Caregiver Compensation

Disability Waivers (DD Waivers) and Paid Family Caregiving

Medicaid HCBS waivers for people with intellectual and developmental disabilities (ID/DD) often provide more caregiver flexibility than senior waivers. Most states allow parents of adult children with ID/DD to be paid caregivers, and some states — led by Oregon's 2025 waiver — now allow parents of minor children with disabilities to receive compensation for attendant care.

ID/DD & children

Updated October 2026

Pathway 7 — Key Details

What it isMedicaid HCBS waivers specifically for adults and children with intellectual/developmental disabilities. Often have more caregiver flexibility than senior waivers.

Who can be paidParents of adult children with ID/DD in most states. Parents of minor children in some states with restrictions.

Oregon update (2025)✅ New 1915(c) waiver (2025) allows parents of minor children with disabilities to be paid as attendant caregivers — first such program (KFF Jan 2026)

Parent CNA modelSome states allow parents to become certified nursing assistants and be paid for medically complex child care (ventilator, feeding tube, etc.)

Key restriction⚠️ Parents of minor children are 'legally responsible individuals' — care must exceed what's normally expected of a parent

Family support scopeKFF (2025): family caregiver supports most widely available for caregivers of people with ID/DD — more so than for aging adults

How to find programsYour state's DD agency; medicaid.gov state waivers list; AARP Foundation Paid4Care (paid4care.aarpfoundation.org)

Eligibility: What to Expect & How to Prepare

To qualify for a Disability or Developmental Disability (ID/DD) Waiver, the focus shifts from age-related decline to long-term functional impairments that began before age 22. Assessments measure "substantial functional limitations" in major life areas.

Assessments like the OEDI (Ohio Eligibility Determination Instrument) measure substantial functional limitations in major life areas.

"Can they communicate their basic needs to others?"
e.g., using words, signs, or a communication device.
"What is their capacity for 'Self-Direction'?"
Do they need help making decisions, managing money, or recognizing dangerous situations?
"Can they perform tasks safely or in a reasonable time?"
For example, if they can use a stove but often leave it on, they are marked as needing assistance.
"Do they require help with 'Self-Care'?"
This includes bathing, dressing, and hygiene.
"Is there an 'Immediate Need' for a waiver slot?"
You will be asked if there is a risk of harm to the person or caregiver if services aren't started within 30 days.

Oregon's landmark 2025 waiver specifically allows parents of minor children to be paid for "extraordinary care" — care that goes beyond what is typical for a child of that same age.

"What is the threshold for 'extraordinary care' in our state's assessment?"
You must document the difference between normal "parental duty" and "waiver-eligible care" that exceeds what's expected for a child of that age.

Proof of Onset (Before Age 22)

School records, IEPs (Individualized Education Programs), or pediatric medical records showing the disability existed before age 22
Formal diagnostic testing results for IQ, adaptive behavior, or specific medical diagnoses (e.g., Autism, Cerebral Palsy, Down Syndrome)

Financial Records

Unlike senior waivers, many states (like Ohio) do not count parental income or assets for a child's eligibility
Only the individual's own assets are reviewed — usually limited to $2,000

Caregiver-Provider Documents

High school diploma or GED (if parent is applying to be a paid provider)
Criminal background check authorization
First Aid/CPR certification (required in some states)

Pro Tips

Contact your local County Board of Developmental Disabilities (in Ohio) or Community Services Board (in Virginia) to request an intake assessment for an ID/DD waiver.
If there is an immediate risk of harm to the person or caregiver, emphasize this during intake — it can move you ahead of multi-year waitlists.
For parents of minor children: document specific tasks that go beyond normal parenting duties (e.g., tube feeding, seizure monitoring, behavioral intervention) to establish "extraordinary care."

Frequently Asked Questions

In most states, yes. Medicaid ID/DD waivers usually allow parents of adult children with intellectual or developmental disabilities to be paid caregivers.

In some states, with restrictions. Parents of minor children are considered legally responsible, so the care must go beyond what a parent would normally provide. Oregon's 2025 waiver lets parents of minor children with disabilities be paid as attendant caregivers.

DD waivers are built for adults and children with intellectual or developmental disabilities, and they often allow more caregiver flexibility than waivers for older adults.

Start with your state's developmental disabilities agency. You can also check the state waivers list on medicaid.gov or AARP Foundation Paid4Care at paid4care.aarpfoundation.org.