Personal Care Aide Training Requirements

BACKGROUND

Training for personal care aides (PCAs)—who constitute one of the largest and fastest growing occupations in the country—is not governed by any federal standards, unlike training for home health aides and nursing assistants. Instead, there is a patchwork of training requirements which vary widely across and within states—and in many cases, these requirements fall short of adequately preparing PCAs to provide high-quality care. Here, we present information on training standards for PCAs who support older adults and people with disabilities across all 50 states and Washington D.C. based on 2024-2025 state policy.

Key Findings

• 31 states and Washington D.C. have consistent training requirements for all Medicaid-funded agency-employed PCAs, while 7  states do not regulate training for PCAs at all. The other 12 states have varying requirements for Medicaid-funded agency-employed PCAs.
• 12 states and Washington D.C. have a state-sponsored or endorsed training curriculum or curriculum outline.
• 26 states and Washington D.C. require a minimum number of training hours for PCAs in at least one set of training requirements; of these, 15 states and Washington D.C. require 40 or more hours of training.
• 42 states and Washington D.C. specify competencies for at least one set of training requirements. The number of competencies ranges from 1 to 30 competencies.
• 34 states and Washington D.C. require PCAs to complete a competency assessment after training in at least one set of training requirements; 18 states and Washington D.C. require recognized credential or training certification that is transferable between employers in at least one set of training requirements.
• 13 states and Washington D.C. have a centralized training registry for at leats one PCA role in the state.
• 17 states have training standards for PCAs working under at least one consumer-directed program/waiver; 23 states and Washington D.C. have training standards for agency-employed PCAs that are privately paid (i.e. not reimbursed through Medicaid).

Methodology

To generate this national catalogue of PCA training requirements, we reviewed the most updated Medicaid regulations, Medicaid waiver documents, Medicaid provider policy manuals, and state statutes and licensure regulations.

The focus of this research is PCAs who provide services to older adults and people with disabilities. We excluded direct support professionals, who assist people with intellectual and developmental disabilities, as they have different on-the-job responsibilities and therefore distinct training needs.

We define a “training requirement” as a set of regulations that specifies training content and/or duration. We excluded regulations that specify neither content nor duration, as well as training regulations that specify only first aid and CPR, as these skills are not specific to PCA roles.

As well as reviewing content and duration requirements, we also searched for requirements on instructor qualifications, competency assessment, continuing education, certificates and/or training credentials, and centralized training registries. If the regulations specify these additional elements, we have included them in our findings.

For states that require PCAs to be trained as home health aides or nursing assistants, we included requirements for those occupations in our findings.

Alabama

Summary

Consistency: Inconsistent requirements across some Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Attendant

Scope: Agencies that receive Medicaid reimbursement under Elderly and Disabled, SAIL, and ACT waivers

Training hours: No

Competencies specified: No

Competency exam or evaluation: No

State-sponsored curriculum: No

Instructor qualifications specified: No

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: No

Centralized training registry: No

Alaska

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Assistant

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 40 hours to be completed within first four months of employment

Competencies specified: Yes, 10 competencies

Competency exam or evaluation: Yes

State-sponsored curriculum: Yes, Senior and Disabilities Services Training

Instructor qualifications specified: Yes, must be a licensed nurse

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

*CNA, RN, community health aide, or community health practitioner certification can be substituted for these training requirements.

Arizona

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Direct Care Worker

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 10 competencies

State-sponsored curriculum: Yes, the Principles of Caregiving curriculum

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, achieved high marks on knowledge and skills tests that are part of the curriculum the trainer teaches, has experience as a caregiver for at least one year, and at least one year of experience teaching groups of adults

Continuing education requirements: Yes, 6 hours of training annually

Certificate or credential: Yes, Direct Care Worker (DCW)

Centralized training registry: Yes

*CNA certification can be substituted for these training requirements.

2. Direct Care Worker

Scope: At least one consumer-directed program

Training hours: No

Competencies specified: Yes, 3 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Arkansas

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role 

1. In Home Assistant

Scope: All home care agencies

Training hours: Yes, 40 hours (at least 4 hours must cover Alzheimer’s Disease and dementia; at least 16 hours must cover physical skills and competent demonstration of those skills)

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

*CNA, LPN, or RN certification can be substituted for these training requirements.

2. Personal Care Aide

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 40 hours (24 classroom hours; 16 practical training hours)

Competencies specified: Yes, 14 competencies

State-sponsored curriculum: No

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, registered nurse (RN) with at least 2 years of nursing experience, at least one of which must be in home health care

Continuing education requirements: Yes, 12 hours of training annually

Certificate or credential: Yes, Certified Personal Care Aide

Centralized training registry: No

California

Summary

Consistency: Inconsistent requirements across some Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Affiliated Home Care Aide

Scope: All home care agencies

Training hours: Yes, 10 hours (5 hours of training before working with clients, including 2 hours of orientation training, 2 hours of safety training, and 5 additional hours of training within the first year)

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, 5 hours of training annually

Certificate or credential: Yes, Home Care Aide (HCA)

Centralized training registry: Yes

2. Personal Care Provider

Scope: Medicaid Home and Community-Based Alternatives waiver

Training hours: Yes, 8 hours

Competencies specified: Yes, 1 competency

State-sponsored curriculum: No   

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, 8 hours

Certificate or credential: No

Centralized training registry: No

Colorado

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Worker

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 6 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, annual training in 4 competencies

Certificate or credential: No

Centralized training registry: No

*CNA certification can be substituted for these training requirements.

2. Personal Care Worker

Scope: Agencies that receive private pay funding

Training hours: Yes, 20 hours

Competencies specified: Yes, 3 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, annual training in 4 competencies

Certificate or credential: No

Centralized training registry: No

Connecticut

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Assistant

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 17 competencies

State-sponsored curriculum: Yes, Connecticut Department of Social Services Standardized Training for Personal Care Assistants for Agency-Based PCAs

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Delaware

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Direct Care Worker

Scope: All home care agencies  

Training hours: No

Competencies specified: Yes, 24 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, annual infection prevention and control; if the agency serves those with Alzheimer’s and related dementias (ADRD), direct care workers must receive annual ADRD training

Certificate or credential: No

Centralized training registry: No

District of Columbia

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Health Aide 

Scope: All home care agencies   

Training hours: Yes, 125 hours (including 20 hours of lab instruction and 40 hours in a clinical setting)

Competencies specified: Yes, 28 competencies

State-sponsored curriculum: Yes, Board of Nursing Home Health Aide Curriculum

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years of experience, with at least one year in home care

Continuing education requirements: Yes, 12 hours annually, including 3 hours on HIV/AIDS and 2 hours on cultural competency on LGBTQ+ issues

Certificate or credential: Yes, Home Health Aide (HHA)

Centralized training registry: Yes

*RN or practical RN certification can be substituted for these training requirements. CNA certification can be substituted if the CNA takes a 16 hour didactic training and has 16 hours of clinical practice.

2. Home Health Aide

Scope: Home care agencies that receive Medicaid reimbursement  

Training hours: Yes, 125 hours (including 20 hours of lab instruction and 40 hours in a clinical setting)

Competencies specified: Yes, 30 competencies

State-sponsored curriculum: Yes, Board of Nursing Home Health Aide Curriculum

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years of experience, with at least one year of which has been in home care

Continuing education requirements: Yes, 12 hours annually, including 3 hours on HIV/AIDS and 2 hours on cultural competency on LGBTQ+ issues

Certificate or credential: Yes, Home Health Aide (HHA)

Centralized training registry: Yes

*RN or practical RN certification can be substituted for these training requirements.

Florida

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Health Aide

Scope: All home care agencies

Training hours: Yes, 40 hours

Competencies specified: Yes, 16 competencies

State-sponsored curriculum: No

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years of nursing experience, one of which must be in home health

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: Yes, Home Health Aide (HHA) or Certified Nursing Assistant (CNA)

Centralized training registry: Yes

Georgia

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Assistant 

Scope: All home care agencies

Training hours: Yes, 40 hours

Competencies specified: Yes, 9 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: Yes, registered nurse (RN) or commensurate healthcare professional

Continuing education requirements: Yes, 8 hours annually

Certificate or credential: No

Centralized training registry: No

Hawaii

Summary

Consistency: Inconsistent requirements across some Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Aide

Scope: All home care agencies

Training hours: Yes, 100 hours (30 classroom hours; 70 supervised practical training hours)

Competencies specified: Yes, 14 competencies

State-sponsored curriculum: No

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, registered nurse (RN) with 2 years of nursing experience (at least one of which must be in long-term care)

Continuing education requirements: Yes, annual performance review and regular in-service training

Certificate or credential: Yes, Certified Nursing Assistant (CNA)

Centralized training registry: Yes

Idaho

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Attendant

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN for some competencies   

Continuing education requirements: Yes, annual renewal of training (hours/details not specified)

Certificate or credential: No

Centralized training registry: No

*CNA certification can be substituted for these training requirements.

