Arizona's Medicaid long-term care program, the Arizona Long Term Care System (ALTCS), pays family members, adult children included, for attendant care, personal care and homemaker help at home. ALTCS pays a relative as a direct care worker through an agency or one of two options the member directs, for hours the case manager sets.

Which Family Members ALTCS Attendant Care Can Pay, Option by Option

The option you pick decides which relative can be the paid direct care worker (DCW).

Family member Through a DCW agency Agency with Choice Self-Directed Attendant Care
Adult child or other listed relative Yes Yes, if not the member's representative Yes
Spouse Yes, under Spouse as Paid Caregiver Not stated; ask the case manager No
Relative who lives with the member Yes Ask the case manager Ask the case manager
Legal guardian Ask the case manager No No

AHCCCS's visit-verification policy says a paid caregiver can include a live-in caregiver. Its Agency with Choice (AWC) and Self-Directed Attendant Care (SDAC) policies state no live-in rule, and under both, parents of minor children can't be the paid DCW.

Working Through a DCW Agency

AHCCCS policy 1240-A covers ALTCS for the elderly and physically disabled (E/PD), the Division of Developmental Disabilities (DDD) and fee-for-service Tribal ALTCS. ALTCS direct care services must be medically necessary and are paid only while the member lives in their own home, not in an institutional or alternative home and community-based setting, so the pay ends if your parent moves into a nursing facility. The hospital-stay exception is on the Arizona caregiver programs page. The ALTCS DCW agency hires or contracts you, supervises you and defines your tasks.

When the paid ALTCS caregiver is legally responsible for the member, such as a spouse, the care must be extraordinary: beyond what a spouse would ordinarily do if the member did not have a disability or chronic illness. A paid spouse's weekly hour cap, employer and pay ceiling are in the Arizona spouse caregiver guide.

Agency with Choice

Under AWC, the provider agency and the member share the employer role: the agency keeps the authority to hire and fire the caregiver and to provide or arrange required minimum training, and the member or their representative can take on employer tasks such as recruiting, scheduling, supervising or training the caregiver.

Under AWC policy 1310-A, the member's Individual Representative can't be the paid DCW, and a guardian automatically serves as that representative. Policy 1310-A doesn't say whether a spouse can be paid under AWC.

Self-Directed Attendant Care

SDAC, available since 2008, makes the ALTCS member or their legal guardian the legal employer, and a Fiscal Employer Agent handles the caregiver's taxes, payroll withholding and paychecks.

SDAC policy 1320-A applies to ALTCS E/PD and fee-for-service Tribal ALTCS. A spouse can't be reimbursed for SDAC services, and a legal guardian can't be the paid worker and must be present when SDAC services are provided. The member keeps the worker's hours within those the case manager authorized.

How Many Hours a Family Caregiver Can Be Paid

The ALTCS case manager sets the paid hours through a needs assessment and a cost-effectiveness study.

What ALTCS Attendant Care Pays a Family Member

Typical pay: about $17.51 an hour (estimate based on home care aide wages in Arizona, BLS, May 2025), the Arizona aide median, not an ALTCS rate.

AHCCCS publishes no ALTCS caregiver wage. Its fee-for-service attendant care rate, effective January 1, 2026, is $6.80 per 15 minutes statewide (S5125, about $27.20 an hour), or $4.89 (about $19.56 an hour) for Self-Directed Attendant Care (S5125 U2): what AHCCCS reimburses for the service, not the caregiver's wage. Flagstaff and Tucson rates are on the programs page.

Your ALTCS DCW agency sets your wage. Under SDAC, AHCCCS's member manual says the member's ALTCS health plan (the Program Contractor) decides how much to pay the worker. So the rate isn't your paycheck; ask your hourly wage before budgeting.

Background Checks and Training

Requirement Through a DCW agency Self-Directed Attendant Care
CPR and first aid Required before providing care Required before employment, from a nationally recognized organization, trained in person
Training and testing 90 days from hire to train and pass tests Universal precautions and health-information privacy training
Criminal background check At hire and every three years Recommended, not required; set up through the case manager if the member asks
Protective services registries At hire and every year Ask the case manager

Through an agency, including under AWC, you can work during the 90-day training period if you've done DCW or similar work in the last two years, but must stop if it runs out before you pass the knowledge and skills tests; without that experience, you must pass both tests before starting. Registered nurses, licensed practical nurses, certified or licensed nursing assistants and licensed health aides are exempt from ALTCS DCW training and testing unless the agency requires it. These 1240-A rules don't apply under SDAC or DDD's Independent Provider Network option. A worker who can't get an Arizona Fingerprint Clearance Card, or who has a substantiated report on the adult protective services or child safety registry, can't provide ALTCS services. The spouse caregiver guide covers family-only background-check waivers; the family caregiver training guide compares states.

SDAC's identity documents and background-check steps are on the programs page.

How to Start

1
Step 1

Apply for ALTCS if your relative isn't on it yet

The Arizona Medicaid application guide covers how.

2
Step 2

Call the ALTCS case manager

Ask for the needs assessment and which of the three options fits your family.

3
Step 3

Get CPR and first aid certified, then confirm your wage

with the DCW agency, or under SDAC with the health plan.,,

Frequently Asked Questions

Which ALTCS health plan will my parent have?

It depends on your county. The three ALTCS E/PD plans, which counties get a choice, and the 2027 contract change are on the Arizona caregiver programs page.

Learn More

CaregiverHow to Get Paid as a Family Caregiver in ArizonaPaid family caregiver in Arizona: 2026 ALTCS attendant care, Agency with Choice, Self-Directed Attendant Care, the spouse-pay rule, and VA caregiver options. CaregiverHow to Get Paid to Care for Your Spouse in ArizonaCan you get paid to care for your spouse in Arizona? Yes, if the care qualifies, through ALTCS. Here is the Medicaid rule, the 40-hour cap, and the VA routes. CaregiverArizona Caregiver ProgramsEvery caregiver program in Arizona: ALTCS paid pathways (spouses can be paid), respite, NFCSP grants, VA benefits, and taxes explained for 2026. MedicaidArizona Medicaid HCBS Waivers: How Home Care Works Through ALTCSArizona Medicaid HCBS waivers explained: how ALTCS pays for home and community care, who qualifies, the 2026 income and asset limits, and how to apply.

Find personalized help setting up paid ALTCS attendant care for your family at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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