For families and caregivers

ALTCS family caregiver rules: how to get paid to care for a family member in Arizona

By the CaregiverConnect team · Updated 2026-10-26 · Sources checked on the same date and listed at the end.

In Arizona, the main way to get paid for looking after a parent, grandparent or other relative is ALTCS (Arizona Long Term Care System), which AHCCCS, the state Medicaid agency, operates. If your relative qualifies and lives at home, AHCCCS policy lets a family member be hired as their paid direct care worker, with tighter rules for spouses and for parents of minor children. This guide sets out who qualifies, which relatives can be paid, who handles payroll and what the pay looks like, Sources are AHCCCS policy manuals and forms plus federal tax, veterans and wage pages, all checked on October 26, 2026.

A smiling caregiver with her arm around an older woman in a bright room at home

Paid family caregiver routes in Arizona at a glance

There is no stand-alone "family caregiver salary" in Arizona. Payment comes through ALTCS home care, VA programs for veterans, or a private arrangement your family funds.

Route	Who can be paid	Who runs payroll
ALTCS attendant care through an agency, including Agency with Choice	Adult children, grandchildren, siblings, in-laws and other listed relatives	The direct care worker agency that employs you
ALTCS Self-Directed Attendant Care (SDAC)	Relatives the member hires, except a spouse or the parent of a minor	A Fiscal and Employer Agent handles taxes, withholding and paychecks
Spouse as Paid Caregiver	The member's husband or wife, up to 40 hours a week	A contracted provider, not SDAC
Parent as Paid Caregiver	Parents or legal guardians of a minor ALTCS member	One agency per parent
VA caregiver programs	Family caregivers of eligible veterans	The VA
Private hire	Anyone the family chooses	The family, as household employer

Who qualifies for ALTCS, and how to apply

ALTCS is the part of AHCCCS for people with an age-related, physical, intellectual or developmental disability who need a nursing facility level of care. AHCCCS says members do not have to live in a nursing home, and many live in their own homes or in assisted living with services brought to them. Paid direct care at home is limited to members who live in their own home.

Non-financial rules. The AHCCCS application sheet DE-828 (revised December 2025) lists a nursing home level of care determined by AHCCCS, US citizenship or qualified immigrant status, a Social Security number (or an application for one), Arizona residency and an approved living arrangement.
Income. The same sheet gives a gross monthly income limit of $2,982 for an individual, effective January 1, 2026. Married applicants are asked to request a Community Spouse Information Sheet, and people over the limit may be able to qualify with a special treatment trust.
Resources. DE-828 says that an applicant under 65 with resources over $2,000 may still qualify by setting up a special type of trust. Ask ALTCS how your relative's accounts and home are counted.
Medical assessment. After the financial review, an assessor interviews the applicant and any caregivers and reviews medical records to decide if they are at immediate risk of institutionalization.

To apply, you can register an application online through Health-e-Arizona Plus (HEAplus), or call ALTCS toll-free at 888-621-6880. AHCCCS says form DE-101 is required to begin an application, and it lists ALTCS offices in Phoenix, Tucson, Yuma, Flagstaff, Kingman and Chinle. Once approved, your relative is enrolled with a long-term care health plan and gets a case manager who builds the service plan with the family. For the Elderly and Physically Disabled (EPD) program, AHCCCS names the plans as UnitedHealthcare Community Plan LTC, Banner-University Family Care LTC and Mercy Care LTC.

Hours are set by assessment, and AHCCCS is revising its HCBS Needs Tool, with a planned December 1, 2026 implementation date for the new policies. If your relative is a child, ask the case manager how this affects their hours.

Which relatives can be an ALTCS family caregiver

AHCCCS Medical Policy Manual section 1240-A says direct care services are provided by direct care workers (DCWs), "including Family Members as paid caregivers". It defines the relatives who may be paid as:

Spouse
Adult children and stepchildren
Sons- and daughters-in-law
Grandchildren
Siblings and step-siblings
Parents, stepparents and adoptive parents
Grandparents
Mothers- and fathers-in-law
Brothers- and sisters-in-law

Spouses

A legally responsible spouse can be paid only under the Spouse as Paid Caregiver option. Under 1240-A, AHCCCS pays a spouse for at most 40 hours in any seven days, combined spouse and other-worker hours are also held to 40 per seven days, and the spouse's rate cannot be higher than a non-spouse caregiver would earn for similar care. The care has to be "extraordinary", meaning beyond what a spouse would ordinarily do if the member had no disability, and the member signs an acknowledgment that they had a choice.

