Independent Choices Program Arkansas: How Consumer-Directed Care Works

What the Independent Choices Program Is

The Independent Choices program is a consumer-directed option within the ARChoices in Homecare waiver. Instead of receiving personal care from a home health agency chosen by the state, the Medicaid beneficiary (or their authorized representative) selects, hires, trains, and manages their own caregiver — including a family member.

This matters because the standard ARChoices pathway assigns a care agency, and the beneficiary has limited control over which aide shows up or when. Independent Choices flips that arrangement. The beneficiary becomes the employer of record, working with a fiscal intermediary that handles payroll taxes, workers' compensation, and Medicaid billing.

Eligibility Requirements

To qualify for Independent Choices, your parent must first meet the ARChoices in Homecare waiver requirements:

Financial eligibility. Gross monthly income must be at or below $2,982 (the 2026 income cap). If it exceeds this threshold, a Qualified Income Trust (Miller Trust) resolves the gap. Countable assets must be $2,000 or less for an individual applicant.

Clinical eligibility. A licensed assessor using the Arkansas Independent Assessment (ARIA) tool must certify that the applicant requires nursing facility level of care. This means significant limitations in at least one core activity of daily living (transferring, eating, or toileting), a cognitive impairment requiring continuous supervision, or a medical condition needing daily clinical monitoring.

Capacity to direct care. The applicant or their representative must be able to manage the employment relationship — selecting a caregiver, setting schedules, and overseeing care quality. If the applicant has significant cognitive decline, a family member with power of attorney or legal guardianship can serve as the authorized representative.

How the Payment System Works

DHS determines a monthly budget based on the Task and Hour Standards (THS) assessment. The ARIA evaluation calculates how many hours of personal care, respite, or other services the beneficiary needs based on their functional limitations. That budget then flows through a fiscal intermediary rather than a care agency.

The caregiver is paid an hourly rate set by the state Medicaid reimbursement schedule. The fiscal intermediary handles withholding, issues W-2s, and manages liability insurance. The beneficiary doesn't write personal checks to the caregiver — everything runs through the intermediary to maintain proper documentation for Medicaid compliance.

Hiring a family member as the caregiver is permitted under Independent Choices, with one restriction: a spouse cannot be the paid caregiver. Adult children, siblings, grandchildren, and non-relatives all qualify. This creates a legitimate way to compensate family caregivers through Medicaid funds while keeping your parent at home.

Why Families Choose Independent Choices Over Agency Care

Consistency. Agency-based care often means rotating aides. A family member or a single trusted caregiver provides continuity, which matters enormously for someone with dementia or anxiety around unfamiliar people.

Scheduling flexibility. Agency workers follow set schedules. Under Independent Choices, the beneficiary and caregiver negotiate hours directly — evening help, weekend coverage, or split shifts during the week.

Cultural and language fit. Families can hire someone who speaks their parent's language or understands their cultural expectations around food, personal care, and daily routines.

The tradeoff is administrative responsibility. Someone has to manage the employment relationship, track hours, and communicate with the fiscal intermediary. If no one in the family can handle that oversight role, agency-based ARChoices may be the better fit.

Preparing for the Assessment

The THS assessment directly determines how many hours of care your parent receives. Families who understate their parent's limitations during the nurse's visit end up with fewer authorized hours — sometimes too few for safe home care.

Document specific incidents before the assessment: falls in the past month, times your parent couldn't manage toileting alone, episodes of wandering or confusion, meals missed because they forgot to eat. The assessor scores functional limitations based on what they observe and what the family reports. Vague statements like "she needs some help" produce lower scores than specific accounts of what goes wrong without assistance.

If the assessment results in insufficient hours, you can request a reassessment or appeal the determination through the DHS Office of Appeals and Hearings. You have 35 calendar days from the notice to request a fair hearing.

The Arkansas Medicaid Long-Term Care & Asset Protection Guide includes an ARChoices assessment preparation worksheet that walks through each functional area the ARIA tool evaluates, so families can organize their documentation before the nurse arrives.

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