Illinois

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Services Worker

Scope: All home care agencies

Training hours: Yes, 10 hours (5 hours prior to first client; remaining 5 hours within the first 30 days after the start of employment)

Competencies specified: Yes, 14 competencies

State-sponsored curriculum: No

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, at least 2 years of experience in healthcare (home health or facility-based) and must be in a current supervisory position with a home services agency

Continuing education requirements: Yes, 10 hours of training annually

Certificate or credential: Yes, certification that a worker completed training with a licensed home services provider within the past year

Centralized training registry: No

2. Home Care Aide 

Scope: Agencies that receive reimbursement through the Medicaid Community Care Program

Training hours: Yes, 24 hours

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: Yes, online training modules via In the Know or Care Academy

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 12 hours of training annually

Certificate or credential: Yes, employer agencies must maintain certifications for all employees after they complete required training

Centralized training registry: No

3. Homemaker 

Scope: Agencies that receive reimbursement through the Medicaid Home Services Program

Training hours: Yes, 12 hours

Competencies specified: Yes, 4 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, 12 hours of training annually

Certificate or credential: No

Centralized training registry: No

Indiana

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

There are no training requirements for PCAs in Indiana.

Iowa

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

There are no training requirements for PCAs in Iowa.

Kansas

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

There are no training requirements for PCAs in Kansas.

Kentucky

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Services Attendant

Scope: Agencies that receive Medicaid reimbursement; at least one consumer-directed program

Training hours: No

Competencies specified: Yes, 19 competencies

State-sponsored curriculum: Yes, Department of Aging and Independent Living Attendant Care Education

Competency exam or evaluation: Yes

Instructor qualifications specified: No 

Continuing education requirements: Yes, annual renewal of training (hours/details not specified)

Certificate or credential: No

Centralized training registry: No

Louisiana

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Direct Service Worker

Scope: All home care agencies

Training hours: Yes, 16 hours

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No 

Continuing education requirements: Yes, 8 hours annually

Certificate or credential: No

Centralized training registry: No

Maine

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Support Specialist  

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 50 hours that must be completed within 6 months of hire

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No  

Continuing education requirements: No

Certificate or credential: Yes, Personal Support Specialist (PSS)

Centralized training registry: Yes

*HHA or CNA certification can be substituted for these training requirements if    certification is current within the past 3 years.

2. Attendant

Scope: At least one consumer-directed program

Training hours: No

Competencies specified: Yes, 5 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Maryland

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Assistance Provider

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: Yes, RN

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Massachusetts

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Homemaker 

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 60 hours (including 17 hours of classroom instruction and a 3 hour practicum)

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: Yes, Mass Council Personal Care Training Outline 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN in Massachusetts

Continuing education requirements: Yes, 6 hours annually

Certificate or credential: Yes, Personal Care Homemaker

Centralized training registry: No

2. Personal Care Attendant 

Scope: At least one consumer-directed program

Training hours: Yes, 4 hours

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: Yes, PCA New Hire Orientation Curriculum

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Michigan

Summary

Consistency: Inconsistent requirements across some Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Direct Care Worker

Scope: Agencies that receive Medicaid reimbursement under the Michigan Choice Waiver; consumer-directed programs under the Michigan Choice Waiver

Training hours: No

Competencies specified: Yes, 6 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: Yes, in-service training twice a year

Certificate or credential: No

Centralized training registry: No

Minnesota

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Assistant

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 9 competencies

State-sponsored curriculum: Yes, Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) Training

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, a mental health professional, RN, licensed social worker, or a qualified designated coordinator

Continuing education requirements: No

Certificate or credential: Yes, Personal Care Assistant (PCA)

Centralized training registry: No

Mississippi

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Attendant

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 40 hours

Competencies specified: Yes, 21 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, annual curriculum training course that covers 10 different topics and requires a scored exam

Certificate or credential: No

Centralized training registry: No

2. Personal Care Attendant

Scope: At least one consumer-directed program

Training hours: No

Competencies specified: Yes, 8 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

*CNA certification can be substituted for these training requirements if the CNA has been employed continuously for a year within the last 3 years.

Missouri

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Aide

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 12 hours (6 hours prior to first client, with at least 2 hours of training on basic orientation and emergencies and a maximum of 2 hours of reading)

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN, LPN, GN, supervisor or an experienced aide who has been employed by the provider agency for at least 6 months

Continuing education requirements: Yes, 5 hours annually

Certificate or credential: No

Centralized training registry: No

Montana

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Attendant

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 16 hours

Competencies specified: Yes, 10 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, must be a licensed nurse

Continuing education requirements: Yes, 8 hours annually

Certificate or credential: No

Centralized training registry: No

Nebraska

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

There are no training requirements for PCAs in Nebraska.

Nevada

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Attendant

Scope: All home care agencies

Training hours: No

Competencies specified: Yes, 6 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 8 hours annually  

Certificate or credential: Yes, each attendant must have evidence of successful completion of a training program

Centralized training registry: No

2. Personal Assistant

Scope: At least one consumer-directed program

Training hours: Yes, 16 hours within the first 120 days of employment  

Competencies specified: Yes, 9 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 8 hours annually

Certificate or credential: Yes, a certificate indicating successful completion of training  

Centralized training registry: No

New Hampshire

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Attendant

Scope: All home care agencies

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

New Jersey

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Certified Homemaker-Home Health Aide

Scope: All home care agencies

Training hours: Yes, 76 hours (60 classroom hours, 16 clinical hours)

Competencies specified: Yes, 15 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years full-time or 4 years part-time experience, with at least one year in home or community health if full-time; at least two years in home or community health if part-time

Continuing education requirements: No

Certificate or credential: Yes, Certified Homemaker-Home Health Aide (CHHA)

Centralized training registry: Yes

New Mexico

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Attendant

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes, 12 hours  

Competencies specified: Yes, 14 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: No

Centralized training registry: No

New York

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Aide

Scope: All home care agencies

Training hours: Yes, 40 hours (must be completed within 90 days of entry into the training program)

Competencies specified: Yes, 12 competencies

State-sponsored curriculum: Yes, the Home Care Curriculum

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years of experience

Continuing education requirements: Yes, 3 hours semiannually

Certificate or credential: Yes, Personal Care Aide (PCA)

Centralized training registry: Yes

North Carolina

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. In-Home Aide Level II

Scope: All home care agencies

Training hours: No (59 hours are recommended but not required)

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN with 2 years of direct patient care experience

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

 2. In-Home Aide Level III

Scope: Agencies that receive Medicaid reimbursement

Training hours: Yes (75 hours; 101 hours are recommended)

Competencies specified: Yes, 13 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN

Continuing education requirements: No

Certificate or credential: Yes, Certified Nursing Assistant (CNA)

Centralized training registry: Yes

North Dakota

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Qualified Service Provider and Family Personal Care Qualified Service Provider

Scope: Agencies that receive Medicaid reimbursement; at least one consumer-directed programs

Training hours: No

Competencies specified: Yes, 21 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, either a physician, chiropractor, RN, LPN, occupational therapist, physical therapist, or an individual with a professional degree in specialized areas of health care

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: Yes

Ohio

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. ODA-Certified Personal Care Aide

Scope: All home care agencies that serve people ages 60 and older

Training hours: Yes, 30 hours

Competencies specified: Yes, 17 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 6 hours annually

Certificate or credential: Yes, Personal Care Aide (PCA)

Centralized training registry: No

*HHA or CNA certification can be substituted for these training requirements with an additional orientation that covers 7 of the 17 competencies that PCAs are trained in.

2. Personal Care Aide

Scope: Home care agencies that receive funding through the Ohio Home Care Waiver

Training hours: No

Competencies specified: No

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: No

Centralized training registry: No

* HHA certification can be substituted for these training requirements.

3. Personal Care Aide

Scope: Non-agency workers who receive funding through the Ohio Home Care Waiver

Training hours: No

Competencies specified: Yes, 3 competencies

State-sponsored curriculum: No 

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 6 hours annually

Certificate or credential: No

Centralized training registry: No

*HHA certification can be substituted for these training requirements.

