Self-Direction and FMS in Arizona

All states: self-direction map

Arizona self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Arizona offer self-direction?

Arizona offers self-direction inside its Medicaid long term care program, the Arizona Long Term Care System (ALTCS). Members who live in their own home can choose one of two member-directed options: Self-Directed Attendant Care (SDAC) or Agency with Choice (AWC). In both, the member picks and directs the worker. Neither one gives the member a dollar budget to manage, because the ALTCS case manager authorizes the hours.

• Self-Directed Attendant Care (SDAC): serves ALTCS Elderly and Physically Disabled (E/PD) members and Tribal ALTCS members who live in their own home, not in a nursing facility or other residential setting. The member must be able to direct their own care or have a legal guardian. It is run by AHCCCS (the Arizona Health Care Cost Containment System, the state Medicaid agency) through the ALTCS E/PD health plans and the Tribal ALTCS fee-for-service program. The member has employer authority but not budget authority. SDAC covers attendant care only, plus a short list of skilled tasks (such as bowel care, non-sterile wound care and glucose monitoring) once a registered nurse has trained the worker.
• Agency with Choice (AWC): serves ALTCS members who live in their own home, including E/PD members, members of the Division of Developmental Disabilities (DDD) and Tribal ALTCS members. It is run by AHCCCS through the ALTCS E/PD health plans, DDD and Tribal ALTCS, and the services come from provider agencies registered with AHCCCS. The member shares the employer role with the agency and has no budget authority. AWC covers attendant care, personal care, homemaker and habilitation.

Employer authority means the member chooses, schedules and directs the worker. Budget authority means the member also manages a set amount of money. Arizona has the first but not the second. AHCCCS describes both options on its member-directed options page, which says SDAC has been offered since 2008. An AHCCCS notice from 2012 says Agency with Choice became available on January 1, 2013. We did not find current enrollment numbers for either option.

Who handles financial management services (FMS) in Arizona?

It depends on the option. Under Self-Directed Attendant Care, a Fiscal and Employer Agent (FEA) handles payroll and taxes while the member stays the legal employer. Under Agency with Choice there is no separate FMS vendor, because the provider agency the member picks is the legal employer and runs payroll itself. We did not find a published list of the FEA companies that serve SDAC.

A Fiscal and Employer Agent is the organization that takes care of the paperwork side of being an employer. Arizona's SDAC policy (AMPM 1320-A) says the FEA gets the member's federal employer ID, runs payroll at least twice a month, handles payroll taxes and year-end filings, arranges workers compensation insurance and checks that workers are eligible to work.

• Legal employer under SDAC: the member, or the member's legal guardian, is the sole legal employer of the worker.
• Legal employer under AWC: the provider agency. The Agency with Choice policy (AMPM 1310-A) makes the member, or an Individual Representative acting for the member, the day-to-day managing employer under a partnership agreement. The agency hires and fires, files payroll taxes and bills. At a minimum the member selects the worker and can dismiss the worker from their own care. Training, managing and supervising the worker are optional roles the member can take on.
• FEA vendors for SDAC: not named in any state document we found. The policy only requires that FEAs be registered AHCCCS providers and that the ALTCS case manager authorize all FEA services. We also did not find whether a member can choose among FEAs or is assigned one. Ask the member's ALTCS case manager or the ALTCS health plan.
• Vendors for AWC: any AHCCCS-registered Direct Care Worker agency that the member partners with fills the payroll role. The member chooses the agency.

Worker requirements differ too. Under AHCCCS direct care policy (AMPM 1240-A), the state's direct care worker training and testing rules apply to agency workers, including those under Agency with Choice. They do not apply to SDAC workers, who need CPR and first aid certification plus training in universal precautions and HIPAA. Background checks for SDAC workers are recommended but not required. The FEA runs one if the member asks and the case manager authorizes it.

Who can be a paid caregiver under self-direction in Arizona?

Members can hire family, but who can be paid depends on the option. Under Self-Directed Attendant Care the worker cannot be the member's spouse, the parent of a minor child or the legal guardian. A spouse, or the parent of a minor, can be paid only when employed or contracted by an agency, and only up to 40 hours in a seven-day period.

• Self-Directed Attendant Care: the member may hire family members. Parents of minor children cannot be the paid worker, and a spouse cannot be paid for SDAC services. A legal guardian cannot be the worker and must be present when services are delivered. The AHCCCS SDAC brochure tells members that a spouse who wants to be the paid caregiver must be hired through an agency.
• Agency with Choice: the member may choose family members as workers. The policy says parents of minor children cannot be the paid worker. The Individual Representative, who is automatically the guardian when there is one, cannot be the member's paid worker.
• Spouses: a spouse can be a paid caregiver only when employed or contracted by a Direct Care Worker agency, and the care must be extraordinary care. The spouse is paid for no more than 40 hours in a seven-day period, and total attendant care from the spouse and any other worker cannot go over 40 hours in that period.
• Parents of minor children: parents and legal guardians of minor ALTCS members can be paid under Arizona's Parents as Paid Caregivers model, and only through a single agency. The limit is 40 hours per child in a seven-day period and 16 hours in any 24 hours.
• Family of adult members: AHCCCS says parents and other family members of adult members can provide paid care with no weekly hour limit, and that this policy will not change.

