Audit faults Arizona for unenforced limits on paying parent caregivers

Arizona auditors found that more than a year after lawmakers passed a law to rein in the ballooning Parents as Paid Caregivers Program, the state's Medicaid agency, AHCCCS, still hasn't implemented the required cost controls — a delay auditors say cost the state between $133 million and $493 million in this fiscal year alone. The program, born during the pandemic to pay parents for extraordinary in-home care of disabled children, saw its costs rocket from $77 million in 2019 to $615 million in 2025 even as federal funding for it dried up.

AHCCCS actually rolled out a new assessment tool meant to cap caregiving hours by the required October 2025 deadline, then suspended it just 15 days later after advocacy groups threatened to sue over the lack of an appeals process. A follow-up attempt to build that appeals process was scrapped in December because it didn't match federal Medicaid rules, and as of May the agency was still trying again. A separate 40-hour weekly cap that was supposed to take effect in June 2025 also isn't being enforced.

AHCCCS disputed the audit's findings entirely, arguing it implemented what it could and blaming federal mandates and litigation risk for the rest; the Department of Economic Security agreed with some findings and not others. Both agencies nonetheless agreed to adopt many of the auditors' recommendations, which is its own kind of admission.

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