Oklahoma

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Supportive Home Assistant

Scope: All home care agencies

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN

Continuing education requirements: Yes, an annual competency assessment

Certificate or credential: Yes, Supportive Home Assistant

Centralized training registry: No

2. Advanced Supportive/ Restorative Assistance Aides

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 11 competencies

State-sponsored curriculum: No    

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, must be an RN or an LPN working under an RN

Continuing education requirements: Yes, annual in-service training

Certificate or credential: No

Centralized training registry: No

Oregon

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Care Worker/Personal Support Worker/Personal Care Attendant

Scope: All home care agencies; consumer-directed programs  

Training hours: Yes, 14 hours (6 hour in-person orientation; 8 hours of self-paced new workers training. All training must be completed within 120 days of receiving a provider number.)

Competencies specified: Yes, 18 competencies

State-sponsored curriculum: Yes, SEIU 503 training

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 12 hours every 24 months, including cultural competency training

Certificate or credential: No

Centralized training registry: Yes

2. Caregiver

Scope: Agencies that receive private pay funding

Training hours: Yes, 12 hours (4 hour minimum agency orientation; 2 hours of training before providing services; 6 hours of training within 120 days of hire)

Competencies specified: Yes, 14 competencies

State-sponsored curriculum: No   

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, 6 hours annually

Certificate or credential: No

Centralized training registry: Yes

Pennsylvania

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Direct Care Worker

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 16 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: Yes, in 6 specific competencies

Certificate or credential: No

Centralized training registry: No

2. Direct Care Worker

Scope: Agencies that receive private pay funding

Training hours: No

Competencies specified: Yes, 16 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

3. Direct Care Worker

Scope: At least one consumer-directed program

Training hours: Yes, 8 hours across the first 4 months of hire

Competencies specified: Yes, 11 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: Yes, training must be provided by an Office of Long-Term Living-approved statewide entity

Continuing education requirements: No 

Certificate or credential: No

Centralized training registry: No

Rhode Island

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Nursing Assistant

Scope:All home care agencies

Training hours: Yes, 120 hours (80 classroom hours; 40 hours of practical experience)

Competencies specified: Yes, 6 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, competent resource personnel from various areas of the health field may participate as program instructors at the discretion of the program coordinator

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: Yes, Nursing Assistant (NA)

Centralized training registry: Yes

2. Personal Care Aide

Scope: At least one consumer-directed programs

Training hours: Yes, 6 hours

Competencies specified: Yes, 5 competencies

State-sponsored curriculum: Yes, Prometric Knowledge and Skills Certification

Competency exam or evaluation: Yes

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: Yes, Personal Care Aide (PCA)

Centralized training registry: Yes, though not required for the PCA to register if the PCA only wants to work for one consumer

South Carolina

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Aide II

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN or LPN

Continuing education requirements: Yes, 10 hours annually

Certificate or credential: No

Centralized training registry: No

2. Caregiver

Scope: Agencies that receive private pay funding

Training hours: No

Competencies specified: Yes, 8 competencies

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

3. Attendant 

Scope: At least one consumer-directed program

Training hours: No

Competencies specified: Yes, 1 competency

State-sponsored curriculum: No

Competency exam or evaluation: No

Instructor qualifications specified: Yes, licensed nurse

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

South Dakota

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Aide

Scope: All home care agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 2 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: No 

Continuing education requirements: Yes, 6 hours annually

Certificate or credential: No

Centralized training registry: No

Tennessee

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

There are no training requirements for PCAs in Tennessee.

Texas

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

There are no training requirements for PCAs in Texas.

Utah

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Personal Care Aide

Scope: All home care agencies

Training hours: No

Competencies specified: Yes, 3 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: No 

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Vermont

Summary

Consistency: No training requirements in any Medicaid program

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: No

Training Requirements by Role

There are no training requirements for PCAs in Vermont.

Virginia

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: No

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Attendant/Personal Care Aide

Scope: All home care agencies

Training hours: Yes, 40 hours

Competencies specified: Yes, 12 competencies

State-sponsored curriculum: Yes, Virginia Department of Medical Assistance Services  

Competency exam or evaluation: No

Instructor qualifications specified: Yes, RN who has at least one year of clinical nursing experience

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: No

Centralized training registry: No

Washington

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: Yes

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: Yes

Training Requirements by Role

1. Home Care Aide/Individual Provider

Scope: All home care agencies; at least one consumer-directed program

Training hours: Yes, 75 hours (5 hours of orientation and safety training prior to providing care and 70 hours of training within first 120 days of providing care)

Competencies specified: Yes, 5 competencies

State-sponsored curriculum: Yes, Home Care Aide certification and 75-hour training

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN or a person with specific knowledge, training, and work experience relevant to the training topics

Continuing education requirements: Yes, 12 hours annually

Certificate or credential: Yes, Home Care Aide (HCA)

Centralized training registry: Yes

West Virginia

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Direct Care Worker

Scope: Agencies that receive Medicaid reimbursement and consumer-directed programs except those under the Aged and Disabled Waiver

Training hours: No

Competencies specified: Yes, 8 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, an RN must provide training on personal attendant skills

Continuing education requirements: Yes, 4 hours annually in addition to CPR, First Aid, and Universal Precautions Training

Certificate or credential: No

Centralized training registry: No

2. Personal Attendant

Scope: Agencies that receive Medicaid reimbursement; consumer-directed programs under the Aged and Disabled Waiver Personal Options Program

Training hours: No

Competencies specified: Yes, 9 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: Yes, an RN must provide training on personal attendant skills

Continuing education requirements: Yes, 4 hours annually in addition to CPR, First Aid, and Universal Precautions Training

Certificate or credential: No

Centralized training registry: No

Wisconsin

Summary

Consistency: Inconsistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Personal Care Worker

Scope: Agencies that receive Medicaid reimbursement

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN serving in a supervisory capacity at the provider agency

Continuing education requirements: No 

Certificate or credential: No

Centralized training registry: No

2. Personal Assistant

Scope: Agencies that receive Medicaid reimbursement; consumer-directed programs for Family Care, Family Care Partnership, and PACE programs

Training hours: No

Competencies specified: Yes, 7 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: No

Instructor qualifications specified: No

Continuing education requirements: No

Certificate or credential: No

Centralized training registry: No

Wyoming

Summary

Consistency: Consistent requirements across all Medicaid programs

Training Required for Private Pay Home Care Agency Workers: No

Training Required for Consumer-Directed Workers: Yes

Home Care Agencies Licensed: No

Training Requirements by Role

1. Home Health Aide

Scope: Agencies that receive Medicaid reimbursement; at least one consumer-directed program

Training hours: Yes, 91 hours (75-hour certified nursing assistant training; 16 hours of training on home health issues)

Competencies specified: Yes, 8 competencies

State-sponsored curriculum: No  

Competency exam or evaluation: Yes

Instructor qualifications specified: Yes, RN   

Continuing education requirements: Yes, at least 15 hours of continuing education if the home health aide has less than 400 hours of employment as a CNA over two years 

Certificate or credential: Yes, Home Health Aide (HHA)

Centralized training registry: Yes

Alabama

Alabama Medicaid. 2025. Waiver Services. https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.2G_Apr2025/Apr25_107.pdf.

Centers for Medicare and Medicaid (CMS). 2022. AL Elderly and Disabled Waiver. Washington DC: CMS. https://medicaid.alabama.gov/documents/6.0_LTC_Waivers/6.1_HCBS_Waivers/6.1.2_Elderly_Disabled_Waiver/6.1.2_Elderly_and_Disabled_Waiver_Application_Updated_10-1-22.pdf.

Centers for Medicare and Medicaid (CMS). 2021. Technology Assisted Waiver- TA Waiver.  Washington DC: CMS. https://medicaid.alabama.gov/documents/6.0_LTC_Waivers/6.1_HCBS_Waivers/6.1.7_TA_Waiver/6.1.7_TA_Waiver_Renewal_2020.pdf.

Alaska

Alaska Administrative Code. 2024. Purpose and Scope of Personal Care Services; Coverage Limitations. 7 AAC §125.010. https://www.akleg.gov/basis/aac.asp#7.125.

Alaska Administrative Code. 2024. Agency-Based Personal Care Services Program; Personal Care Assistant Education and Training Requirements. 7 AAC §125.160. http://www.akleg.gov/basis/aac.asp#7.125.160.

Alaska Administrative Code. 2024. Consumer-Directed Community First Choice Personal Care Services; Provider Agencies. 7 AAC §127.130. https://www.akleg.gov/basis/aac.asp#7.125.130.

