-home supports or supported living.

Arizona

Arizona allows parents of minors to be paid to provide attendant care and habilitation services when the care meets an “extraordinary care” definition. 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 Arizona and can be a helpful resource for the most up-to-date-information.

California

California allows parents to be paid for personal care services only through the In-Home Support Services (IHSS) program through a 1915(j) waiver and the Home and Community Based Alternatives program. To participate, a child must demonstrate extraordinary care needs above what a typically developing child of the same age would require.

Colorado

In Colorado, the IHSS Program and CDASS Program provide in-home care through Medicaid, including allowing parents to be paid to provide personal care services for children.

Connecticut

Updates: Connecticut approved paid family caregiving for the three developmental disability waivers in 2023. Parents with school-age children can be paid to provide respite and individualized day services with a combined cap of 800 awake hours of support annually, with the ability to request a prior approval exception for hours over the cap. An assessment is required to show that the child’s needs exceed the typical standard of care for any child.

Delaware

In Delaware, parents can be paid for providing personal care to children up to 40 hours per week, and another adult must be responsible for and sign paperwork.

Florida

The Florida Family Home Health Aide for Medically Fragile Children program allows parent caregivers to be paid for complex skilled services, including tube feedings and trach care, after completing a training program. A 1915(j) amendment allows parents of minor children to be paid for self-directed personal care services and for parents who are nurses to be paid.

Georgia

Georgia allows some paid caregiving through its GAPP program.

Idaho

Cuts: Idaho is completely ending their paid parent program. Previously, Idaho allowed parents of minor children to be reimbursed for providing personal care services to eligible individuals, but CMS approved Idaho’s request to end this program in 2024.

Illinois

Updates: In June 2024, Illinois created a parent CNA program to allow parents to be paid to provide personal care to minor children. Parents can also be paid as CNAs, LPNs, or RNs if their child or adult requires that level of care through the Home Services Program.

Indiana

Cuts: as of January 2024, Indiana has suspended their paid parent caregiver program for the Health and Wellness Waiver and TBI Waiver. A structured family caregiving program is still available. The Family Supports Waiver allows parents of minors to be paid for Participant Assistance and Care (PAC) services up to 40 hours per week if the care is considered extraordinary and the parent is hired through an agency. A family caregiver shares their thoughts on this in our article here.

Iowa

Updates: In Iowa, as of June 2024, parents/guardians of minors can be paid to care for their children, including a new service called Medical Day Care for Children, who are medically fragile or have complex behavioral issues.

Kansas

Limited: Kansas allows paid family caregiving only on its Technology Assisted, Brain Injury, and Physical Disability Waivers.

Kentucky

Limited: Kentucky allows parents to be paid only if they have a specific skillset or qualification.

Louisiana

Louisiana allows parents to be paid for care in the New Opportunities, Children’s Choice and adult developmental disability waivers and the Monitored In-Home Caregiving Program, which provides a per diem payment to a caregiver who lives in the home.

Maine

Updates: Maine’s new Family Home Health Aide program now allows parents to be paid for home health care for minor children.

Maryland

Maryland allows parents to provide up to 40 hours a week of Community Development Services or Personal Supports in the Community Pathways Waiver and under the Autism Waiver.

Massachusetts

Updates: Massachusetts added a Complex Care Assistant provider type that will allow parents to be paid to care for their children for personal care and enhanced services, such as tube feedings and oxygen delivery.

Minnesota

Minnesota pays parents for services under its CAC, CADI, DD, and BI Waivers for personal care services.

Mississippi

Limited: Mississippi, Missouri, and Michigan do not allow payments to legal guardians or to relatives who are legally responsible for the individual, but relatives can be paid if they meet the same qualifications as non-relative providers.

Montana

Montana has a Pediatric Complex Care Assistant Program, the DD and Big Sky waiver that allow parents to be paid for personal care. Care can include line of sight supervision and night supervision when not required by a person without a disability of the same age. The following services may be provided by a legally responsible person: Personal Assistance Services (BSW/PAS), Specially Trained Attendant, Homemaker, and Homemaker Chore.

Nebraska

Updates: In Nebraska, as of July 2025, parents can be paid for personal care services through all waivers when the care is considered to be extraordinary.

New Jersey

Updates: New Jersey approved a new Family Home Health Aide program. Parents are able to provide personal care services as well as skilled care, including tube feedings, trach care, and medications.

New York

Updates: New York’s OPWDD waiver currently only allows parents of adult children over 21 to provide personal care services. Two bills, A464 and S4462, in the legislature would create a Complex Care Assistant Program, allowing parents to be paid caregivers for minor children who are medically fragile.