Parents of minor children and guardians

The Parent as Paid Caregiver option lets legally responsible parents, and legal guardians with formal physical or legal custody, be paid to care for a minor child who is an ALTCS member. Paid parent hours are capped at 40 per seven days for any one minor child, and each parent must be employed by one agency for the children they care for. The policy does not set out rules for a guardian of an adult member; ask the case manager.

Self-direction excludes spouses and parents

Under AMPM 1320-A, a member using Self-Directed Attendant Care can hire family members, but parents of minor children cannot serve as paid workers and a spouse as paid caregiver cannot be reimbursed for SDAC services.

Agency, Agency with Choice or self-direction: who pays the family caregiver

ALTCS members who live at home choose how attendant care is delivered, and the choice decides who your employer is.

Agency. A registered DCW agency employs you, pays you and supervises your visits. AHCCCS requires agencies to run background checks at hire and every three years, though an agency may allow exceptions for workers who only care for family members, but never for Parent as Paid Caregiver workers or where the member cannot legally consent.
Agency with Choice. The agency and the member share employer duties. The agency keeps the authority to hire and fire and arranges training, while the member can take on recruiting, scheduling, supervising and dismissing workers.
Self-Directed Attendant Care. The member or their legal guardian is the legal employer and takes on every employer duty. AHCCCS says a Fiscal and Employer Agent "takes care of the taxes, payroll withholding and paychecks for the caregiver", and workers record visits through electronic visit verification.

Every DCW, family included, needs current CPR and first aid certification and must complete Level I, Introduction to and Fundamentals of Caregiving. A worker who cares only for family members is exempt from the Level II specialized modules.

How much does ALTCS pay a family caregiver?

None of the AHCCCS pages read for this guide publish a statewide hourly rate for family caregivers. Ask the agency, or under self-direction the member's case manager, what the hourly wage will be before you start. Pay is also capped by the hours in the service plan, and for a spouse by the 40-hour weekly limit and the rule that a spouse cannot earn more than another worker would.

Two public figures give a sense of the range. They are reference points, not program rates.

Benchmark	Amount	Published by
Arizona statewide hourly median pay, BLS code 31-1120 (aides in home health and personal care), May 2025	$17.51 (74,540 jobs)	BLS OEWS
Arizona minimum wage	$15.15 an hour	US Department of Labor state table, updated July 1, 2026

If you also hold another job, Arizona law lets employees use earned paid sick time to care for a family member who is ill or needs medical care. Employers with 15 or more workers must let staff accrue at least one hour for every 30 worked, up to 40 hours a year; smaller employers, up to 24 hours.

Taxes and the Difficulty of Care exclusion

Under IRS Notice 2014-7, payments under a state Medicaid home and community-based waiver program for care of an eligible person in the care provider's own home can be treated as difficulty of care payments and left out of gross income. The IRS questions and answers say a relative who moved into a parent's home and has no separate home is providing care in "the provider's home", and that more than one provider living with the recipient can each use the exclusion. A provider who has a separate home elsewhere cannot.

AHCCCS treats this income in a related way when deciding the caregiver's own Medicaid eligibility. Pay for attendant or personal care to an ALTCS member living in the same home counts as a Difficulty of Care payment and is not counted for some AHCCCS programs. Because AHCCCS's electronic income data cannot tell these payments apart, the agency asks anyone denied or cut off for being over the income limit to call 602-417-5010 and report the income as Difficulty of Care income.

If your family pays a caregiver privately instead, IRS Topic 756 applies: once 2026 cash pay to one household worker hits $3,000, the family generally owes FICA (Social Security plus Medicare), withholding the worker's half and paying its own. For federal unemployment tax, pay to your spouse, your parent or your own child under 21 does not count.