Alaska Department of Health. “Home and Community Based Waiver Programs.” Accessed April 7, 2025. https://health.alaska.gov/en/services/hcbs-waivers/.

Arizona

Arizona Health Care Cost Containment System (AHCCCS). 2024. AHCCCS Medical Policy Manual, Direct Care Services. Phoenix, AZ: AHCCCS. https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/1200/1240-A.pdf.

Arizona Health Care Cost Containment System (AHCCCS). 2022. AHCCCS Medical Policy Manual, Direct Care Worker Training and Testing Program. Phoenix, AZ: AHCCCS. https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/400/429.pdf.

Arizona Health Care Cost Containment System (AHCCCS). 2022. 1320-A – Self-Directed Attendant Care. Phoenix, AZ: AHCCCS. https://www.azahcccs.gov/shared/Downloads/MedicalPolicyManual/1300/1320-A.pdf.

Arkansas

Arkansas Code. 2024. Training Requirement. 20 ACA §77-2303. https://law.justia.com/codes/arkansas/title-20/subtitle-5/chapter-77/subchapter-23/section-20-77-2303/.

Arkansas Department of Human Services. “Personal Care.” Accessed April 7, 2025. https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/perscare-prov/.

California

California Department of Social Services. “Information for Home Care Aides.” Accessed September 10, 2024. https://www.cdss.ca.gov/inforesources/community-care/home-care-services/resources-for-home-care-aides.

California Health and Safety Code. 2016. Registry and Exemptions. 1796 HSC §14. https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=2.&title=&part=&chapter=13.&article=2.

California Health and Safety Code. 2016. Affiliated Home Care Aides. 1796 HSC §44. https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=2.&title=&part=&chapter=13.&article=8.

Centers for Medicare and Medicaid (CMS). 2023. Home and Community Based Alternatives Waiver. Washington DC: CMS. https://www.dhcs.ca.gov/services/ltc/Documents/HCBA-Waiver-2023-2027.PDF.

Colorado

Code of Colorado Regulations. 2018. Medical Assistance. 10 CCR §2505-10. https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=6419&fileName=10%20CCR%202505-10%208.400.

Code of Colorado Regulations. 2017. Standards for Hospitals and Health Facilities: Chapter 26- Home Care Agencies. 6 CCR §1011-1. https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=7003&fileName=6%20CCR%201011-1%20Chapter%2026.

Consumer Direct Care Network Colorado. 2025. Consumer Directed Attendant Support Services Training Manual. Denver, CO: CDCN. https://consumerdirectco.com/wp-content/uploads/2025/04/CDASS_Program_Manual_FINAL_032625.pdf.

Connecticut

Connecticut Department of Social Services. 2019. Standardized Training for Personal Care Assistants for Agency-Based PCAs. Hartford, CT: CTDSS. https://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/PCA_Training_Modules.pdf.

Connecticut Department of Social Services. 2015. Overview of Medicaid Waiver Programs in Connecticut. Hartford, CT: CTDSS. https://portal.ct.gov/-/media/departments-and-agencies/dss/long-term-care/overview_of_connecticut_medicaid_waiver_programs_2_6_15.pdf.

Connecticut Department of Social Services. 2015. The Personal Care Attendant Program. Hartford, CT: CTDSS. https://portal.ct.gov/-/media/departments-and-agencies/dss/health-and-home-care/community-options/the-personal-care-attendant-program.pdf.

Connecticut Department of Social Services Medical Assistance Program. 2018. Provider Bulletin 2018-37. Hartford, CT: CTDSS. https://www.ctdssmap.com/CTPortal/Information/Get-Download-File?Filename=PB18_37.pdf&URI=Bulletins/PB18_37.pdf.

Delaware

Delaware Regulations. 2023. Personal Assistance Services Agencies. 3345 DR §. https://regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Health%20Care%20Quality/3345.pdf.

District of Columbia

Centers for Medicare and Medicaid (CMS). 2024. Elderly and Physical Disabilities Waiver Amendment. Washington D.C.:CMS. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81286.

District of Columbia Municipal Regulations and District of Columbia Register. 2016. Personal Care Aide Qualifications. 63 DCR 14134. https://www.dcregs.dc.gov/Common/DCMR/SectionList.aspx?SectionNumber=29-5009.

District of Columbia Municipal Regulations and District of Columbia Register. 2017. Home Health Aide Training Program Requirements. 17 DCMR 9327. https://www.dcregs.dc.gov/Common/DCMR/SectionList.aspx?SectionNumber=17-9327.

District of Columbia Department of Health. “Search for a License.” Accessed September 9, 2024. https://doh.force.com/ver/s/.

District of Columbia Department of Health. “Board of Nursing Home Health Aide Curriculum.” Accessed September 9, 2024. https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Home%20Health%20Aide%20Curriculum.pdf.

Florida

Florida Administrative Code. 2023. Personnel. 59A FAC §8.0095. https://www.flrules.org/gateway/ruleno.asp?id=59A-8.0095.

Florida Agency for Health Care Administration, Bureau of Medicaid Policy. “An Introduction to the Participant Direction Option – A Long-Term Care Benefit.” Accessed April 8, 2025. https://ahca.myflorida.com/content/download/8190/file/LTC_PDO_Provider_Webinar_20181204.pdf.

Florida Agency for Health Care Administration. “Long-Term Care Plans Participant Direction Option (PDO).” Accessed April 8, 2025. https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care/long-term-care-program/long-term-care-plans-participant-direction-option-pdo.

Florida Statutes. 2024. Definitions. 24 FS §400.462. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0400/Sections/0400.462.html.

Florida Statutes. 2024. Licensure of Nurse Registries; Requirements; Penalties. 24 FS §400.506. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0400/Sections/0400.506.html.

Georgia

Rules and Regulations of the State of Georgia. 2017. Rules and Regulations for Private Home Care Providers. 111 GAC 8-65. http://rules.sos.state.ga.us/gac/111-8-65.

Hawaii

Centers for Medicare and Medicaid. 2020. QUEST Integration Medicaid Section 1115 Demonstration. Washington, D.C.: CMS. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/hi/hi-quest-expanded-ca.pdf.

Centers for Medicare and Medicaid. 2020. QUEST Integration Medicaid Section 1115 Demonstration. Washington, D.C.: CMS. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/hi/hi-quest-expanded-ca.pdf.

Electronic Code of Federal Regulations (ECFR). 2024. Requirements for Approval of a Nurse Aide Training and Competency Evaluation Program. 42 FR § 483.152. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-D/section-483.152.

Hawaii Administrative Rules. 2018. Home Care Agencies. 11 HAR §700 https://health.hawaii.gov/opppd/files/2018/08/11-700-8-1-18.pdf.

Hawaii Administrative Rules. 2009. Requirements for Nurse Aide Certification. 16 HAR §89A-3. http://cca.hawaii.gov/pvl/files/2013/08/har_89a-c2.pdf.

State of Hawaii Department of Human Services. 2004. State Certified Nurse Aide Training Program. Honolulu, HI: DHS.  https://medquest.hawaii.gov/content/dam/formsanddocuments/resources/Provider-Resources/certification-programs/NATP-state-certified-nurse-aid-training-program.pdf.

Idaho

Centers for Medicare and Medicaid. 2024. ID Aged and Disabled Waiver. Washington, D.C.: CMS. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81471.

Idaho Administrative Code. 2024. Aged and Disabled Waiver Services: Provider Qualifications and Duties. 16 IAR §03.10.329. https://casetext.com/regulation/idaho-administrative-code/title-idapa-16-health-and-welfare-department-of/rule-160310-medicaid-enhanced-plan-benefits/sub-area-home-and-community-based-services/section-160310329-aged-and-disabled-waiver-services-provider-qualifications-and-duties.

Idaho Department of Health and Welfare. “Long-Term Care Provider Training.” Accessed September 10, 2024. https://healthandwelfare.idaho.gov/providers/home-and-community-based-long-term-care/long-term-care-provider-training.

Idaho Department of Health and Welfare. 2024. “Medicaid Enhanced Plan Benefits.” 16 IAR §03.10. https://adminrules.idaho.gov/rules/current/16/160310.pdf.

Idaho Department of Health and Welfare (DHW). 2024. Provider Training Matrix, Standards for Direct Care Staff and Allowable Tasks/Activities. Boise, ID: DHW. https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=28630&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1.

Idaho Statutes. 2024. Training of Personal Assistants. 39 IS §5605. https://legislature.idaho.gov/statutesrules/idstat/Title39/T39CH56/SECT39-5605/.

