Rhode Island Personal Choice Program: Hire Family as a Paid Caregiver

You have been providing daily care for your parent — bathing, dressing, cooking, managing medications — without compensation, while your own career and finances suffer. Rhode Island's Personal Choice Program lets your parent hire you as a paid personal care assistant through Medicaid, turning the care you are already providing into a funded job.

This is one of the most underused programs in the state. Here is exactly how it works.

How Personal Choice Works

Under Rhode Island's Section 1115 Global Waiver, Medicaid LTSS beneficiaries can choose to self-direct their home care instead of receiving services through a licensed agency. Your parent becomes the employer, manages a monthly budget based on their assessed care needs, and hires their own personal care assistants (PCAs).

The budget, hours, and care tasks are determined during the EOHHS clinical assessment — the same assessment used for all Medicaid LTSS services. The difference is the delivery model: instead of an agency sending a stranger, your parent picks who provides the care.

A state-certified fiscal intermediary handles the administrative side — payroll, taxes, workers' compensation, and billing Medicaid. Your parent does not deal with the paperwork of being an employer. Current fiscal intermediaries in Rhode Island include AccessPointRI, Seven Hills Rhode Island, and Tri-County.

Who Can Be Hired (and Who Cannot)

The eligibility rules for PCAs are specific:

Can be hired:

• Adult children
• Grandchildren
• Nieces, nephews, siblings
• Friends, neighbors, other trusted individuals

Cannot be hired:

• Spouses
• Legal guardians
• Financial powers of attorney
• Designated representative decision-makers

The spouse exclusion is absolute — even if your parent's spouse is their primary caregiver, they cannot be paid through Personal Choice. Non-spouse family members face no such restriction, which is why adult children are the most common paid PCAs under this program.

The Background Check Process

Every prospective PCA must complete a multi-stage background screening before they can start:

1. Multi-registry screening: The fiscal intermediary checks seven state registries for disqualifying offenses related to abuse, neglect, or clinical violations.
2. National fingerprint-based BCI check: After clearing the registries, the candidate takes a state eligibility letter to the Attorney General's Bureau of Criminal Identification at 4 Howard Avenue in Cranston. This requires an in-person visit and a mandatory fee of $46.20.
3. Electronic Visit Verification (EVV): Once hired, the PCA is legally required to use the state's EVV system (Sandata or a compliant alternative). The system uses geo-fencing to electronically document service type, date, location, provider, and patient for each shift.

The entire background check process typically takes three to six weeks — plan accordingly and do not wait until the current care arrangement is falling apart.

Why This Matters Financially

Beyond getting paid for caregiving work, a Personal Choice care contract creates a documented, fair-market-value exchange. This distinction is critical for Medicaid asset protection: if DHS reviews the family's finances during the 60-month look-back and finds cash flowing from parent to child without a documented service contract, those payments could be classified as disqualifying gifts, triggering a penalty period.

A properly structured Personal Choice contract — with documented hours, tasks performed, and market-rate compensation verified by the fiscal intermediary — protects both the parent's Medicaid eligibility and the family's financial position.

Getting Started

To access Personal Choice, your parent must first qualify for Medicaid LTSS:

1. Submit the Medicaid LTSS application through DHS
2. Pass the financial eligibility review (under $2,982/month income, under $4,000 in countable assets)
3. Complete the EOHHS clinical assessment demonstrating a nursing facility level of care need
4. During the CP-12 Recipient Choice process, elect self-directed care under Personal Choice

Once approved, contact one of the authorized fiscal intermediaries to set up the employment arrangement, begin the PCA background check, and establish the EVV system.

The Rhode Island Home Care Navigation Guide includes the complete Medicaid application checklist, a caregiver contract template, and step-by-step instructions for coordinating with the fiscal intermediary — everything you need to transition from unpaid family caregiver to compensated PCA.

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