Can a Family Member Be Paid to Provide Care Under the NHTD Waiver in New York?

# Can a Family Member Be Paid to Provide Care Under the NHTD Waiver in New York?

This is the single most common question Priority Cares receives from families exploring the NHTD Waiver: Can I — or my adult child, or my sibling — be paid to provide the care my family member needs?

The answer is nuanced, and most families get an incomplete answer when they first ask. Here is a clear, complete explanation of what is and is not allowed under the NHTD Waiver in New York, and what alternatives may apply.

NHTD Waiver: What the Rules Say About Family Caregivers

Under the NHTD Waiver’s Home and Community Support Services (HCSS) component — the primary personal care service — family members generally cannot be hired as paid HCSS workers for the individual.

Specifically:

• A legal guardian of the participant cannot be paid as an HCSS worker
• A legally responsible relative (spouse, or parent of a minor child) cannot be paid as an HCSS worker
• Other family members — adult children, siblings, aunts, cousins, close friends — are not automatically excluded, but their employment as HCSS workers is subject to oversight and must meet the same hiring and background check requirements as any other worker

In practice: Non-legally-responsible family members can sometimes be employed as HCSS workers through a provider agency, but this is uncommon because most agencies hire from their own staffing pool, and the participant does not hire and manage workers directly under NHTD (unlike some consumer-directed programs).

The bottom line for most families: under the standard NHTD HCSS model, the program assigns a professional caregiver through the provider agency. A family member is not paid to provide this care.

Why Isn’t NHTD Like the Old CDPAP?

Many families in New York are familiar with consumer-directed personal care — a model where Medicaid-eligible individuals could hire and manage their own workers, including family members. That program model was significantly restructured in New York in 2024.

The NHTD Waiver is not a consumer-directed program. It is an agency-directed, provider-managed program. Care workers are employed by the NHTD provider agency (like Priority Cares), not directly hired and managed by the participant.

Self-Direction Under the NHTD Waiver

The NHTD Waiver does include a Fiscal Intermediary (FI) service that enables some degree of self-direction — meaning the participant can have more input into selecting their own workers, scheduling, and managing their care budget. Under self-direction with an FI:

• The participant has greater choice in who provides their care
• A Fiscal Intermediary handles the administrative and payroll functions
• The participant acts as the “employer of record” in a limited sense

However, even under NHTD self-direction, the rules around family members as paid workers still apply. Legally responsible relatives remain prohibited from being paid.

For Families Who Want to Be Compensated Caregivers: The PPP (In NJ) or Other Options

For families in New Jersey (not New York), the Personal Preference Program (PPP) is New Jersey’s consumer-directed home care option under Medicaid, and it explicitly allows non-legally-responsible family members (adult children, siblings, other relatives) to be hired and paid as personal care assistants.

For New York residents, the options for compensating family caregivers within a Medicaid framework are more limited after recent program changes. Consult with a benefits counselor or Medicaid planning attorney about the current landscape.

What Families CAN Do Under the NHTD Waiver

While family members typically are not paid under NHTD HCSS, the waiver provides real support for family caregivers in other ways:

Respite Care: The NHTD Waiver covers planned and emergency respite care — giving family caregivers time off while a trained professional provides care. This is a benefit specifically designed to prevent caregiver burnout.
Service Coordination: A professional service coordinator manages the care plan, handles provider communication, and navigates systems — taking significant administrative burden off the family.
Environmental Modifications and Assistive Technology: Home modifications (grab bars, ramps, accessible bathrooms) and adaptive equipment reduce the physical demands on family caregivers who are providing informal support.
Training: The NHTD Waiver provides training for informal caregivers to improve their ability to safely support their family member. This is distinct from paying them — but it formally recognizes and supports their role.

The Real Value of the NHTD Waiver for Families

The most common framing families use — “can we get paid to do this ourselves?” — often reflects an underlying concern about care quality and consistency. Families provide care because they know and love the person; a stranger doesn’t know their preferences, their routines, or how to communicate with them.

The NHTD Waiver addresses this in a different way: through caregiver consistency, matching, and quality oversight. At Priority Cares, we match HCSS workers based on language, personality, and schedule preferences, and we monitor care quality through regular supervisory visits. For most participants, a stable, matched HCSS worker who has been with them for months or years provides an experience that approaches the continuity of family care.

The respite care component then gives family members relief — rather than being the primary care provider, they can be the family member.

Call Priority Cares to Discuss Your Situation

Every family’s situation is different. If you are exploring the NHTD Waiver and have questions about family caregiver compensation, informal care arrangements, or how self-direction works in Monroe County, Priority Cares can walk through your specific situation.

Call (585) 201-7179 for a free consultation. We serve all Monroe County communities from our Rochester base.