Idaho Statutes. 2024. Standards for Provision of Personal Assistance Services. 39 IS §5603. https://legislature.idaho.gov/statutesrules/idstat/title39/t39ch56/sect39-5603/#:~:text=39%2D5603.,provision%20of%20personal%20assistance%20services.

Illinois

Illinois Administrative Code. 2014. Personal Assistant (PA) Requirements. 77 IAC §686.10. http://www.ilga.gov/commission/jcar/admincode/089/089006860A00100R.html.

Illinois Administrative Code. 2014. Homemaker Service Provider Requirements. 77 IAC §686.200. http://www.ilga.gov/commission/jcar/admincode/089/089006860C02000R.html.

Illinois Administrative Code. 2023. Qualifications and Requirements for Home Services Workers. 77 IAC § 245.71. http://www.ilga.gov/commission/jcar/admincode/077/077002450B00710R.html.

Illinois Administrative Code. 2024. Home Services Agencies. 77 IAC §245.210. https://www.ilga.gov/Commission/jcar/admincode/JCARTitlePart.asp?Title=077&Part=0245.

Illinois Department of Human Services. “Home Services Program.” Accessed April 8, 2025. https://www.dhs.state.il.us/page.aspx?item=29738.

Indiana

Indiana Code. 2023. Personal Services Agency. 16 IC §27-4-5. https://iga.in.gov/laws/2023/ic/titles/16#16-27-4-5.

Iowa

Iowa Administrative Code. 2017. Conditions of Participations for Providers of Medical and Remedial Care. 441 IAC § 77. https://www.legis.iowa.gov/docs/iac/chapter/11-08-2017.441.77.pdf.

Iowa Administrative Code. 2018. HCBS Elderly Waiver Service Providers. 441 IAC § 77.33 (249A). https://www.legis.iowa.gov/docs/iac/rule/441.77.33.pdf.

Iowa Department of Health and Human Services. 2024. Home- and Community Based-Services (HCBS) Consumer-Directed Attendant (CDAC) Agreement. Des Moines, IA: HHS.   https://hhs.iowa.gov/media/5085/download?inline.

Iowa Department of Human Servies. 2022. “An Introduction to Iowa’s Home- and Community -Based Services.” https://hhs.iowa.gov/media/10422/download?inline.

Kansas

Kansas Statutes. 2017. Definitions. 65 KS § 5101. https://www.ksrevisor.org/statutes/chapters/ch65/065_051_0001.html.

Kansas Statutes. 2017. Home Health Agencies Required to Be Licensed; Temporary License; Penalty for Violation. 65 KS § 5102. https://www.ksrevisor.org/statutes/chapters/ch65/065_051_0002.html.

Kentucky

Kentucky Cabinet for Health and Family Services. “DAIL Attendant Care Training Test.” Accessed April 8, 2025. https://www.chfs.ky.gov/agencies/dail/Documents/ATTCTrainingtest92016.pdf.

Kentucky Cabinet for Health and Family Services, Department of Aging and Independent Living. “Attendant Care Education.” Accessed April 8, 2025. https://www.chfs.ky.gov/agencies/dail/Documents/DAIL%20ATTCTraining92016.pdf.

Kentucky Administrative Regulations. 2023. Provider Participation Requirements Excluding Participant-Directed Services. 907 KAR §7:010. https://apps.legislature.ky.gov/law/kar/907/007/010.pdf.

Louisiana

Louisiana Administrative Code. 2022. Home and Community-Based Services Providers Licensing Standards. 50 LAC §5001. https://ldh.la.gov/assets/medicaid/hss/docs/HCBS/HCBS_regs_as_of_3-14-22.pdf.

Maine

Code of Maine Regulations. Home Based Supports and Services for Older and Disabled Adults Routine Technical Rule/Major Substantive Rule. 10 CMR §149-5-63. Accessed April 8, 2025. https://www.maine.gov/dhhs/sites/maine.gov.dhhs/files/inline-files/149c5-63.pdf.

Maine Department of Health and Human Services (DHHS). 2024. Consumer-Directed Attendant Services. Augusta, ME: DHHS.

Maine Office of Elder Services. Section 69 Office of Elder Services Independent Support Services Program. Augusta, ME: Office of Elder Services.

Maryland

Maryland Division of State Documents. Training. 10 COMAR §07.05.11. Accessed April 8, 2025. https://dsd.maryland.gov/regulations/Pages/10.07.05.11.aspx.

Maryland Code of Regulations. 2024. Specific Conditions of Provider Participation – Personal Assistance. 10 COMAR § 09.20.05. https://dsd.maryland.gov/regulations/Pages/10.09.20.05.aspx.

Maryland Department of Health and Mental Hygiene, Office of Health Care Financing. Personal Care Services in Maryland. Annapolis, MD: MDH. Accessed April 8, 2025. https://health.maryland.gov/procumnt/Documents/CFC-Facts-Sheet-13407.pdf.

Maryland Health Care Commission. Opening a Maryland Residential Service Agency Fact Sheet. Annapolis, MD: MHCC. Accessed April 8, 2025. https://mhcc.maryland.gov/mhcc/pages/hcfs/hcfs_homehealth/documents/RSA_fact_sheet_provider.pdf.

Massachusetts

Executive Office of Elder Affairs, Commonwealth of Massachusetts. “Frail Elder Waiver: Information for Providers.” Accessed April 8, 2025. https://www.mass.gov/info-details/frail-elder-waiver-information-for-providers.

Executive Office of Elder Affairs, Commonwealth of Massachusetts. “Personal and Home Care Aide Training (PHCAST).” Accessed April 8, 2025. https://mahomecaretraining.org/.

Executive Office of Health and Human Services, Commonwealth of Massachusetts. “Moving Forward Plan (MFP) Waivers.” Accessed April 8, 2025. https://www.mass.gov/info-details/moving-forward-plan-mfp-waivers#services-offered-to-mfp-waiver-participants-.

Executive Office of Health and Human Services, Commonwealth of Massachusetts. “Personal Care Attendant (PCA) New Hire Orientation.” Accessed April 8, 2025. https://www.mass.gov/info-details/personal-care-attendant-pca-new-hire-orientation.

Personal Care Attendant Workforce Council, Commonwealth of Massachusetts. “Mass PCA Directory.” Accessed April 8, 2025. https://www.masspcadirectory.org/.

Michigan

Centers for Medicare and Medicaid. 2023. MI Choice Waiver Renewal. Washington, D.C.: CMS. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder1/Folder71/1915-c_HCBS_Waiver.pdf?rev=f095ac2dd86f4793bc1963edf75c2245&hash=6B5A6BADD7CCC31DBF2C342F1FA1BB9D

Centers for Medicare and Medicaid. 2024. MI Health Link HCBS. Washington, D.C.: CMS. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder3/Folder1/Folder2/Folder101/Folder1/Folder201/Section_1915c_MI_Health_Link_Waiver.pdf?rev=fd12e8426afb42219c9f124dbafaa9e0&hash=6482460CA4CAC0423F32450B783A71EA.

Michigan Department of Health and Human Services. 2024. “Home and Community-Based Services Comparison Chart.” https://www.michigan.gov/-/media/Project/Websites/mdhhs/Adult-and-Childrens-Services/Adults-and-Seniors/Forms-and-Publications/HCBS_Comparison_Chart-FINAL.pdf?rev=4ac9d49aef55434ca12a6bc6373d7898.

Michigan Department of Health and Human Services. 2024. “Independent Living (Home Help).” Accessed September 11, 2024. https://www.michigan.gov/mdhhs/adult-child-serv/adults-and-seniors/independent.

Michigan Department of Health and Human Services (MDHHS). 2024. Medicaid Provider Manual Overview. Lansing, MI: MDHHS. https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf.

Michigan Department of Health and Human Services (MDHHS). 2022. MI Choice Waiver. Lansing, MI: MDHHS. https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder50/Folder9/MSA_21-48B.pdf?rev=a9c29b449d604a8cad591a38349a35b7.

Michigan Department of Health and Human Services (MDHHS). 2023. Minimum Operating Standards for MI Health Link Program and MI Health Link HCBS Waiver. Lansing, MI: MDHHS. https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder2/Folder3/Folder1/Folder103/Minimum_Operating_Standards_for_MI_Health_Link.pdf?rev=3f859e91696d412c8660cd4d4128abed.

