newsfromthestates.com · September 4, 2026
The parent caregiver ‘savings’ Arizona is chasing don’t exist — unless care disappears | News From The States [ Skip to main content ](#main-content) [   Part of States Newsroom ](https://www.newsfromthestates.com/) search Sort by Latest Relevant Search Search  Stories From The States Colorado ranchers join fight against fossil fuel companies 28:57 https://play.prx.org/e?ge=prx\_14251\_3c1657e2-db5d-478b-98db-eb90ca023a81&uf=https%3A%2F%2Fpublicfeeds.net%2Ff%2F14251%2Fstoriesfromthestates.xml [   Part of States Newsroom ](https://www.newsfromthestates.com/) Commentary ###### The parent caregiver ‘savings’ Arizona is chasing don’t exist — unless care disappears ## Share [Bluesky](https://www.newsfromthestates.com/#bluesky)[X](https://www.newsfromthestates.com/#x)[Facebook](https://www.newsfromthestates.com/#facebook)[Email](https://www.newsfromthestates.com/#email)[Copy Link](https://www.newsfromthestates.com/#copy_link)  [Arizona](https://www.newsfromthestates.com/state/arizona) [Commentary](https://www.newsfromthestates.com/commentary) # The parent caregiver ‘savings’ Arizona is chasing don’t exist — unless care disappears [Gov & Politics](https://www.newsfromthestates.com/category/gov-politics) [Healthcare](https://www.newsfromthestates.com/category/healthcare-0) Sep 04, 2026 | 3:43 pm ET By Amy Haley Share [Bluesky](https://www.newsfromthestates.com/#bluesky)[X](https://www.newsfromthestates.com/#x)[Facebook](https://www.newsfromthestates.com/#facebook)[Email](https://www.newsfromthestates.com/#email)[Copy Link](https://www.newsfromthestates.com/#copy_link)  Description Disability rights advocates gather Feb. 26, 2025, at the Arizona Capitol in Phoenix to urge Democratic Gov. Katie Hobbs and Republican legislative leaders to remedy a funding shortfall in the state's Division of Developmental Disabilities that could leave them suddenly without essential services. (Photo by Caitlin Sievers/Arizona Mirror) Want to save hundreds of millions of dollars on care for children with significant disabilities? There’s a remarkably effective way: just don’t provide all of the necessary care. We wouldn’t call it that, of course. We’d call it “savings.” That distinction is at the heart of Arizona’s increasingly contentious debate over Parents as Paid Caregivers. The confusion starts with the name. Parents as Paid Caregivers, or PPCG, sounds like a program that pays parents simply for taking care of their children. It isn’t. [ ](https://azmirror.com/subscribe) First, PPCG isn’t a separate “program” or disability service at all. Even the July [Arizona Auditor General report](https://www.azauditor.gov/sites/default/files/2026-07/26-105_Report.pdf) at the center of the [recent controversy](https://azmirror.com/2026/08/13/audit-faults-arizona-for-unenforced-limits-on-paying-parent-caregivers/) calls PPCG a “service delivery model.” In plain English, PPCG does not create a new service or authorize additional care. Instead, it expands the existing direct-care workforce by allowing qualified, trained and certified parents to provide services already assessed and authorized for their children. [> A PhD in Lilyan: When ‘ordinary parenting’ is anything but ordinary ](https://azmirror.com/2025/10/01/a-phd-in-lilyan-when-ordinary-parenting-is-anything-but-ordinary/) Second, these are [not simply ordinary parenting responsibilities](https://azmirror.com/2025/10/01/a-phd-in-lilyan-when-ordinary-parenting-is-anything-but-ordinary/). Parents are expected to feed, dress and supervise a child. But specialized tube feeding, transferring a growing teenager who cannot move independently or providing [intensive disability-related care](https://azmirror.com/2025/04/15/lives-are-on-the-line-families-fight-to-preserve-arizonas-parents-as-paid-caregivers-program/) long after a child would ordinarily be independent is something different. Arizona recognizes that difference, too: extraordinary care, beyond what would ordinarily be expected of a parent of a child without a disability. Those distinctions must be clarified when we talk about cost. ## The service existed before the parent caregiver did If a qualified non-parent caregiver provides an authorized hour of care, Medicaid pays for that service. If a qualified parent provides that same authorized hour, Medicaid pays the same. The child’s need didn’t change. The work didn’t change. Only the worker did. The Arizona Health Care Cost Containment System, our state’s Medicaid agency, made the same point in its formal response to the recent audit: “The State’s obligation to cover the authorized service does not disappear.” So, if Arizona removed parents from the paid workforce tomorrow and other qualified caregivers filled every shift, where would the savings come from? They wouldn’t. There is, however, a very effective way to make the expenditure disappear: No one provides the necessary service. Arizona knows what that looks like. ## The ‘cheaper’ alternative has a cost For years, Arizona struggled with a [serious direct-care workforce shortage](https://www.yourvalley.net/cave-creek-carefree-independent/stories/arizonas-caregiver-crisis-is-growing-but-lawmakers-can-help,669490). People could qualify for long-term care services and have necessary care authorized without enough workers available to provide it. When Arizona sought permanent federal authority for paid parent caregiving, AHCCCS specifically identified the historical workforce shortage and access-to-care challenges as reasons for the model. An unfilled shift generates no Medicaid claim. It also generates no care. Calling that lower spending a success is like celebrating an understaffed fire department for coming in under budget when it couldn’t answer every call. No one would call that efficiency. We would ask why the calls went unanswered. Research on Medicaid home and community based services has also found that receiving Home and Community Based Services [can reduce reliance on costly emergency and inpatient care](https://pmc.ncbi.nlm.nih.gov/articles/PMC13032151/). The cost of an unfilled shift may simply move elsewhere in the healthcare system, like costly emergency services, crisis care, and institutionalization. We have already seen what the cheaper model looks like in Arizona. We called it a direct-care workforce crisis. ## What the audit actually tells us That history matters when we return to the recent state audit fueling much of the controversy over PPCG spending. The report criticized aspects of the state’s implementation and oversight, although AHCCCS formally disagreed with all four findings directed to the agency. One thing the audit did not find was evidence of widespread fraud by parent caregivers. Importantly, its largest projected reduction in spending came from **decreasing actual services to children with disabilities. **The audit estimated Arizona could have reduced fiscal-year 2026 spending by $133 million to $493 million had a new age-based standardized assessment approach to total services for disabled children remained in effect last fall. That approach [lasted only 16 days](https://azmirror.com/2025/10/16/hobb