New Hampshire

New Hampshire’s In-Home Supports Waiver for Children with Developmental Disabilities allows parents to be paid for some services if 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 their developmentally disabled peers.

New Mexico

Limited: New Mexico’s Mi Via Waiver is very limited in the types of roles that parent caregivers can be paid for.

Nevada

Limited: Nevada limits paid parent caregiving to individuals with physical disabilities.

North Carolina

Updates: Through North Carolina’s CAP/C Waiver, parents of minor children can be paid to provide a number of services restricted to nursing and extraordinary care, such as a child requiring 24-hour supervision or specialized health care needs. A new Innovations Waiver allows for parents of minor children to provide community living and supports up to 40 hours per week.

North Dakota

Updates: North Dakota created a Family Paid Caregiver Pilot Program in spring 2024, allowing caregivers to be paid a lump sum five days per week for care on the 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.

Ohio

In Ohio, three developmental disability waivers (Individual Options, Level One, and SELF) and the Home Care Waiver allow parents of minors to be paid to provide personal care services under certain circumstances. There are several lawsuits pending relating to paid personal care in Ohio that may change the restrictions.

Oklahoma

Updates: Oklahoma introduced an option to pay parents for non-residential Habilitation Training Specialist (HTS) services in spring 2025. Individuals must be part of a developmental disability waiver, such as the Community Waiver or In-Home Supports Waiver for Children.

Oregon

Updates: Oregon added a new 1915(c) waiver, Children’s Extraordinary Needs Waiver, in July 2024. The waiver allows parent caregivers to be paid for up to 20 hours for children with high levels of medical or behavioral needs. However, the program is limited to 155 families.

Pennsylvania

Updates: Pennsylvania introduced a Family Home Health Aide program, allowing parents to be paid for providing care to their own children as a licensed home health aide. Parents can only provide unskilled care. The Consolidated Waiver, Person/Family Directed Support Waiver, and Community Living Waiver allow more flexibility in paid caregiving called In-Home and Community Support and Life Sharing.

South Carolina

Limited: South Carolina’s Medically Complex Children Waiver allows paid parent caregiving only as a part of self-directed attendant care.

South Dakota

Limited: South Dakota allows parents of adult children to be paid for some services, such as personal care or habilitation, but parents of minors cannot be paid.

Tennessee

Limited: In Tennessee, a small group of individuals who receive services through the Employment and Community First CHOICES waiver can receive a small monthly stipend, but otherwise legally responsible adults cannot be paid.

Texas

Limited: In Texas, parents of children with complex needs can be paid if their child is approved for home nursing care, is enrolled in Medicaid, and qualifies for the Community First Choice option.

Utah

Updates: In Utah, two waivers can pay parents to provide 13 hours of attendant care instead of respite: the Waiver for Technology-Dependent, Medically Fragile Individuals and the Medically Complex Children’s Waiver. In 2023 the state allowed parents of minors being paid for 10-40 hours of care per week through the five other waivers under the Division of Services for People with Disabilities (DSPD).

Vermont

Updates: Like many states, Vermont paid parents of minor children to provide Personal Care Services (CPCS) during the pandemic and has recently consolidated this program.

Virginia

Updates: Virginia also recently solidified pandemic-era programs that allow parents of minors to be paid for personal care amendments to the Family and Individual Support Waiver, Community Living Waiver, and Commonwealth Coordinated Care Plus Waiver. Legally responsible individuals may provide personal care services.

Washington

Limited: In Washington, parents of minors are excluded from being paid for services funded by the waiver.

Updates: Washington State ordered a study in their Department of Social and Health Services (DSHS) to address Home Care Workforce Shortages in late 2023. The study looked at the feasibility of paying parents to provide personal care to their minor children with intellectual or developmental disabilities. At the time of the study, 13 U.S. states allowed legally responsible individuals (typically parents of minor children) to be paid for extraordinary caregiving under Medicaid HCBS waivers. The cost was estimated to be up to $20.2 million annually.

West Virginia

Limited: In West Virginia, the Intellectual and Developmental Disabilities Waiver, using self-directed services through Personal Options, a parent can be paid for limited personal services.

Wisconsin

Limited: In Wisconsin, only parents for over 18 can only be paid for some personal care and respite services.

Wyoming

Wyoming allows for parents to be paid through the Supports and Comprehensive Waivers. The criteria for extraordinary care have to be documented in the participant’s ICAP assessment. Personal care services are limited to 4 hours per day per participant.