Minnesota

Minnesota Department of Human Services. “Elderly Waiver.” Last modified July 23, 2024. https://mn.gov/dhs/people-we-serve/seniors/services/home-community/programs-and-services/elderly-waiver.jsp.

Minnesota Department of Human Services. “Individual Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) Training.” Last modified March 27, 2024. https://mn.gov/dhs/partners-and-providers/training-conferences/minnesota-health-care-programs/provider-training/pca.jsp.

Minnesota Department of Human Services. 2022. “Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) Training and Tests.” Accessed April 8, 2025. https://registrationtraining.dhs.state.mn.us/?BusinessUnitID=16.

Minnesota Department of Human Services. “PCA/CFSS Worker Criteria, Requirements and Responsibilities.” Last modified August 26, 2024. https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=cfss-0007#.

Minnesota Statues. 2024. Personal Care Assistance Program. 256B MS §0659. https://www.revisor.mn.gov/statutes/cite/256B.0659.

Mississippi

Mississippi Division of Medicaid. 2017. Home and Community Based Services (HCBS), Long Term Care. 23 MAC §208. https://medicaid.ms.gov/wp-content/uploads/2023/09/Title-23-Part-208-HCBS-LTC-eff.-9.1.23.pdf.

Mississippi Division of Medicaid (DOM). 2020. Personal Care Services Quality Assurance Standards. Jackson, MS: DOM. https://medicaid.ms.gov/wp-content/uploads/2019/01/PCS-Quality-Assurance-Standards.pdf.

Missouri

Missouri Code of State Regulations. 2024. Consumer-Directed Services. 19 CSR §15-8. https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c15-8.pdf.

Missouri Department of Health and Senior Services. 2021. Independent Living Waiver. Jefferson City, MO: Missouri Department of Health and Senior Services. https://health.mo.gov/seniors/hcbs/hcbsmanual/pdf/3.55.pdf.

Missouri Department of Social Services. 2024. Personal Care Manual. Jefferson City, MO: Missouri Department of Health and Senior Services. https://mydss.mo.gov/media/pdf/personal-care-manual.

Montana

Administrative Rules of Montana. 2024. Self-Directed Personal Assistance Services: Provider Requirements. 37.40.1127. https://rules.mt.gov/browse/collections/aec52c46-128e-4279-9068-8af5d5432d74/policies/3d578064-6c5c-45fe-9e05-14a0a8f68b22.

Montana Department of Public Health and Human Services. “Community Services for Seniors and People with Disabilities.” Accessed April 8, 2025. https://dphhs.mt.gov/sltc/csb/.

Montana Department of Public Health & Human Services (DPHHS). 2015. Community First Choice Policy Manual. Helena, MT: DPHHS. https://dphhs.mt.gov/Portals/85/sltc/documents/CommunityFirst/CFCAgencyBased/Section700/AB706.pdf.

NORC at the University of Chicago. 2014. Montana ACA Section 2401k State Plan Amendment Summary. Chicago, IL: NORC. https://www.medicaid.gov/medicaid/home-community-based-services/downloads/mt-cfc-spa-matrix.pdf.

Nebraska

Nebraska Department of Health and Human Services. “Home and Community-Based Services.” Accessed April 8, 2025. https://dhhs.ne.gov/Pages/Medicaid-Home-and-Community-Based-Programs.aspx.

Nevada

Nevada Administrative Code. 2021. Client to Serve as Managing Employer and Provide Training to Personal Assistant; Reporting of Training to Organization. 449 NAC §39519. https://www.leg.state.nv.us/NAC/NAC-449.html#NAC449Sec39519.

Nevada Administrative Code. 2021. Attendants: Required Knowledge and Training. 449 NAC §3977. https://www.leg.state.nv.us/NAC/NAC-449.html#NAC449Sec3977.

Nevada Department of Health and Human Services (DHHS). 2022. PCA Training Requirements. Carson City, NV: DHHS. https://dhhs.nv.gov/uploadedFiles/dhhsnvgov/content/Programs/HCESB/PCA%20Training%20Requirements_030222_FINAL.pdf.

Nevada Department of Health and Human Services, Division of Public and Behavioral Health. “Attendant Training Checklist for Intermediary Service Organization (ISO).” Accessed April 8, 2025. https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Reg/HealthFacilities/HF_-_Non-Medical/Agency_to_provide_personal_care_services_in_the_home_(Files)/AttendantTrainingChecklist.pdf.

Nevada Medicaid. Nevada Medicaid’s PCS Program Offers Distinct Choice for In-Home Care. Accessed April 8, 2025. https://www.leg.state.nv.us/App/InterimCommittee/REL/Document/2586.

New Hampshire

Centers for Medicare and Medicaid. 2023. Choices for Independence Waiver Renewal: 2022–> 2027. Washington, D.C.: CMS. https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents2/dltss-cfiwaiver-2022-amended-04-01-2023.pdf.

New Hampshire Care Path. 2016. Choices for Independence (CFI). Concord, NH: NH Care Path. https://nhcare-c.org/wp-content/uploads/2022/01/cb-choices-booklet-1.pdf.

New Hampshire Code of Administrative Rules. 1994. Training Requirements. He-W 552.07. http://gencourt.state.nh.us/rules/state_agencies/he-w500.html.

New Jersey

New Jersey Administrative Code. 2024. CHHA Training Program. 37 NJAC §13:37-14.4. https://www.njconsumeraffairs.gov/regulations/Chapter-37-New-Jersey-Board-of-Nursing.pdf

New Jersey Department of Human Services Division of Medical Assistance and Health Services (DMAHS). Personal Preference Program Fact Sheet. Accessed September 11, 2024. Trenton, NJ: DMAHS. https://www.nj.gov/humanservices/dmahs/clients/PPP_Fact_Sheet.pdf.

New Jersey Board of Nursing. 2020. New Jersey Board of Nursing Law. 45 NJAC §11:23 – 11:52. Trenton, NJ: New Jersey Board of Nursing. https://www.njconsumeraffairs.gov/Statutes/nursing-law.pdf.

New Jersey Office of the Attorney General. 2019. Homemaker-Home Health Aide Training Program and Instructor Personnel Record Form Information. Newark, NJ: New Jersey Office of the Attorney General. https://www.njconsumeraffairs.gov/hhh/Documents/Training-Book.pdf.

New Mexico

New Mexico Human Services Department Medical Assistance Division (MAD). 2020. Managed Care Policy Manual. Albuquerque, NM: MAD. https://www.hsd.state.nm.us/wp-content/uploads/2020/12/Centennial-Care-Managed-Care-Policy-M.pdf.

New York

New York State. 2021. Personal Care Services. 18.505.14. https://regs.health.ny.gov/volume-c-title-18/content/section-50514-personal-care-services.

New York State Department of Health (DOH). 2022. Guide to the Operation of a Personal Care Aide Training Program. Albany, NY: DOH. https://www.health.ny.gov/professionals/home_care/guide_to_operate_pcatp/docs/guide.pdf.

New York State Department of Health (DOH). 2007. Home Care Curriculum. Albany, NY: DOH.  https://www.health.ny.gov/professionals/home_care/curriculum/docs/home_care_curriculum.pdf

New York State Department of Health. 2021. “11OHIP/ADMI-6 – Consumer Directed Personal Assistance Program (CDPAP) Scope and Procedures.” Last modified December 2021. https://www.health.ny.gov/health_care/medicaid/publications/adm/11adm6.htm.  

New York State Department of Health. 2024. “NYS Department of Health Office of Health Insurance Programs: Guidelines for the Provision of Personal Care Services in Medicaid Managed Care.” Last modified September 2024. https://www.health.ny.gov/health_care/medicaid/redesign/final_personal_care_guidelines.htm.

New York State Department of Health. 2009. “New York State Home Care Registry.” Accessed April 8, 2025. https://apps.health.ny.gov/professionals/home_care/registry/home.action.

North Carolina

North Carolina Administrative Code. The Licensing of Home Care Agencies. 10A NCAC §§ 13J.0901-1110. http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2013%20-%20nc%20medical%20care%20commission/subchapter%20j/subchapter%20j%20rules.html.

North Carolina Administrative Code. Aging: In-Home Aide Services for Older Adults. 10A NCAC §§ 06A .0101 – 0310. http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2006%20-%20aging%20-%20programs%20operations/subchapter%20a/subchapter%20a%20rules.pdf.

North Carolina Division of Health Service Regulation, Health Care Personnel Education and Credentialing Section. “Listing and Re-listing on the N.C. Nurse Aide I Registry.” Last modified November 9, 2016. https://info.ncdhhs.gov/dhsr/hcpr/floaide.html.

