DD parental caregivers

AN ACT Relating to authorizing payment for parental caregivers of 1
minor children with developmental disabilities; amending RCW 2
71A.12.---; adding new sections to chapter 71A.12 RCW; creating a new 3
section; providing an effective date; and providing expiration dates.4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. The legislature finds that Washington has 6
promised to fund home and community-based supports to help children 7
with developmental disabilities grow up as fully included members of 8
their families and communities. The legislature also finds that 9
personal care hours have been allocated to these children on the 10
basis of need, but have historically only been budgeted based on 11
utilization. Efforts to increase the in-home care workforce to meet 12
demand have never produced full employment, and 41 percent of 13
authorized hours systemwide go unused.14
The legislature further finds that the unique needs of children 15
to have stable and familiar caregivers are complicated by the current 16
caregiver workforce shortage. Additionally, while the child care 17
crisis has widespread effects on Washington families, it is 18
particularly acute for families of children with disabilities, who 19
often cannot find the highly trained providers to meet their child's 20
needs. Nationwide research has shown that families of children with 21
S-0517.1
SENATE BILL 5211
State of Washington 69th Legislature 2025 Regular Session
By Senators Frame, Harris, Bateman, Christian, Cortes, Dhingra,
Hasegawa, Krishnadasan, Lovelett, Nobles, Orwall, Saldaña, Salomon,
Shewmake, Slatter, Trudeau, Valdez, Wagoner, and C. Wilson
Prefiled 01/09/25. Read first time 01/13/25. Referred to Committee
on Human Services.
p. 1 SB 5211
disabilities often have to forgo income opportunities due to these 1
care needs and that a lack of income has lasting impacts on those 2
children. 3
The legislature further finds that long term in-home care 4
services are a less costly alternative to institutional care, saving 5
taxpayers significant amounts. Many other states have demonstrated 6
the positive effects of employing parents as caregivers after being 7
authorized to do so during the COVID-19 public health emergency. In 8
these states, paid family caregiving leads to better outcomes for 9
medically fragile children and lower costs to taxpayers in the form 10
of fewer hospitalizations. Washington currently allows employment of 11
parent caregivers for their adult children assuring their access to 12
home and community-based services and avoiding more costly forms of 13
care like institutionalization. 14
The legislature further finds that the centers for medicare and 15
medicaid services has recently updated its guidance to instruct 16
states to strongly consider allowing legally responsible individuals, 17
such as parents, to be paid for their caregiving in order to meet the 18
requirement placed on all states to provide for the delivery of 19
needed services. 20
Therefore, the legislature intends to support children with 21
developmental disabilities and their family caregivers through 22
legislative actions that promote fair labor practices, equitable 23
compensation, and comprehensive support systems. 24
NEW SECTION. Sec. 2. A new section is added to chapter 71A.12 25
RCW to read as follows: 26
(1) No later than January 31, 2026, and as necessary thereafter 27
in order to comply with section 4 of this act, the administration 28
shall submit requests to the centers for medicare and medicaid 29
services for amendments to applicable developmental disabilities 30
administration home and community-based services waivers to allow 31
parents who provide personal care services to their minor children 32
with developmental disabilities to receive payment for providing 33
personal care services that qualify as extraordinary care.34
(2) If amendments as described in subsection (1) of this section 35
are approved by the centers for medicare and medicaid services, upon 36
receiving approval, the administration shall authorize payments to 37
parents providing extraordinary care services to their minor 38
children. 39
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(3) In implementing the authorization to pay parents for 1
providing extraordinary care to their minor children:2
(a) In addition to its existing rule-making authority, the 3
administration may adopt rules for assessing and authorizing personal 4
care hours for minors with compensated parental caregivers and other 5
rules as necessary to comply with centers for medicare and medicaid 6
services requirements related to payments to legally responsible 7
individuals, such as parents; 8
(b) The administration must allow parental caregivers the option 9
to be employed as individual providers, as defined in RCW 74.39A.240, 10
subject to the same training and oversight requirements as other 11
individual providers who are parents of the person for whom they are 12
providing care; and 13
(c) The administration may only offer personal care services 14