Paid family caregiver options for Arizona veterans

VA's caregiver stipend program (official name: Program of Comprehensive Assistance for Family Caregivers). VA lists four conditions on the veteran's side: a disability rating, single or combined, of at least 70%; discharge from service or a set medical discharge date; membership in VA health care; and an expected need, lasting six months or more, for continuous hands-on personal care. The caregiver has to be an adult who is related to the veteran or lives, or will live, with them full time. Only the Primary Family Caregiver can receive the monthly stipend.
Veteran Directed Care. Here VA gives the veteran a spending budget; a counselor helps plan it and recruit helpers, and a relative or neighbor can be one of them. Availability differs by location, and the veteran must qualify for VA community care and meet clinical criteria, so start with a VA social worker.

Local aging agencies and elder abuse reporting in Arizona

Area Agencies on Aging can explain ALTCS, family caregiver support and other services in your county.

Area Agency on Aging, Region One (Phoenix): 24-hour Senior HELP LINE 602-264-4357, toll-free 888-783-7500.
Western Arizona Council of Governments Area Agency on Aging, serving La Paz, Mohave and Yuma counties: 1-800-782-1886.

Arizona Adult Protective Services takes reports about a vulnerable adult who may be suffering harm, neglect or money exploitation: 1-877-767-2385 (877-SOS-ADULT; TDD 877-815-8390). Calls are answered from 7 in the morning until 7 at night on weekdays, and from 10 until 6 on weekends and state holidays; reports can also be filed online at any hour. Dial 911 if someone is in immediate danger.

Where CaregiverConnect fits

CaregiverConnect does not enroll anyone in ALTCS. It is not a Medicaid provider, a fiscal agent or a home care agency, so it cannot make a relative into a paid ALTCS worker. If your family is paying for care itself, while waiting on an application or to cover hours the service plan does not, you can publish a free job post and hire someone yourself, which puts your family in the household employer role. See how it works, the optional plans on pricing, and our private hiring checklist.

On the worker side, a profile costs nothing, and Arizona caregivers can reply to family job listings in Phoenix, Yuma, Somerton, San Luis and across Yuma County. Families can browse caregivers in Yuma and Yuma County. For pay across the border region, see caregiver pay in California and Arizona, and for other states, Medicaid programs for family caregivers.

Frequently asked questions

What is ALTCS?

It stands for Arizona Long Term Care System: the AHCCCS program for people with an age-related, physical, intellectual or developmental disability who need a nursing facility level of care. Members do not have to live in a nursing home; many receive services in their own home or in assisted living.

Can an ALTCS family caregiver get paid in Arizona?

Yes. AHCCCS policy 1240-A lets family members work as paid direct care workers, including adult children, grandchildren, siblings, parents, grandparents and in-laws. A spouse can be paid only under Spouse as Paid Caregiver, capped at 40 hours a week, and parents of minor children only under Parent as Paid Caregiver.

Can I get paid to take care of my mom in Arizona?

If she qualifies for ALTCS and lives at home, she or her representative can choose you as her worker through an agency, Agency with Choice, or Self-Directed Attendant Care, where a Fiscal and Employer Agent runs payroll. You need CPR and first aid certification and Level I caregiver training. Start the application by calling 888-621-6880 or through Health-e-Arizona Plus.

How much does ALTCS pay family caregivers?

AHCCCS does not publish one statewide rate on the pages reviewed here; ask the agency or case manager, and remember pay is limited to the hours in the service plan. For reference, the May 2025 BLS median for Arizona's home health and personal care aides was $17.51 an hour, and the state minimum wage is $15.15.

What is the ALTCS income limit in 2026?

The AHCCCS DE-828 sheet gives a gross monthly income limit of $2,982 for an individual from January 1, 2026. People over the limit may be able to qualify with a special treatment trust; married applicants should ask for the Community Spouse Information Sheet.

Do I pay income tax on ALTCS caregiver pay if I live with my relative?

Possibly not. IRS Notice 2014-7 treats Medicaid waiver payments for care in the provider's own home as excludable difficulty of care payments, and the IRS says a relative who lives in the parent's home with no separate home qualifies. Check with a tax professional for your situation.

Sources

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