Are Live-In Caregivers Exempt from EVV?
CMS says EVV does not apply when caregiver and client live together, but states may still require it. Which states exempt, what to prove, what to keep.
By Caregiver Scheduling Team ·
Sometimes. CMS says federal EVV requirements do not apply when the caregiver and the Medicaid client live together, but it lets each state require EVV anyway. Some states exempt live-in caregivers with an attestation; others, including Texas and Arizona, require EVV for every visit. If your state exempts, you still have to document residence and record hours worked. Check your state in the EVV state directory.
What does CMS actually say about live-in caregivers?
That a caregiver who lives in the home isn’t making an “in-home visit.” CMS’s August 8, 2019 informational bulletin answers the question directly: “EVV requirements do not apply when the caregiver providing the service and the beneficiary live together.” It adds that states “may choose to implement EVV in these instances, particularly when using discrete units of reimbursement, such as on an hourly basis.” So the exemption is a federal floor, and the state decides. The underlying mandate and deadlines are on CMS’s EVV guidance page.
Which states exempt live-in caregivers, and which don’t?
It splits both ways. Here are states whose official pages we verified. Others exist; always check your own.
| State | Live-in EVV rule | Source |
|---|---|---|
| Ohio | Exempt when the worker is “a resident of the same household” as the waiver recipient; request online, keep logging EVV until approved | ODM bulletin, Feb. 2025 |
| Virginia | Exempt since January 1, 2021 for consumer-directed attendants and agency aides who live in the same residence; agencies add the UB modifier to claims | DMAS bulletin |
| Colorado | Exempt for caregivers who permanently live with the member; attestation form with documentation, expires in 365 days | HCPF EVV FAQ |
| North Carolina | Exempt for paid live-in caregivers under CAP/C and CAP/DA; agency signs an attestation and bills place of service 99 | NC Medicaid |
| Texas | Not exempt. “Live-in caregivers are not exempt from EVV requirements in Texas.” | HHSC EVV Policy Handbook |
| Arizona | Not exempt. AHCCCS “decided to continue to require EVV” for members with live-in caregivers | AHCCCS FAQ |
Two patterns stand out. States that exempt still make you prove residence and approve the exemption before you stop using EVV. Ohio says workers must keep logging visits until approval arrives. And an exemption may cover only certain programs, as in North Carolina.
What does “live-in” mean to the state?
Usually a permanent, primary residence shared with the client, proven with documents. Several states borrow the federal wage-and-hour definition. The Department of Labor’s Fact Sheet 79B treats a worker as live-in if they reside on the premises permanently, meaning seven days a week with no other home, or for extended periods, meaning five days a week and 120 hours or more. Colorado’s FAQ points to the DOL and IRS definitions for its own test.
Being a family member isn’t enough on its own. A daughter who lives across town and visits daily needs EVV. A paid spouse who lives in the home may qualify, if the state allows it and the paperwork is done.
| Requirement | Typical form |
|---|---|
| Shared residence | Same address for caregiver and client |
| Proof | Lease, utility bill, ID, or a signed attestation |
| Approval | Filed with the state, plan or aggregator before EVV stops |
| Renewal | Often yearly, as in Colorado’s 365-day expiry |
| Hours | Still recorded on a timesheet, and often still billed in units |
What changes for your agency when a caregiver is exempt?
Only the check-in. Pay, billing and records don’t change.
- Mixed caseloads. A caregiver who lives with one client and also visits another needs EVV for the second client.
- Moving out. The exemption ends the day the caregiver moves. Report it and start EVV that day.
- Overtime. EVV exemption has nothing to do with wage law. Under Fact Sheet 79B, agencies cannot claim the live-in overtime exemption, so a live-in caregiver you employ gets overtime after 40 hours. See live-in caregiver sleep time pay and 24-hour home care shifts.
- Billing. Some states want a modifier or place-of-service code on exempt claims. Virginia uses UB; North Carolina uses POS 99. Miss it and the claim hits an EVV edit.
What records do you keep when EVV doesn’t apply?
Residence proof, the approval, and hours worked. Fact Sheet 79B is explicit that the employer “must still track and record all hours worked” for live-in employees, even with a sleep-time agreement in place, and must keep a copy of that agreement. Keep the state’s approval letter or your attestation for as long as your state’s EVV and Medicaid record rules require. See EVV record retention.
How Caregiver Scheduling handles this
Clients who need EVV get geofenced GPS check-in and check-out. Live-in caregivers are scheduled in the same system as everyone else. On Growth and up, authorization caps still apply to exempt clients, so hours never run past the plan. Timesheets, including for live-ins who don’t use GPS check-in, are coming soon. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.
FAQ
Are family caregivers exempt from EVV? Only if they live with the client and your state uses the live-in exemption. Family status by itself changes nothing.
Does the exemption cover home health aides? CMS’s 2019 answer covers both personal care and home health services, but each state sets the details and may limit it to certain programs.
Do exempt caregivers still need timesheets? Yes. Hours worked must be recorded for pay under federal law, and most states still bill in units.
What if my state is not in the table? Check your state Medicaid agency’s EVV page or the EVV state directory. Assume EVV is required until you find the exemption in writing.
This article is general information, not legal advice. Check your state’s EVV rules.