Idaho Medicaid Attendant Care: Can a Family Member Be Paid Now?

Idaho Medicaid no longer pays a spouse for attendant care, and for an adult child or other family member its rules don't say yes or no. Family Personal Care Services, which let a spouse be paid for attendant care and personal care, ended on July 15, 2025. Idaho's Aged and Disabled waiver rule bars only the spouse from direct care work, and attendant care workers must be employees of an agency, so any paid role would come through one.1

Which Family Member Can Idaho Medicaid Pay for Attendant Care?

If you're already helping a parent at home, the answer depends on two things: your relationship to them, and which program pays for the care. Attendant care is a service of Idaho's Aged and Disabled (A&D) Waiver, a Section 1915(c) waiver for people 65 or older and adults 18 to 64 with physical or other disabilities who meet a nursing facility level of care. Personal Care Services (PCS), which cover grooming, bathing, toileting, dressing, and food and nutrition, are a separate State Plan benefit.4

The rules for who can be the paid worker sit in IDAPA 16.03.26, Idaho's Medicaid Plan Benefits rule, and in an IDHW notice to providers. Here's how they line up by relationship.1

"Not stated" isn't a yes: neither Idaho's A&D and PCS rule sections nor the IDHW page say whether an adult child or other relative may be the paid attendant or PCS worker.1 That's frustrating when you're already doing the care. Put the question to the agency and IDHW in writing, so you have an answer to point back to.

If your parent could move into your home, there's a second route to look at. Idaho's certified family home (CFH) rules cover care providers who are paid to care for an adult living in the provider's own home, and they apply to a relative who is paid through a publicly funded program. The provider must live in the home, and whether a particular home can be certified is decided through the Department's CFH certification process.5 IDHW says a CFH provider may or may not be related to the resident, and that residents may be eligible for Medicaid to pay their CFH provider. A spouse still can't be the paid A&D adult residential care provider.6 See getting paid as a relative in an Idaho certified family home.

What Changed When Family Personal Care Services Ended

Until mid-2025, a spouse could be paid. IDHW says the Family Personal Care Services (FPCS) program "allowed a parent of a minor child or spouse to provide Personal Care Services and Attendant Care to eligible members" and that it "has terminated effective July 15, 2025." IDHW adds that "Legally Responsible Individuals (LRI’s) for members are no longer allowed to be the paid caregiver."1

If you were counting on that income, losing it is a real blow. The rule now closes the door for the A&D waiver too: under IDAPA 16.03.26.544.03, "Direct care workers cannot be a participant’s spouse." That subsection sets the qualifications for the A&D waiver's providers of homemaker, respite care, adult day health, transportation, chore, companion, attendant care, adult residential care, case management, and home-delivered meal services.1

State Plan personal care follows a federal Medicaid rule, too. Under 42 CFR 440.167, State Plan personal care must be provided by someone "who is not a member of the individual's family," and for that benefit a family member means a legally responsible relative.7 For routes outside Idaho Medicaid, see getting paid to care for a spouse in Idaho.

Do You Have to Work Through an Agency for Idaho Medicaid Attendant Care?

Usually, yes: a family member doing Idaho Medicaid attendant care would be hired by an agency, not paid by Medicaid directly. Idaho's A&D rule says attendant care providers "must be employees of an agency," and more broadly that "unless otherwise specified by the Department, each individual service provider must be an employee of an agency." The Department may also sign provider agreements with individuals when no agency exists or no fiscal intermediary is willing to provide services.1 So an adult child hired as an attendant would usually be an agency employee. Ask each agency what it pays its attendants before you agree to anything; the BLS wage estimate above is only a guide.

There's a role in the rule that does name family. The A&D rule defines the employer of fact, the person who "hires, fires, and directs the services delivered by a waiver provider," as the participant or their representative, and adds: "This individual may be a family member."1 So as your parent's representative, you can direct the care. That doesn't make you the paid worker.

Two more definitions speak to questions you may have: whether the paid worker can live with your parent, and whether respite pays you. Idaho's A&D companion services definition says "the provider may live with a participant," without saying whether that provider may be a relative. And A&D respite care is defined as "short-term breaks from caregiving responsibilities to non-paid caregivers," so respite is built to give you a break, not to pay you.1

Who Decides How Many Hours Get Paid?

You don't set the hours. Under Idaho's A&D rule, the Department reviews and approves every individual service plan based on the assessment and other medical information, and "authorizes services by type, scope, and amount." Services not in the plan, or beyond what the Department approved, "are not eligible for Medicaid payment." The A&D sections of the rule state no weekly hour cap for attendant care.1

State Plan personal care is tighter. Idaho's rule limits PCS to 16 hours a week unless authorized under EPSDT, bases authorizations on the participant's assessment and service plan, and requires every PCS provider to be an RN, an LPN, or meet personal assistant standards.1 For a parent who needs help with bathing, dressing and meals every day, a 16-hour week can leave gaps your family still has to fill. That's why the assessment matters so much: describe what your parent can't do on a hard day, not a good one.

Does Idaho Have Self-Direction or CDPAP?

If you've read that families can hire a relative through self-direction, Idaho's version is narrower than you may hope. Idaho's Consumer-Directed Community Supports (CDCS) program, set out in IDAPA 16.03.26, isn't for the A&D population. To choose CDCS, a person must be Medicaid-eligible and meet the requirements of the Adult DD waiver for adults with developmental disabilities or the Children's HCBS State Plan Option. Within CDCS:

• A paid community support worker (CSW) must not be the participant's spouse.
• Under Family-Directed Community Supports (FDCS), the children's option, a paid CSW also must not be the participant's parent or legal guardian.
• Under self-directed community supports (SDCS), a legal guardian may be chosen as the CSW if the circle of supports includes at least one non-family member who isn't the support broker.1

The A&D waiver has its own form of control. Idaho's A&D rule defines a fiscal intermediary (FI) as an entity whose services let the participant, their designee or legal representative choose their level of control to recruit, select, manage, train and dismiss direct care staff, regardless of the employer of record. The rule doesn't say whether that staff may be a relative.1

If you searched for CDPAP in Idaho, you may have heard of a program that pays family directly. That's New York's. The Consumer Directed Personal Assistance Program is created by New York law, which bars a person legally responsible for the consumer's care and support, the consumer's spouse and the designated representative, but allows other adult relatives to be the paid personal assistant when the program's conditions are met.8 For older adults in Idaho, attendant care comes through the A&D waiver, where attendant care workers must be agency employees.1

How to Ask About Being the Paid Attendant

For the full list of A&D waiver services, see Idaho Medicaid HCBS waivers.

Is Attendant Care Pay Taxable?

It may not be, if you live with your parent. Under IRS Notice 2014-7, the IRS treats qualified payments under a state's Section 1915(c) waiver as difficulty-of-care payments excludable from federal gross income, but only for care in the caregiver's own home where the care recipient also lives, and not when the caregiver has a separate home.9 Idaho's A&D Waiver is a 1915(c) waiver.4 State Plan personal care is a separate State Plan benefit, not an A&D waiver service.4 For payments outside a 1915(c) waiver, the IRS says excludability for payments under other state programs "will depend on the nature of the payments and the purpose and design of the program."9,8 Ask a tax professional how this applies to agency wages, and see whether Medicaid waiver payments are taxable.

Learn More

Find personalized help getting paid for Idaho Medicaid attendant care as a family member 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.