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ND Health Department outlines limits, safeguards and next steps for paid family caregiving in Medicaid waivers
Summary
Department of Health and Human Services staffers told the Senate Human Services Committee that federal rules prevent paid family caregiving under the Medicaid state plan and that access must come through HCBS waivers; officials described program caps, CMS requirements and steps toward a cross-disability children’s waiver.
Sarah Acre, Executive Director of the Division of Medical Services at the North Dakota Department of Health and Human Services, told the Senate Human Services Committee that federal rules bar payment to a legally responsible relative for state-plan personal care services and make paid family caregiving available only through Home and Community-Based Services (HCBS) waivers.
Acre said, “This is 42 CFR 440.167, which governs the federal regulations around personal care,” and emphasized that the federal regulation defines a family member who is a “legally responsible relative” as ineligible to provide state-plan personal care. She said, “in order for somebody to ever access paid family caregiving, it has to be through one of our HCBS waivers.”
The department summarized differences across existing waivers and how family-paid caregiving would fit. For medically fragile children the waiver includes a yearly dollar cap — Acre said that cap is $25,300 per individual — and…
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