Nobody warns you that the first day of being your mother's paid caregiver starts with electronic visit verification: an app telling you to clock in at her front door. If you're a family caregiver paid through Medicaid for personal care or home health services that need an in-home visit, and you don't live with the person you care for, being asked to use that app is normal and expected, because federal law makes your state require it., That doesn't make it feel less strange. What electronic visit verification records is a short federal list; how it works where you live is your state's call.

In This Guide

Yes, Family Caregivers Really Do Have to Clock In

The instruction isn't your case manager's preference, and it isn't a judgment about you. Congress wrote electronic visit verification into federal law in 2016. Section 12006 of the 21st Century Cures Act added section 1903(l) to the Social Security Act, which requires states to use an electronic visit verification system for Medicaid personal care services and home health care services that require an in-home visit by a provider. The federal electronic visit verification deadline for Medicaid personal care services was January 1, 2020, and Medicaid home health care services followed on January 1, 2023.

The reason states press so hard on this is financial, and it explains the tone. Under Section 1903(l) of the Social Security Act, a state that does not require electronic visit verification for Medicaid personal care and home health services loses federal matching money on a written schedule that climbs to a full 1 percentage point of the federal match for personal care services from 2023 onward, and for home health care services from 2027 onward. The EVV penalty applies only to personal care and home health dollars rather than to a state's whole federal match, but a state that runs a large in-home program is still looking at real money.

So when the financial management agency that issues your pay (some states call it a fiscal intermediary) chases you about an unverified visit, that's the machinery behind it, and it isn't discretionary at their end either. The Cures Act sets a floor and leaves the rest to your state, which is why your neighbor two states over has a different app and different rules about fixing mistakes.

The Six Things Electronic Visit Verification Records at Every Visit

Federal law is unusually specific here, and the list is more reassuring than imagining it. An electronic visit verification system has to electronically verify six things about each visit:

  1. The type of service performed
  2. The individual receiving the service
  3. The date of the service
  4. The location of service delivery
  5. The individual providing the service
  6. The time the service begins and ends

That is the whole federal list, and it maps onto what a paper timesheet has always asked: who, for whom, what, where, when it started, when it stopped.

Your state can add to that list. It cannot satisfy the federal list with paper. CMS was asked in 2019 whether a web-based timesheet with the client signing off would count, and answered no, because "web-based timesheets alone do not provide the state with auditable confirmation of the data entered by the provider and approved by the individual." That is why the app exists at all.

Is It Tracking Me All Day?

The federal floor is narrower than the fear: capturing where a visit starts and where it stops is enough to satisfy it, and your state may require more.

CMS put this in writing when it was asked how EVV could be implemented in ways that minimize privacy concerns: "The Cures Act does not require states to capture each location as the individual is moving throughout the community." CMS went on: "Services either starting or stopping in the individual's home are subject to EVV requirements, and capturing the location in which the service is started and stopped is sufficient for meeting the minimum requirements specified in the Cures Act."

CMS was equally direct about the technology. "CMS also notes that there is no requirement to use global positioning services (GPS), but it is one approach for implementation of the EVV requirements. A common alternative to GPS is Interactive Voice Response, which requires the caregiver to check-in and out using a landline or cellular device located at the individual's home." GPS is allowed; the law just didn't make it the only option.

One more thing belongs here, because leaving it out would make this sound better than it is. The federal rule is a floor, not a ceiling: in the same answer, "CMS notes that states may choose to require more information as a factor to control for fraud, waste, and abuse." What your particular system records is a question about your state's vendor, not about the Cures Act.

What about the afternoon you take your mother to the pharmacy? CMS addressed that too: "EVV is only required for the portion of the service rendered in the home." At least one state describes its own system that way: Hawaii Med-QUEST tells families outright that "The devices only capture information at the start and end of a visit."

If You Live With the Person You Care For

If you share a home with the person you care for, the federal answer may surprise you, and it sits in a 2019 CMS bulletin.

CMS was asked directly whether EVV requirements apply when the person receiving care lives with the caregiver providing it. The answer was: "No, EVV requirements do not apply when the caregiver providing the service and the beneficiary live together." The reasoning is that "PCS or HHCS rendered by an individual living in the residence does not constitute an 'in-home visit'." If you moved into your father's house to care for him, or he into yours, the federal mandate doesn't reach that arrangement.

But read the rest of CMS's answer before you make a phone call about it, because the second half is what decides your case. "However, states are encouraged to apply appropriate oversight to services provided in these circumstances to curb fraud, waste and abuse. Additionally, states may choose to implement EVV in these instances, particularly when using discrete units of reimbursement, such as on an hourly basis."

So the federal exemption is real, and your state can decline it. States have gone both ways, and the two examples below are not a survey of all fifty:

  • Ohio treats it as something you apply for. The Ohio Department of Medicaid Electronic Visit Verification Resource Guide, updated April 28, 2026, answers the question "Do providers have to participate in EVV if they live with the person receiving services?" with: "Providers who live in the same household as the person receiving services can request an EVV exemption using the live-in caregiver online request form." The Ohio guide adds that live-in caregivers requesting the exemption "must upload documentation to confirm the shared address."
  • Hawaii went the other way. In an April 19, 2022 town hall for self-direction members, Hawaii Med-QUEST told participants that "Hawaii has chosen to require Live-In Caregivers to use EVV" and that "Live-In Caregivers are also required to check-in and check-out when providing services."

