ALTCS does not publish a single hourly wage for caregivers. How much the Arizona Long Term Care System pays a caregiver depends on three things: the AHCCCS fee-for-service reimbursement rate for the service being delivered, whether the caregiver works through an agency or directly for the member, and the number of hours a case manager has authorized on the member’s care plan.1AHCCCS. AHCCCS – HCBS Fee-For-Service Rates In practice, most Arizona caregivers earn somewhere between the state minimum wage and the full reimbursement rate, with self-directed arrangements typically paying more per hour than agency ones.
What Sets the Hourly Rate
AHCCCS sets fee-for-service rates for home and community-based services. That rate is what the state (through a contracted health plan) will reimburse for an hour of attendant care, personal care, or a similar service. It is not the caregiver’s paycheck.
The caregiver’s wage is set by whoever acts as the legal employer. That employer takes the reimbursement, subtracts payroll taxes, workers’ compensation, administrative costs, and any benefits, and pays the caregiver what’s left. The floor is Arizona’s minimum wage, which the Industrial Commission of Arizona enforces at $14.70 per hour in 2025.2Arizona Legislature. A.R.S. § 23-364 Most home care employers in Arizona pay above the minimum to stay competitive, but the exact figure varies by agency, region, and health plan contract.
Agency Pay vs. Self-Directed Pay
Under the Agency with Choice model, a home health agency is the formal employer. The agency hires, trains, and schedules the caregiver, and keeps a share of the reimbursement to cover insurance, supervisors, and overhead.3AHCCCS. AHCCCS – Self Directed Attendant Care (SDAC) Resources – Section: Agency with Choice Resources That overhead comes out of the same reimbursement dollar that funds wages, so agency hourly pay generally sits below the self-directed figure.
Under Self-Directed Attendant Care (SDAC), the member or legal guardian is the employer and hires the caregiver directly.4AHCCCS. AHCCCS – Self Directed Attendant Care (SDAC) Resources Without an agency taking a cut, more of the reimbursement can flow to the caregiver’s wage. The employer still has to cover payroll taxes and follow program rules, and the caregiver gives up the scheduling backup, training, and HR support an agency provides. That tradeoff is worth weighing before choosing a model.
Authorized Hours Decide Total Pay
Hourly rate is only half the picture. Total earnings depend on how many hours the member’s care plan authorizes. A case manager assesses the member’s ability to perform Activities of Daily Living and Instrumental Activities of Daily Living, such as bathing, dressing, toileting, and meal preparation, and translates that into a weekly hour authorization.
Hours can change. If the member’s health declines, the case manager can increase authorized hours during a scheduled review or after a reported change in condition. Preadmission Screening reassessments confirm the member still meets the nursing-facility level of care; some members are reassessed annually, and reviews can happen any time a health change is reported.5AHCCCS. ALTCS Eligibility Policy Manual – PAS Reassessments A 40-hour weekly authorization can produce full-time income, but only if the caregiver bills all the hours and the member isn’t hospitalized or otherwise out of service.
How the Payment Actually Reaches the Caregiver
Agency caregivers are paid on the agency’s regular payroll cycle, with taxes withheld and a W-2 at year end.
In the self-directed model, a Fiscal Employer Agent handles payroll for the member, withholds state and federal taxes, and issues the caregiver’s W-2 when household employment thresholds are met.4AHCCCS. AHCCCS – Self Directed Attendant Care (SDAC) Resources6Internal Revenue Service. IRS – Tax Situations for Family Caregivers Hours have to be verified before payment goes out. Caregivers either use Electronic Visit Verification or submit detailed timesheets, and pay is released only after the hours are properly submitted and approved.
Some caregiver wages qualify as “difficulty of care” payments, which may be excluded from gross income depending on the living arrangement. Whether that applies turns on specific facts, so a caregiver who thinks the exclusion might fit should confirm with IRS guidance or a tax professional rather than assume it.
Putting It Together
If you are weighing a caregiver role under ALTCS, ask the employer three questions before accepting: what is the hourly wage, how many hours per week has the member’s case manager authorized, and is the position agency-directed or self-directed? Those answers, not a published statewide rate, determine the paycheck.