North Carolina Division of Social Services (DSS). Family Services Manual, In Home Aide Services. Accessed April 8, 2025. Raleigh, NC: DSS. https://www.ncdhhs.gov/documents/files/homeaide-manual/open.

North Carolina Medicaid Division of Health Benefits. 2024. “Community Alternatives Program for Disabled Adults (CAP/DA).” Last modified September 5, 2024. https://medicaid.ncdhhs.gov/providers/programs-and-services/long-term-care/community-alternatives-program-disabled-adults-capda.

North Dakota

North Dakota Legislature. 2025. Provision of Home and Community-Based Services Under the Service Payments for Elderly and Disabled Program and the Medicaid Waiver for the Aged and Disabled Program. Bismarck, ND: North Dakota Legislature. Accessed April 8, 2025. https://ndlegis.gov/information/acdata/pdf/75-03-23.pdf.

North Dakota QSP Hub. 2024. “What is a QSP?” Accessed September 11, 2024. https://www.ndqsphub.org/about/qsps.

Ohio

Ohio Administrative Code. 2023. ODA Provider Certification: Requirements for Providers to Become, and to Remain, Certified. 173 OAC §39-02. http://codes.ohio.gov/oac/173-39-02.

Ohio Administrative Code. 2023. ODA Provider Certification: Choices Home Care Attendant Service.173 OAC §39-02.4. http://codes.ohio.gov/oac/173-39-02.4.

Ohio Administrative Code. 2023. ODA Provider Certification: Personal Care. 173 OAC §39-02.11. http://codes.ohio.gov/oac/173-39-02.11.

Ohio Administrative Code. 2024. Ohio Home Care Waiver: Definitions of the Covered Services and Provider Requirements and Specifications. 5160 OAC §46-04. https://codes.ohio.gov/ohio-administrative-code/rule-5160-46-04.

Ohio Department of Aging. “PASSPORT Participant Direction.” Accessed April 10, 2025. https://aging.ohio.gov/care-and-living/get-help/home-and-community-care/passport-participant-direction#:~:text=In%20participant%20direction%2C%20the%20individual,certified%20personal%20care%20service%20agency.

Oklahoma

Centers for Medicare and Medicaid. 2021. ADvantage. Washington, DC: CMS. https://oklahoma.gov/content/dam/ok/en/okhca/docs/individuals/programs/advantage-waiver/210908%20-%20ADvantage%20Waiver%20OK-0256.pdf.

Centers for Medicare and Medicaid. 2022. Medically Fragile. Washington, DC: CMS. https://oklahoma.gov/content/dam/ok/en/okhca/docs/individuals/programs/medically-fragile/Medically%20Fragile%20Waiver%20-%20Proposed%20rate%20increase%20amendment%207.6.2022.pdf.

Oklahoma Health Care Authority. 2021. Oklahoma’s Medically Fragile Waiver. Oklahoma City. Accessed April 10, 2025. https://oklahoma.gov/content/dam/ok/en/okhca/docs/individuals/programs/medically-fragile/Medically%20Fragile%20Provider%20Training%202021.pdf.

Oklahoma State Department of Health. 2023. Services Provided. 310 O.S. § § 662-5-3. https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/organization/recently-adopted-amendments/permanent-rule-adoptions/2023/OSDH%20Chapter%20662.pdf.

The Oklahoma Statutes. 2017. Home Care Act. 63 O.S. §§ 1-1960. https://oklahoma.gov/content/dam/ok/en/health/health2/documents/662-and-664-home-care-act.pdf

Oregon

Carewell SEIU 503. “Frequently Asked Questions.” Accessed April 10, 2025.  https://www.carewellseiu503.org/resources/faqs/.

Carewell SEIU 503. “New Worker Training.” Accessed April 10, 2025. https://www.carewellseiu503.org/training/orientation/.

Centers for Medicare and Medicaid. 2023. OR Aged and Physically Disabled Waiver. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82986.

Oregon Administrative Rules. 2023. Caregiver Qualifications and Requirements. 333 OAR §536-0070. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=306483.

Oregon Administrative Rules. 2010. Caregiver Registries. 333 OAR § 540-0005.  https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1373.

Oregon Administrative Rules. 2023. Definitions. 411 OAR §031-0020. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=299296.

Oregon Administrative Rules. 2024. Definitions. 418 OAR § 020-0010. https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1999.

Oregon Administrative Rules. 2024. Mandatory Training and Competency Evaluations. 418 OAR § 020-0035. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=310285.

Oregon Administrative Rules. 2023. Independent Choices Program. 411 OAR §030-0100. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=303074.

Oregon Administrative Rules. 2022. Provider Qualifications. 411 OAR §034-0050. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=297789.

Oregon Revised Statutes. 2018. Authority of Commission. 410 ORS § 625.   https://oregon.public.law/statutes/ors_410.625.

Pennsylvania

Centers for Medicare and Medicaid. 2020. PA Community HealthChoices Waiver. Washington DC: CMS. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83041.

Pennsylvania Code. Home Care Agencies and Home Care Registries General. 28 Pa. Code §611. Accessed April 10, 2025. https://www.pa.gov/content/dam/copapwp-pagov/en/health/documents/topics/documents/facilities-and-licensing/Chapter611.pdf .

Pennsylvania Code. 2012. Subchapter B. Provider Qualifications and Participation. 55 Pa. Code § § 52.11-30. https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter52/subchapBtoc.html&d=reduce.

Pennsylvania Department of Human Services. 2024. 2024 Community Healthchoices Agreement. Harrisburg, PA. https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/healthchoices/hc-providers/documents/2024-CHC-Agreement-Final.pdf.

Rhode Island

Executive Office of Health and Human Services, State of Rhode Island. 2021. What you Need to Know as a Personal Care Aide in the Independent Provider Program. Providence, RI. https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2021-03/RI-PCA-IP-Manual-v22-Final.pdf.

Rhode Island Code of Regulations. 2022. Licensing Home Nursing Care Providers and Home Care Providers. 216 RICR §40-10-17. https://risos-apa-production-public.s3.amazonaws.com/DOH/REG_11478_20220304155610.pdf.

Rhode Island Code of Regulations. 2023. Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs. 216 RICR §40-05-22. https://risos-apa-production-public.s3.amazonaws.com/DOH/REG_12854_20230112113624604.pdf.

Rhode Island Code of Regulations. 2019. Self-Directed Care. 210 RICR § 50-10-2. https://risos-apa-production-public.s3.amazonaws.com/EOHHS/REG_10845_20191008121712.pdf.

State of Rhode Island Department of Health. “Nursing Assistant Licenses.” April 10, 2025. https://health.ri.gov/find/licensees/index.php?prof=Nursing%20Assistant&state=RI.

South Carolina

South Carolina Department of Health and Human Services (DHHS). 2022. CLTC Standards for Waiver Services. Columbia, SC: DHHS. https://www.scdhhs.gov/internet/pdf/manuals/cltc/Section%206.pdf.

South Carolina Department of Health and Human Services (DHHS). 2017. SCDHHS Self-Directed Attendant and Companion Care Stakeholder Training. Columbia, SC: DHHS. https://www.scdhhs.gov/sites/default/files/SCDue2/SCDHHS%20SD%20AC%20Training%20MMPvf%20May%2022%202017.pdf.

South Carolina Department of Health and Environmental Control (DHEC). 2014. Regulation 61-122 Standards for Licensing In-Home Care Providers. Columbia, SC: DHEC. https://dph.sc.gov/sites/scdph/files/Library/Regulations/R.61-122.pdf.

South Dakota

South Dakota Department of Human Services. (DHS). 2022. In-Home Services Provider Provisions. Pierre, SD: DHS. https://dhs.sd.gov/content/dam/digital/united-states/south-dakota/sdo/pdf/long-term-services-and-supports/provider-portal/FY23%20In-Home%20Provider%20Provisions.pdf

South Dakota DHS. “HOPE Waiver.” Accessed April 10, 2025. https://dhs.sd.gov/en/ltss/hope-waiver.

Tennessee

Rules of Tennessee Department of Finance and Administration Bureau of TennCare. 2018. TennCare Long-Term Care Programs. 1200-13-01. https://publications.tnsosfiles.com/rules_all/2018/1200-13-01.20180730.pdf.

TennCare. “CHOICES.” Accessed April 10, 2025. https://www.tn.gov/tenncare/long-term-services-supports/choices.html.

