How to Get Paid as a Family Caregiver Through Arizona ALTCS

If you are already caring for an aging parent in Arizona — helping them bathe, managing medications, preparing meals, driving to appointments — you can get paid for that work through ALTCS. Arizona's long-term care system allows eligible family members to serve as authorized attendant care providers through two programs: Agency with Choice (AWC) and Self-Directed Attendant Care (SDAC). Spouses are eligible through AWC; adult children and siblings may use AWC or SDAC, subject to the model's requirements. Pay rates average $13 to $16 per hour through AWC and $12 to $15 per hour through SDAC, and at 20 to 40 authorized hours per week, that translates to about $12,480 to $33,280 per year.

This is not a general overview. This is the specific sequence of steps you need to follow to activate paid family caregiving through ALTCS in Arizona — from confirming your parent's eligibility through negotiating hours with the MCO case manager.

Prerequisites: What Must Be in Place First

Paid family caregiving through ALTCS is not available to everyone. Your parent must meet these conditions:

ALTCS enrollment. Your parent must be an active ALTCS member, enrolled in one of the three contracted managed care organizations: Mercy Care, Banner-University Family Care, or UnitedHealthcare Community Plan (Arizona Physicians IPA). If your parent is not yet enrolled, they need to qualify both financially (countable assets at or below $2,000, gross income at or below $2,982/month or with a Miller Trust) and medically (PAS score of 60+ on the EPD scale). The application process takes 60 to 180 days.

A care plan that includes attendant care hours. The MCO case manager builds an individualized service plan for your parent. This plan specifies the types and hours of services authorized. Attendant care — help with bathing, dressing, toileting, grooming, eating, mobility, medication reminders, meal preparation, and light housekeeping — must be included in the plan. If your parent's current plan does not include attendant care, you can request a care plan review.

Willingness to be a W-2 employee. Under AWC, the contracted ALTCS provider agency becomes the employer of record. You receive a W-2, taxes are withheld, and you may be eligible for unemployment insurance and workers' compensation. Under SDAC, your parent becomes the employer of record with fiscal intermediary support. Either way, this is taxable employment income, not a casual family arrangement.

Agency with Choice (AWC): The Simpler Path

AWC is the option most families choose because it handles the employment logistics for you. Here is how it works:

Step 1: Tell the MCO case manager you want to be the attendant care provider. This is a conversation during a care plan meeting or a phone call. The case manager cannot refuse your request solely because you are a family member — Arizona permits eligible family caregivers, including spouses through AWC and adult children or siblings through AWC or SDAC, subject to the model's requirements.

Step 2: Complete the background check. You will need a Level 1 Fingerprint Clearance Card issued by the Arizona Department of Public Safety. This requires a fingerprint-based FBI and state criminal history check. Certain criminal offenses (called "precluded offenses" under A.R.S. § 41-1758.07) will disqualify you unless you obtain a Good Cause Exception. Disqualifying offenses include abuse, neglect, or exploitation of vulnerable adults.

Step 3: Complete required training. Training requirements vary by model and provider and may include CPR/First Aid, fundamentals of caregiving, and any condition-specific training the care plan requires (dementia care, transfer techniques, medication management).

Step 4: Sign the AWC agreement. The fiscal intermediary provides the employment paperwork — W-4, I-9, direct deposit enrollment, and the AWC participation agreement. This formalizes the arrangement: you are an employee of the fiscal intermediary, your parent directs your work schedule and tasks, and the intermediary handles payroll, tax withholding, and compliance.

Step 5: Begin providing care and logging hours. You submit timesheets — typically biweekly — documenting the hours worked and tasks performed. The fiscal intermediary processes payroll and deposits your pay. Your authorized hours are capped by the care plan. For a spouse, paid care is capped at 40 hours in any seven-day period.

Self-Directed Attendant Care (SDAC): More Control, More Responsibility

SDAC gives your parent (or their legal representative) direct control over hiring, firing, scheduling, and supervising the care provider — which can be you. The key differences from AWC:

• Your parent is the employer. They set the schedule, define the tasks within the care plan, and supervise the work. A fiscal intermediary handles payroll mechanics, but your parent holds employer authority.
• More flexibility in scheduling. AWC providers typically follow a schedule set in coordination with the MCO. SDAC allows your parent to adjust the schedule day by day as needs change, within the authorized total hours.
• More paperwork. Your parent (or you, as their representative) is responsible for additional employment records, hour verification, and communication with the fiscal intermediary.

For most families where an adult child is the caregiver, AWC is simpler. SDAC works better when the parent is cognitively intact and wants direct control over their care arrangement.

How to Negotiate the Right Number of Hours

The MCO case manager authorizes attendant care hours based on the PAS assessment and the care plan. This is a negotiation, not a decree. Here is how to approach it:

Document your parent's actual daily needs. Before the care plan meeting, keep a one-week log of every task you perform, the time each task takes, and how often it occurs. If bathing assistance takes 30 minutes daily, medication management takes 15 minutes three times daily, and meal preparation takes 45 minutes twice daily, that is roughly 2.75 hours per day or 19.25 hours per week — documented, specific, and defensible.