hours served by parent providers as a waiver service. All other 15
assessed personal care services hours served by providers who are not 16
parents must remain on the community first choice option.17
(4) Nothing in this section shall be interpreted to affect the 18
availability of personal care services hours assessed to persons who 19
are not clients of the administration, or who are clients of the 20
administration who are not minors, through the community first choice 21
option. 22
(5) For purposes of this section: 23
(a) "Extraordinary care" means care provided to a minor child who 24
is assessed in an E classification category or the B high 25
classification category by the comprehensive assessment and reporting 26
evaluation, that exceeds the range of activities that a legally 27
responsible individual, such as a parent, would ordinarily perform in 28
the household on behalf of a person without a disability or chronic 29
illness of the same age, and is necessary to assure the health and 30
welfare of the minor child and avoid their institutionalization.31
(b) "Minor child" means a person who is under the age of 18 and 32
who is a client of the administration. 33
(c) "Parent" means a natural parent, an adoptive parent, a 34
stepparent, or a legal guardian. 35
Sec. 3. RCW 71A.12.--- and 2025 c ... s 2 (section 2 of this 36
act) are each amended to read as follows: 37
(1) No later than January 31, 2026, and as necessary thereafter 38
in order to comply with section 4 of this act, the administration 39
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shall submit requests to the centers for medicare and medicaid 1
services for amendments to applicable developmental disabilities 2
administration home and community-based services waivers to allow 3
parents who provide personal care services to their minor children 4
with developmental disabilities to receive payment for providing 5
personal care services that qualify as extraordinary care.6
(2) If amendments as described in subsection (1) of this section 7
are approved by the centers for medicare and medicaid services, upon 8
receiving approval , the administration shall authorize payments to 9
parents providing extraordinary care services to their minor 10
children. 11
(3) In implementing the authorization to pay parents for 12
providing extraordinary care to their minor children:13
(a) In addition to its existing rule -making authority, the 14
administration may adopt rules for assessing and authorizing personal 15
care hours for minors with compensated parental caregivers and other 16
rules as necessary to comply with centers for medicare and medicaid 17
services requirements related to payments to legally responsible 18
individuals, such as parents; 19
(b) The administration must allow parental caregivers the option 20
to be employed as individual providers, as defined in RCW 74.39A.240, 21
subject to the same training and oversight requirements as other 22
individual providers who are parents of the person for whom they are 23
providing care; and 24
(c) The administration may only offer personal care services 25
hours served by parent providers as a waiver service. All other 26
assessed personal care services hours served by providers who are not 27
parents must remain on the community first choice option.28
(4) Nothing in this section shall be interpreted to affect the 29
availability of personal care services hours assessed to persons who 30
are not clients of the administration, or who are clients of the 31
administration who are not minors, through the community first choice 32
option. 33
(5) For purposes of this section: 34
(a) "Extraordinary care" means care provided to a minor child 35
((who is assessed in an E classification category or the B high 36
classification category by the comprehensive assessment and reporting 37
evaluation,)) that exceeds the range of activities that a legally 38
responsible individual, such as a parent, would ordinarily perform in 39
the household on behalf of a person without a disability or chronic 40
p. 4 SB 5211
illness of the same age, and is necessary to assure the health and 1
welfare of the minor child and avoid their institutionalization.2
(b) "Minor child" means a person who is under the age of 18 and 3
who is a client of the administration. 4
(c) "Parent" means a natural parent, an adoptive parent, a 5
stepparent, or a legal guardian. 6
NEW SECTION. Sec. 4. A new section is added to chapter 71A.12 7
RCW to read as follows: 8
(1) The department shall make timely requests to the centers for 9
medicare and medicaid services for any waiver amendments that are 10
necessary to expand the authorization to pay parents for the 11
provision of extraordinary personal care services as described in 12
section 2 of this act in accordance with the definition of 13
extraordinary care in section 3 of this act. 14
(2) This section expires July 1, 2032. 15
NEW SECTION. Sec. 5. Section 2 of this act expires July 1, 16
2031.17
NEW SECTION. Sec. 6. Section 3 of this act takes effect July 1, 18
2031.19
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