An adult child or other non-spouse relative can be paid to care for a family member at home in Rhode Island through a Medicaid program that lets the person needing care hire a helper.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf In the Rhode Island Personal Choice Program, your parent hires their own personal care attendant (PCA) and sets that caregiver's pay from a Medicaid care budget.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Who Can Get Rhode Island Personal Choice Program Caregiver Pay?
| Your relationship to the participant | Can you be the paid PCA? |
|---|---|
| Parent, adult child or other non-spouse relative | Yes |
| Spouse | No |
| Representative, financial POA or Social Security representative payee | No |
| Legal guardian | No if you serve as the representative; otherwise ask the program |
Rhode Island's Personal Choice regulation, 210-RICR-50-10-2, bars the participant's representative, spouse, financial power of attorney or Social Security representative payee from being the paid PCA, but not a relative who lives with them.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Your parent, not the case manager, hires; Rhode Island's Personal Choice regulation says "Individuals choose who provides their services and when and how the services are provided."Centers for Medicare & Medicaid Services. (2026). Rhode Island Comprehensive Section 1115 Demonstration - CMS approval and Special Terms and Conditions (approval period January 1, 2026 through December 31, 2030) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Caring for a husband or wife? See getting paid to care for your spouse in Rhode Island for other routes.
What the Rhode Island Personal Choice Program Does
Personal Choice is a self-directed option for Medicaid long-term services and supports (LTSS). EOHHS runs it and contracts with community agencies that help each participant build a plan of care, manage services and pay the caregiver they choose.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
EOHHS lists personal care, homemaker and chore services, self-directed goods and services, and supports. Under Rhode Island's 2026 to 2030 Comprehensive Demonstration, only personal care and homemaker services can be self-directed in Personal Choice.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Rhode Island's Personal Choice regulation caps goods and services at 10% of the monthly budget.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Who qualifies. Personal Choice serves Medicaid LTSS beneficiaries: adults 18 to 64 with disabilities and anyone 65 or older eligible for Medicaid LTSS.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Your parent must also:
- meet the High or Highest nursing facility level of care;
- have shown the ability to direct their own care, or have a qualified designated representative to direct it; and
- want to stay in, or return to, their home.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Under Rhode Island's level-of-care rule, highest need includes, among other criteria, needing extensive help or total dependence with at least one of toileting, bed mobility, eating or transferring plus limited help with one other daily activity; high need includes at least limited daily help with two of bathing or hygiene, dressing, eating, toilet use, walking or transferring.webserver.rilegislature.gov. (2025). R.I. Gen. Laws § 40-8.10-3 — Levels of care (as amended by P.L. 2025, ch. 278, art. 8, § 7, effective June 29, 2025). Retrieved Oct 4, 2026, from https://webserver.rilegislature.gov/Statutes/TITLE40/40-8.10/40-8.10-3.htm
What a PCA Must Do Before the First Paycheck
Rhode Island's Personal Choice regulation says "PCAs will not be paid until the participant has verified that training has occurred."Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf A Personal Choice PCA must:
- be at least 18 and authorized to work in the United States;
- complete training: a parent who already knows you can train you at home, send you to the mandatory orientation and training, or combine the two (a registry PCA takes the orientation and training first);
- hold CPR and First Aid certification, renewed every two years, to be on the registry (Certified Nursing Assistants and those with an active certification excepted); and
- pass a fingerprint-based National Criminal Background Check every five years, plus annual Inspector General screenings and an annual Abuse Registry Record Check.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
A disqualifying conviction bars Rhode Island Personal Choice PCA work unless an EOHHS review committee grants an exception.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Rhode Island Personal Choice Program Caregiver Pay and Hours
Rhode Island's Personal Choice regulation, effective February 12, 2024, says "Participants determine the hourly wage for PCA, which can range from fifteen dollars ($15.00) up to twenty-one dollars ($21.00) per hour."Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Each Rhode Island Personal Choice PCA is capped at 40 hours a week, so more care needs a second PCA.Centers for Medicare & Medicaid Services. (2026). Rhode Island Comprehensive Section 1115 Demonstration - CMS approval and Special Terms and Conditions (approval period January 1, 2026 through December 31, 2030) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Your parent needs an emergency back-up plan for when a PCA can't work.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Ask the agency how many hours your parent's budget covers.
You don't run payroll yourself: a certified fiscal intermediary provides financial management services and helps your parent employ PCAs.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf For how that paycheck is reported, see whether a Medicaid-paid caregiver gets a W-2 or a 1099.
Don't assume the wages are tax-free: IRS Notice 2014-7 is written for 1915(c) waiver payments,Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Jul 10, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income and Rhode Island delivers home- and community-based services, Personal Choice included, through its Comprehensive Demonstration rather than standalone 1915(c) waivers.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf,Centers for Medicare & Medicaid Services. (n.d.). Rhode Island Comprehensive Demonstration Fact Sheet — Medicaid.gov (CMS). medicaid.gov. Retrieved Sep 4, 2026, from https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ri/ri-global-consumer-choice-compact-fs.pdf See whether Medicaid caregiver pay is taxable, and check with a tax professional.
How to Start
Get your parent on Medicaid LTSS
Apply with the Rhode Island Department of Human Services Application for Assistance plus the supplemental LTSS forms.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026). medicaid.gov. Retrieved Oct 13, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Call EOHHS about Personal Choice
at 401-462-6393.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Complete the initial functional assessment
that EOHHS performs.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Work with a contracted agency on the plan of care
Its case manager guides and supports your parent rather than directing them. EOHHS lists AccessPointRI (401-941-1112), Seven Hills (401-229-9700) and Tri-County (401-351-2750).Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Finish your training and checks
, and have your parent verify your training so pay can start.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Frequently Asked Questions
I'm my mom's legal guardian or health care power of attorney. Can I be her paid PCA?
A legal guardian or health care power of attorney is not named on the PCA bar in Rhode Island's Personal Choice Program, but cannot be the paid PCA while also acting as the participant's Personal Choice representative.Centers for Medicare & Medicaid Services. (2026). Rhode Island Comprehensive Section 1115 Demonstration - CMS approval and Special Terms and Conditions (approval period January 1, 2026 through December 31, 2030) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Rhode Island's Comprehensive Demonstration lets a representative act under a guardianship or power of attorney, and the Personal Choice regulation says "the representative cannot be a paid PCA."Centers for Medicare & Medicaid Services. (2026). Rhode Island Comprehensive Section 1115 Demonstration - CMS approval and Special Terms and Conditions (approval period January 1, 2026 through December 31, 2030) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Ask the agency before you start.
I live with my dad. Do I still have to log my visits?
Rhode Island's Personal Choice regulation makes the participant responsible for Electronic Visit Verification "unless the PCA lives in the same household."Centers for Medicare & Medicaid Services. (2026). Rhode Island Comprehensive Section 1115 Demonstration - CMS approval and Special Terms and Conditions (approval period January 1, 2026 through December 31, 2030) - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf Ask the agency what records it needs from you instead.
Can Personal Choice pay me just to keep Mom company?
No. The Rhode Island Personal Choice budget "does not allow for companionship, watching, or general supervision of a participant"; it is limited to personal care, homemaking, goods and services, and related taxes and fees.Centers for Medicare & Medicaid Services. (n.d.). medicaid.gov. Retrieved Sep 5, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ri-comp-demo-appvl-11282025.pdf
Learn More
Find personalized help getting paid through Rhode Island's Personal Choice program 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.