If you share an address with the person you care for, ask your state Medicaid agency one specific question: does this state exempt live-in caregivers from EVV, and if it does, what do I file?

What the Law Says EVV Can't Be Used to Do

The fear under the clock-in fear is usually bigger than the app: if they can track when I'm in the house, how long before somebody decides I'm not the right person to be caring for her?

Congress wrote something about that. Section 12006(c)(3) of the Cures Act, printed as a construction note to 42 U.S.C. 1396b, says: "Nothing in the amendment made by this section may be construed to limit, with respect to personal care services or home health care services provided under a State plan under title XIX of the Social Security Act (or under a waiver of the plan) (42 U.S.C. 1396 et seq.), provider selection, constrain beneficiaries' selection of a caregiver, or impede the manner in which care is delivered."

The same section says the amendment can't be read to require one particular or uniform electronic visit verification system to be used by every agency or entity that provides these services. CMS describes the same latitude from the state's side, writing that "states have significant discretion to utilize the system(s) of their choosing. CMS does not endorse one type of system over another."

Two honest limits on all of that. First, these are rules of construction: they govern how the EVV amendment is read, they are not a complaint process, and nothing here tells you that you have an appeal if your state's system does get in the way. Second, none of it disarms your state. Paragraph (4) of the same section provides that nothing in the amendment bars a State from establishing quality-measure requirements for its EVV system.

Your State Has to Offer You Training

If somebody handed you a phone and a login and walked away, that isn't how this was supposed to go.

Section 1903(l) of the Social Security Act, in the same subsection that creates the EVV mandate, tells states to ensure that individuals who furnish personal care services or home health care services "are provided the opportunity for training on the use of such system." It also tells states to consult with the agencies and entities providing those services so the system "is minimally burdensome," takes account of systems already in use in the state, and runs in line with HIPAA privacy and security law. And it tells states to take into account a stakeholder process that includes input from beneficiaries, family caregivers, and the people actually furnishing the services. That training language is a duty the statute places on your state, not an individual right it hands you.

Family caregivers are named in the statute, so you are not an afterthought in this system on paper, whatever it feels like in practice. If nobody has trained you, asking your financial management agency for that training is a reasonable request, and your state is the party the law tells to make it available.

What Happens If a Visit Doesn't Verify

The question that keeps people up is simple: you forgot to clock out, or the app crashed, and you've just worked six hours the system has no record of. Are you paid?

Your state answers this one. Section 1903(l) lists the six data elements and the duties it places on states implementing the system, and none of those items sets a deadline for correcting a visit. State rules differ, sometimes sharply, but looking at one state's rules closely still helps, because the shape of the answer is fairly consistent even where the details aren't.

Take Texas. The Texas process for fixing an incomplete visit record is called visit maintenance, and it has a clock: Texas requires visit maintenance, including manually entering a visit an employee failed to clock, to be completed within 95 calendar days from the date of service delivery, though the Texas Health and Human Services Commission may extend that window. After that window expires, the Texas EVV system locks the visit transaction, and the only way back in is a Visit Maintenance Unlock Request.

That unlock is narrower than it sounds. Texas directs payers to approve a Visit Maintenance Unlock Request where a state or proprietary EVV system error wasn't resolved inside the 95-day visit maintenance window, or where Texas determines an exception is required for something like a payer error or a natural disaster. Texas also directs that payers may not approve an unlock request where the caregiver simply failed to clock in or out and nothing stopped the visit being entered inside the Texas 95-day window. In plain terms: in Texas a forgotten punch is fixable, the fix has a deadline, and after it usually isn't.

Texas also decides in advance who does that fixing. A Texas consumer-directed services employer, the person who holds the employer role for the worker, picks one of three options on a Texas HHSC form: the employer performs all visit maintenance and approves the employee's time, the financial management agency performs the maintenance while the employer approves the time, or the agency performs the maintenance and confirms the time based on the employer's approval documentation.

Those are Texas's rules, not your state's unless you live there. What generalizes is the shape: how long do I have to correct a visit, who has the authority to correct it, and what happens when that window closes? Ask whoever pays you, before the first mistake rather than after it.

No Smartphone, No Signal, Dead Battery

The federal guarantee here is smaller than you'd hope, but it isn't nothing.

CMS was asked whether an EVV system requires the Medicaid beneficiary to have an internet connection, a cell phone, or a landline, and answered: "No. CMS notes that there are a number of options available within an EVV system. CMS believes there are EVV system options that meet the six verification criteria specified in the legislation without relying upon a Medicaid beneficiary to supply any technology, including those in which the provider has a phone or electronic tracker available to staff and/or the service recipient." That answer is about what the system may require of the person receiving care, not about which of those options your own state has chosen to offer.

