For many Arizona families of children with developmental disabilities, the Parents as Paid Caregivers program is more than a source of income. It can help families provide consistent care when finding qualified direct care workers is difficult or impossible.
A recent Arizona Auditor General report is putting new attention on the program, including its costs and how the state has implemented requirements intended to control spending.
What the audit found
The Arizona Auditor General released a special audit of the Parents as Paid Caregivers service delivery model on July 30. The audit examined the Arizona Health Care Cost Containment System (AHCCCS) and Arizona Department of Economic Security (DES), which includes the Division of Developmental Disabilities (DDD).
The audit found that costs for the Arizona Long Term Care System (ALTCS), which includes the Parents as Paid Caregivers program, have continued to increase. It also concluded that AHCCCS and DES had not fully implemented several cost-control measures required by state law.
Among the issues identified, the audit found that the state did not implement a new standardized assessment tool by the October 2025 deadline and did not begin taking steps to enforce a 40-hour weekly limit on parent-provided care until April 2026.
What the audit does not mean
For families who rely on the Parents as Paid Caregivers program, headlines about increasing costs may understandably raise concerns about what comes next.
It is important to distinguish between concerns about the state’s administration of the program and the role parents play in providing care.
The audit focuses largely on how AHCCCS and DES implemented requirements established by the Legislature, including assessment processes, service limits and other cost-control measures. It does not eliminate the Parents as Paid Caregivers program.
Families do not need to take any action simply because the audit was released.
Changes to assessments are still underway
The audit comes while AHCCCS is separately working on changes to the way home- and community-based service needs are assessed for ALTCS members.
AHCCCS introduced a new Home and Community Based Services Needs Tool, or HNT, in October 2025, but paused its use for children under 18 following concerns from families and other stakeholders.
AHCCCS has since been revising the HNT and developing an Extraordinary Care Review process for children under 18 whose needs may not be adequately reflected because of age-related assumptions or service-hour limits.
The current timeline calls for additional rulemaking and public input before revised HNT and Extraordinary Care Review policies are finalized later this year. Implementation is currently planned for December 2026.
Why families should continue paying attention
The Parents as Paid Caregivers program has undergone significant changes since it began as a temporary pandemic-era flexibility and later became a permanent option in Arizona.
The new audit adds another element to an ongoing discussion about how Arizona can provide needed home- and community-based services while managing the growing cost of the ALTCS program.
For families, the most important point right now is that the Parents as Paid Caregivers program continues, but policies affecting how services are assessed and how parent-provided care is authorized continue to evolve.
Encircle Families will continue following developments and sharing information that can help families understand changes that may affect their services.
More Information
Read the Arizona Auditor General’s Parents as Paid Caregivers Service Delivery Model audit and visit AHCCCS’s ALTCS information page for current information about the HNT and Extraordinary Care Review process.