A few rules apply across the board. AMPM 1240-A lists the relatives who count as paid family members: spouse, adult children and stepchildren, in-laws, grandchildren, siblings, parents and grandparents. It caps any direct care worker at 16 hours of paid care in a 24-hour period. A paid spouse or parent cannot be paid more than a non-family caregiver would be for similar attendant care, and the rate an agency pays a parent caregiver is agreed between the parent and the agency.

We did not find a state statement on whether the agency that employs a paid spouse or parent can be an Agency with Choice agency. Ask the ALTCS case manager, or the DDD support coordinator for DDD members, before a family makes plans around it.

Does EVV apply to self-directed workers in Arizona?

Yes. Electronic visit verification (EVV) applies to self-directed workers in Arizona under both options. Under Self-Directed Attendant Care the member must have workers use EVV and must verify each visit before it can be billed and the worker paid. Under Agency with Choice the provider agency manages EVV and billing, and the member verifies the dates and times of service. Live-in caregivers are not exempt.

• Self-Directed Attendant Care: the member verifies service delivery at the point of care or within a timeframe the FEA sets, and may not hand that verification to another person. The member also fixes missing or wrong visit information (called visit maintenance), or can delegate that to the FEA while still supplying the missing details. The FEA must train the member, confirm workers are trained on EVV, tell members their deadlines and comply with EVV itself.
• Agency with Choice: the provider agency, as legal employer, manages EVV and billing.
• Whose system: Arizona's EVV policy (AMPM 540) requires providers to use an EVV system that shares data with the AHCCCS Aggregator, the state's central collection point for visit data. The SDAC policy ties EVV duties to the FEA. We did not find which EVV system SDAC workers use today, since no state document names the FEAs.
• Does pay depend on it: AMPM 540 makes timely EVV data submission a condition of reimbursement. The member, decision maker or designee must verify hours at the point of care or within 14 days.
• Live-in caregivers: they must be flagged in the EVV system, with their relationship to the member, within 30 days of hire. A weekly schedule is not required for them, and paper timesheets are allowed with a signed attestation when other methods would be a burden.

EVV data is also used to check the family caregiver limits. A DES notice from August 2025 says DES and AHCCCS use EVV data to monitor the single-agency and 40-hour limits for paid parents. From October 1, 2025, DDD vendor agencies had to use the live-in caregiver EVV data fields and add a claim modifier (CG) for care provided by a parent.

What is changing next for self-direction in Arizona?

We did not find an upcoming change to self-direction in Arizona as of the last check on October 13, 2026. No future-dated rule, vendor change or program change was found for Self-Directed Attendant Care or Agency with Choice. The changes below have already taken effect, and they shape how the programs work today.

• DDD Independent Provider Program ended: DES gave notice on March 3, 2026 that the Independent Provider Agreements would expire on June 30, 2026. Independent Providers were told they could continue only by becoming employed or subcontracted by a DDD vendor agency, with DDD moving the member's service authorizations to the agency the member selects. That appears to leave Agency with Choice as the member-directed option for DDD members. We did not find a DDD statement that says so directly, so DDD members should confirm their options with their support coordinator.
• EVV policy revised: the current version of AMPM 540 took effect on August 6, 2026.
• Paid parent safeguards: the Parents as Paid Caregivers model became a permanent part of Arizona's Medicaid program when federal approval came on February 16, 2024. A state law signed in April 2025 (HB2945) added safeguards. The 40-hour weekly limit per child has been in effect since July 1, 2025, and revised direct care policy (AMPM 1240-A) took effect October 1, 2025, including a six-month Arizona residency check for paid parents.

For the latest, check the AHCCCS member-directed options page or ask the member's ALTCS case manager.

Arizona self-direction sources

• AHCCCS: ALTCS member-directed options (Agency with Choice and Self Directed Attendant Care)
• AHCCCS Medical Policy Manual 1320-A: Self-Directed Attendant Care
• AHCCCS Medical Policy Manual 1310-A: Agency with Choice
• AHCCCS Medical Policy Manual 1240-A: Direct Care Services (effective October 1, 2025)
• AHCCCS Medical Policy Manual 540: Electronic Visit Verification (effective August 6, 2026)
• AHCCCS: Parents as Paid Caregivers FAQ
• AHCCCS: Self-Directed Attendant Care brochure
• Arizona DES Division of Developmental Disabilities: Independent Provider Agreements ending (March 3, 2026)
• Arizona DES Division of Developmental Disabilities: Required claims modifiers and EVV indicators for parent caregivers (August 20, 2025)

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Arizona EVV requirements

Page history

• October 13, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.