Reference the PAS score. The EPD PAS score establishes medical eligibility at 60 points and triggers a review window at 56–59, but it does not by itself guarantee a particular number of attendant-care hours. Use the case manager's PAS results and the specific ADL deficits documented in the assessment to support the hours your parent needs.

Know the applicable limit. A spouse's paid attendant care is capped at 40 hours in any seven-day period. For other caregivers, the authorized total follows the care plan; if more care is needed, arrange other eligible providers or unpaid support.

Request a care plan review if hours are insufficient. If the initial authorization does not cover your parent's actual needs, you have the right to request a formal care plan review. If the review does not resolve the issue, you can file a grievance with the MCO or appeal to AHCCCS directly. The guide provides the exact contact information and process for appeals.

What You Can and Cannot Be Paid For

Paid tasks (when included in the authorized care plan):

• Personal care: bathing, dressing, grooming, toileting assistance, oral hygiene
• Mobility assistance: transfers, walking support, wheelchair assistance
• Meal preparation and feeding assistance
• Medication reminders (not administration of injectable medications)
• Light housekeeping directly related to the member's care area
• Laundry for the member
• Accompaniment to medical appointments
• Errand assistance (grocery shopping, pharmacy pickups)

Tasks you cannot bill for:

• General household cleaning unrelated to the member's personal care
• Yard work, home maintenance, or repairs
• Transportation (ALTCS covers non-emergency medical transportation separately through the MCO)
• Skilled nursing tasks (wound care, injections, catheter management) unless you hold appropriate clinical credentials
• Hours when the member is hospitalized or in a facility

The Financial Impact Most Families Miss

The paid family caregiver pathway changes the financial picture of home care dramatically. Consider a typical scenario:

Without paid caregiving: An adult child provides 25 hours per week of care for free while also working a reduced schedule. The family's total care-related cost includes lost wages from reduced employment, plus any private-pay aide hours the family member cannot cover. If the family member reduced their work hours by 15 hours per week at $20 per hour, that is $15,600 per year in lost income.

With AWC paid caregiving at $16/hour for 25 hours/week: The caregiver earns $20,800 per year (before taxes) for work they were already doing. Combined with recovering the lost wages from reducing outside employment, the net financial swing can be $30,000 or more per year.

This is why the paid family caregiver pathway is often the single most valuable piece of information in the entire ALTCS process for families providing home care. The care is already happening. The only question is whether the family knows to formalize it and get compensated.

Who This Pathway Is For

• Adult children already providing regular care for an ALTCS-eligible parent in Arizona
• Spouses providing daily personal care and wanting to convert unpaid labor into income
• Family members who have reduced their outside employment to provide care and need to replace that income
• Families currently paying private-pay aides who could replace some or all of those hours with a family provider at no cost to the parent

Who This Pathway Is NOT For

• Family members who cannot pass the Level 1 Fingerprint Clearance Card background check due to precluded criminal offenses
• Caregivers who are unwilling to complete required training or submit timesheets — the formalization is not optional
• Situations where the parent is not ALTCS-eligible (assets above $2,000, income above $2,982 without a Miller Trust, or PAS score below 60)
• Families seeking a casual, undocumented payment arrangement — ALTCS-funded caregiver compensation is formal W-2 employment with tax withholding

Frequently Asked Questions

Can a spouse get paid as a caregiver under ALTCS?

Yes, through AWC. The care must meet the extraordinary-care standard, the spouse must meet the background-check and training requirements and be included in the care plan, and paid care is capped at 40 hours in any seven-day period. Spouses are not eligible to be hired under SDAC.

Does getting paid as a caregiver affect my parent's ALTCS eligibility?

The compensation is paid to you, not your parent, and is subject to standard income taxes. Ask the MCO or eligibility worker how the payment is treated in your parent's specific eligibility case, especially where spouses or other household finances are involved.

How long does it take to set up paid family caregiving from scratch?

If your parent is already enrolled in ALTCS with an active care plan, timing depends on completing the Fingerprint Clearance Card, required training, employment paperwork, and care-plan authorization. If your parent is not yet enrolled in ALTCS, add 60 to 180 days for the ALTCS application process.

Can I be a paid caregiver and still work another job?

Yes. There is no prohibition on outside employment. The practical limitation is the number of attendant-care hours authorized in the plan — and, for a spouse, the 40-hour cap in any seven-day period. If you are working another job, you and your parent need to structure the care schedule within the authorized hours that fit alongside your other employment.

What happens if I take a vacation or get sick?

The MCO can authorize temporary substitute providers — another family member or a professional aide — to cover your authorized hours during absences. Notify the case manager in advance when possible. You are only paid for hours you actually work and document on your timesheet.

The Arizona Home Care & Aging in Place Guide includes the complete paid family caregiver setup process — Agency with Choice enrollment, SDAC comparison, training requirements, timesheet protocols, and hour negotiation strategies — along with the full ALTCS eligibility walkthrough that gets your parent into the system in the first place.

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