Tennessee Commission on Aging and Disability. 2019. Home and Community Based-Services. Nashville, TN: TCAD. https://www.tn.gov/content/dam/tn/aging/documents/ppmch16_02_17_23.pdf.

Tennessee Department of Disability and Aging. “Home & Community Based Services (HCBS).” Accessed April 10, 2025. https://www.tn.gov/disability-and-aging/disability-aging-programs/hcbs.html.

Texas

Texas Administrative Code. 2024. Attendant Orientation. 26 TAC § 277.25. https://www.law.cornell.edu/regulations/texas/26-Tex-Admin-Code-SS-277-25.

Texas Administrative Code. 2024. Attendant Qualifications. 26 TAC § 277.23.https://www.law.cornell.edu/regulations/texas/26-Tex-Admin-Code-SS-277-23.

Texas Administrative Code. 2024. Definitions. 26 TAC § 558.2. https://www.law.cornell.edu/regulations/texas/26-Tex-Admin-Code-SS-558-2.

Texas Health and Human Services. 2022. “Consumer Managed Personal Attendant Services (CMPAS) Program. https://www.hhs.texas.gov/providers/long-term-care-providers/consumer-managed-personal-attendant-services-cmpas.

Utah

Utah Department of Health. 2017. Physical Disabilities Waiver. Salt Lake City, UT: UDOH. https://medicaid.utah.gov/Documents/pdfs/ltc/pd/PDW_Fact_Sheet.pdf.

Utah Department of Health and Human Services. 2022. Waiver for Individuals Age 65 or Older. Salt Lake City, UT: UDHHS.  https://medicaid.utah.gov/Documents/pdfs/ltc/AG/AW_Fact_Sheet.pdf.

Utah Office of Administrative Rules. 2021. Rule 725: Personal Care Agency Rule. https://adminrules.utah.gov/public/rule/R432-725/Current%20Rules?.

Vermont

Vermont Department of Disabilities, Aging and Independent Living. 2020. Choices for Care.  Montpelier, VT: DAIL. https://asd.vermont.gov/sites/asd/files/documents/_Merged%20CFC_High_Highest_Manual.pdf.

Vermont Department of Disabilities, Aging and Independent Living. 2016. Choices for Care Moderate Needs Group. Montpelier, VT: DAIL.  https://asd.vermont.gov/sites/asd/files/documents/Moderate%20Needs%20Manual%20Merged%205.26.16.pdf.

Vermont Department of Disabilities, Aging and Independent Living. 2023. State of Vermont Older Americans Act Policy and Operations Manual. Montpelier, VT: DAIL. https://asd.vermont.gov/sites/asd/files/documents/Older%20American’s%20Act%20Policy%20and%20Operations%20Manual%202023%20(002).pdf.

Virginia

Virginia Administrative Code. 2006. Home Attendants. 12 VAC §5-381-290. https://law.lis.virginia.gov/admincode/title12/agency5/chapter381/section290/.

Virginia Department of Medical Assistance Services (DMAS). 2022. Commonwealth Coordinated Care Plus Waiver Provider Manual. https://vamedicaid.dmas.virginia.gov/sites/default/files/2022-10/Chapter-2%20Provider%20Participation%20Requirements%20%28CCC%20Plus%20Waiver%29.pdf.

Virginia Department of Medical Assistance Services (DMAS). 2003. Personal Care Aide Training Curriculum. Richmond, VA: DMAS. https://www.huntcountryhealth.com/wp-content/uploads/2020/06/Personal-Care-Aid-Training-02.pdf.

Washington

SEIU 775 Benefits Group. 2023. Caregiver Welcome Guide. Seattle, WA: SEIU 775 Benefits Group. https://seiu775benefitsgroup.org/wp-content/uploads/2024/05/Welcome-Guide-Fall-2023_Single-Pages.pdf

Washington Administrative Code. 2024. Individuals Exempt from Obtaining a Home Care Aide Certification. 246 WAC § 980-025. https://app.leg.wa.gov/WAC/default.aspx?cite=246-980-025&pdf=true.

Washington Administrative Code. 2024. What are the Training and Certification Requirements for Individual Providers and Home Care Agency Long-Term Care Workers? 388 WAC § 71-0523. https://app.leg.wa.gov/WAC/default.aspx?cite=388-71-0523&pdf=true.

Washington State Department of Social and Health Services (DSHS). “Becoming a Paid Caregiver.” Accessed November 11, 2024. https://www.dshs.wa.gov/altsa/home-and-community-services/becoming-paid-caregiver.

Washington State Department of Social and Health Services (DSHS). 2021. DSHS Community Instructor- Qualification Requirements. Olympia, WA: DSHS. https://www.dshs.wa.gov/sites/default/files/publications/documents/22-1854.pdf.

Washington State Department of Social and Health Services (DSHS). 2021. DSHS Facility Instructor- Qualification Requirements. Olympia, WA: DSHS. https://www.dshs.wa.gov/sites/default/files/publications/documents/22-1855.pdf.

Washington State Department of Social and Health Services (DSHS). 2022. Home Care Aide Certification and 75 Hour Training Overview. Olympia, WA: DSHS.  https://www.dshs.wa.gov/sites/default/files/ALTSA/hcs/documents/LTC%20Worker%20Training%20Requirements.pdf.

Washington State Department of Social and Health Services (DSHS). Home Care Aide Skills Checklist. Olympia, WA: DSHS. Accessed April 10, 2025. https://www.prometric.com/sites/default/files/WAHCACHECKLISTWITHHEAVIESTWEIGHTCHECKPOINTS20130529.pdf.

Washington State Department of Social and Health Services (DSHS). “Individual Providers.” Accessed September 13, 2024. https://www.dshs.wa.gov/altsa/home-and-community-services/individual-providers.

West Virginia

West Virginia Department of Health and Human Resources Bureau for Medical Services (BMS). 2015. Aged and Disabled Waiver. Charleston, WV: BMS. http://dhhr.wv.gov/bms/Provider/Documents/Manuals/Chapter_501_Aged_and_Disabled_Waiver.pdf

West Virginia Department of Health and Human Resources Bureau for Medical Services (BMS). 2018. Personal Care Services. Charleston, WV: BMS.  https://dhhr.wv.gov/bms/Provider/Documents/Manuals/Chapter%20517-Personal%20Care%20effective%201.1.18%20rev.%2012.19.17.pdf.

West Virginia Department of Health and Human Resources Bureau for Medical Services (BMS).  2024. Fiscal Employer Agent: West Virginia Personal Options Employer Guide. Charleston, WV: BMS. https://palcofirst.com/wp-content/uploads/2024/03/Personal-Options-Employer-Guide.pdf.

Wisconsin

My Choice Wisconsin. “Self-Directed Supports.” Last modified September 30, 2020. https://mychoicewi.org/family-care/self-directed-supports/.

Wisconsin Administrative Code. 2024. Personal Care Providers. DHS105.17.   https://docs.legis.wisconsin.gov/code/admin_code/dhs/101/105/17.

Wisconsin Department of Health Services. 2021. IRIS Participant Handbook. Madison, WI: Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/publications/p01008.pdf.

Wisconsin Department of Health Services. 2016. Managed Care Organization Training and Documentation Standards for Supportive Home Care. Madison, WI: Wisconsin Department of Health Services. https://www.dhs.wisconsin.gov/publications/p01602.pdf.

Wyoming

Code of Federal Regulations. 1991. Nurse Aide Competency Evaluation. 42 CFR §483.154. https://gov.ecfr.io/cgi-bin/text-idx?SID=5de1a5b780da0cb33cd22cd4a576ad82&mc=true&node=sp42.5.483.d&rgn=div6#se42.5.483_1154.

Wyoming Administrative Rules. 2016. Program Administration of Home Health Agencies. Chapter 9. https://health.wyo.gov/wp-content/uploads/2016/11/HLS-Rule-Ch-9-Home-Health.pdf.

Wyoming Department of Health Division of Healthcare Financing. 2023. Community Choices Waiver Service Index. Cheyenne, WI: DHCF. https://health.wyo.gov/wp-content/uploads/2024/12/CCW-Waiver-Service-Index-Effective-4.2023-Updated-12.6.24.pdf.

Wyoming Department of Health. “CNAs.” Last updated November 2023. https://health.wyo.gov/aging/hls/certified-nurse-aides/.

Wyoming State Board of Nursing. 2023. Nurse Practice Act. Chapter 2: Licensing and Certification Requirements. Cheyenne, WY: Board of Nursing. https://drive.google.com/file/d/1hUyYziVhCEfHELDEnIvjYxWztDTcaVHo/view.