Beyond that, the answer is your state's. Texas, again as one worked example, approves exactly three clock-in and clock-out methods: a mobile app, the person's home landline, and a standalone alternative device. In Texas the mobile method is the only approved one when a visit begins or ends out in the community, and a Texas caregiver who can't use it in that situation isn't shut out of the visit; they document the visit data under program policy instead. The device that needs neither a smartphone nor a landline is rationed: Texas caps how many free alternative devices a program provider or financial management agency can order from the state vendor at the greater of one device or 7.5% of its member census, and anything past that has to be bought.

If your phone dies mid-visit, don't guess. Write down the actual start and stop times immediately, in ink, and call your financial management agency the same day to ask how their system wants that visit recorded. Ask, while you have them, how long your state's window for fixing it stays open.

Who Decides What in Electronic Visit Verification: Federal Floor, State Rules

Your question Who decides What's settled
Do I have to clock in at all? Federal Yes, for Medicaid personal care and home health services needing an in-home visit
What gets recorded each visit? Federal floor, state can add The six elements are the minimum; a state may require more
Is my location tracked between clock-in and clock-out? Federal floor, state can add Start-and-stop capture meets the federal minimum, and GPS isn't required by it
Which app or device do I use? Your state CMS says states have significant discretion to choose their system; the Cures Act doesn't require one uniform system across all providers
Am I exempt because I live with her? Federal by default, state can override Federal rules don't reach a live-in caregiver, and a state may still require EVV
How long do I have to fix a missed punch? Your state None of the Cures Act's six data elements or state duties sets one; Texas allows 95 days
Do I get paid if a visit never verifies? Your state Your state's rules decide; Texas locks the visit after 95 days
Who fixes the record, me or the agency? Your state, and often whoever employs you on paper In Texas the consumer-directed services employer picks one of three options

The rows in the bottom half are the ones that decide your paycheck, and your state is where you get those answers., Knowing which of your questions has a federal answer saves you from arguing the wrong point with the wrong office.

Two offices matter: your state Medicaid agency, and the financial management agency or fiscal intermediary that issues your pay. For a specific visit, correction, or deadline, the second is almost always the right call.

Frequently Asked Questions

Do family caregivers have to use EVV, or is it only for agency workers?

Electronic visit verification applies to a Medicaid personal care or home health visit whether the person providing it is the beneficiary's daughter or a stranger from an agency: the federal requirement attaches to the service, not to your relationship. The federal carve-out that turns on relationship is living in the same home, and your state can choose to apply EVV anyway.

Does EVV know where I am between clocking in and clocking out?

Federal EVV rules don't require it. CMS has written that capturing where the service starts and stops meets the federal minimum, and that the Cures Act doesn't require states to track a caregiver through the community. CMS also says states may choose to require more, so ask whoever runs your system what it records.

What happens if I forget to clock in or out?

Your state decides whether that visit can still be corrected and paid, and how long you have to do it. In Texas, required visit maintenance must be completed within 95 calendar days of the date of service delivery, and Texas directs payers not to approve a later unlock request where a caregiver simply failed to clock in or out. Write down the real start and stop times immediately and call the agency that pays you the same day.

What if I don't own a smartphone?

Your state decides which clock-in methods it approves; Texas, as one worked example, approves a mobile app, the person's home landline, and a standalone alternative device that needs neither. The federal guidance addresses the person receiving care rather than the caregiver: CMS says an EVV system does not require the Medicaid beneficiary to supply an internet connection, a cell phone, or a landline.

Can they cut my hours or replace me over EVV data?

Section 12006(c) of the 21st Century Cures Act says its EVV amendment may not be construed to "constrain beneficiaries' selection of a caregiver, or impede the manner in which care is delivered." That is a limit on how the law is read rather than a complaint process, so it does not by itself give you a remedy. Raise a specific decision with your case manager or the agency that authorized the service.

Learn More

CaregiverMedicaid Self-Direction and Consumer-Directed Services: How Family Caregivers Get PaidHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverHow to Get Paid as a Family Caregiver: The 50-State GuideHow to get paid to care for a family member in 2026: Medicaid self-direction, VA caregiver programs, personal care agreements, plus all 50 state guides. CaregiverHow to Get Paid to Care for Your SpouseCan you get paid to care for your spouse? Spouses are often excluded from Medicaid pay, but some states, the VA PCAFC program, and Aid and Attendance do. CaregiverConsumer Direction in Ohio: The Operational Guide to Being a Paid Family Caregiver Under Ohio MedicaidHow Ohio consumer direction works in 2026: enroll with Public Partnerships LLC, set up EVV and timesheets, and use the Difficulty of Care tax exclusion. MedicaidHow Georgia Electronic Visit Verification Works for Medicaid In-Home CareHow Georgia Medicaid electronic visit verification (EVV) works: which services require it, how caregivers clock in and out, and how to avoid claim denials. CaregiverHow to Get Paid as a Family Caregiver in TexasLearn how to get paid as a family caregiver in Texas through Medicaid CDS, CAS, VA programs, and CMPAS. Covers pay rates, eligibility, and step-by-step process.

Find personalized help sorting out your state's electronic visit verification rules 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.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.