How to Become a PCA for a Family Member in Minnesota

To become a paid PCA for a family member in Minnesota, your relative must first qualify for services through a MnCHOICES assessment, and you must complete a state training and test, pass a Department of Human Services (DHS) background study, and enroll through a DHS-approved provider agency or financial management services (FMS) provider. Since October 1, 2024, Minnesota has been moving people from the older Personal Care Assistance (PCA) program to Community First Services and Supports (CFSS), which for the first time allows spouses and parents of minor children to be paid, subject to limits.

The Program You’ll Be Enrolling Under

Minnesota’s traditional PCA program under Section 256B.0659 is being phased out and replaced by CFSS under Section 256B.85. DHS began the transition on October 1, 2024, and counties, tribal nations, and managed care organizations are moving people at their yearly reassessments.¹ If your family member already has PCA services, they will shift to CFSS at their next reassessment.

CFSS runs on two models. In the agency model, a DHS-enrolled provider agency employs you and handles payroll and billing. In the budget model, the recipient (or their representative) manages a budget and hires their own workers through an FMS provider.² The budget model gives families more control over scheduling, hiring, and, within limits, wages.

Get Your Family Member Assessed First

Nothing else matters until the person receiving care qualifies. Contact the health and human services department of the county or tribal nation where your family member lives and request a MnCHOICES assessment.³ The assessor reviews functional limitations in daily activities such as bathing, dressing, and mobility, along with any behavioral supports or complex health-related needs. Have medical records ready.

The assessment sets the monthly hours the recipient is authorized to receive, which becomes the ceiling on what you can work and be paid for. If your relative’s health or function changes significantly later, tell the lead agency; they may reassess and adjust the hours.

Check Whether Your Relationship Qualifies

Most adult relatives — adult children, siblings, grandparents, aunts, uncles — have long been eligible to serve as PCAs or CFSS support workers as long as they meet the general worker rules. The rules that changed with CFSS are for spouses and parents of minors.

Spouses and Parents of Minor Children

Under the older PCA program, spouses and parents of minor children were generally barred from paid caregiving.⁴ CFSS opens the door, but only for tasks beyond what a spouse or parent would normally do.⁵ A parent, for instance, can be paid for extra laundry caused by a child’s incontinence, but not for ordinary household chores, age-appropriate supervision, or typical transportation.

Hours are capped. A spouse or single parent providing services cannot be billed for more than 60 hours in a seven-day period. When two parents both provide services to their minor child, the combined cap is 80 hours per seven-day period, and neither parent can exceed 40 hours individually.⁵ A case manager or care coordinator must review spouse- or parent-provided services every six months.

Legal Guardians

An unpaid legal guardian can serve as a support worker. Someone who is paid for guardian services cannot also be paid as the recipient’s caregiver.⁴

Requirements That Apply to Every Worker

At least 18 years old, or 16 with additional supervision requirements.³
Complete the DHS PCA/CFSS training and score 80% or higher on the certification test.⁶
Pass a DHS background study through NETStudy 2.0.
Be able to communicate with the recipient or their representative.
Provide or bill for no more than 310 hours of CFSS services per month across all recipients.⁷

Complete the DHS Training and Test

The training and test are free, online, and one-time. Content covers recipient rights, first aid, infection control, emergency preparedness, body mechanics, and documentation such as timecards.⁸

Register through the DHS online training page using your legal name and an active email address. DHS recommends going through the free training modules before taking the exam, though only the test itself is required, and you can retake it as many times as you need.⁹ A passing score is 80%.

Once you pass, print your certificate of completion and save a digital copy. Your provider agency will ask for it, and the certificate number lets DHS confirm your qualification if you ever move between agencies.

Pass the Background Study

Every caregiver must clear a DHS background study submitted through NETStudy 2.0.¹⁰ You cannot start this on your own. The provider agency or FMS provider initiates the request for you through the state’s secure portal.

Once the study is opened, you have four days to complete the consent and disclosure form. After that, you have 10 days to visit a certified collection site for fingerprinting and a digital photograph.¹¹ Miss either deadline and the study can close, forcing your agency to start over. Bring a valid government-issued photo ID. The fee is $10.50, paid at the appointment to the vendor, IDEMIA.¹²

The study looks at criminal records and maltreatment findings. If you lived outside Minnesota within the past five years, it also includes a Child Abuse and Neglect Registry check from those states.¹² The agency will also confirm you are not on the federal Office of Inspector General’s List of Excluded Individuals and Entities, which bars anyone from participating in a Medicaid-funded program.¹³

Enroll Through a Provider Agency or FMS Provider

With training done and the background study cleared, you finish enrollment through the entity that will actually employ or pay you. Under the agency model, that’s a DHS-enrolled provider agency. Under the budget model, it’s an FMS provider chosen by the recipient. Either way, this entity handles payroll, billing, and compliance.

You’ll submit your training certificate, Social Security card, government-issued ID, and a completed I-9 Employment Eligibility Verification. The agency verifies your background study results, checks federal and state exclusion lists, and reviews the recipient’s service delivery plan so your duties are defined in writing. Once everything clears, the agency enrolls you with Minnesota Health Care Programs (MHCP) and you’re assigned a Unique Minnesota Provider Identifier (UMPI). Every timecard and billing entry going forward is tied to that number.¹³

Expect an orientation covering timekeeping, incident reporting, and any annual refresher training the agency requires.

What the Job Looks Like: Electronic Visit Verification

Federal law requires states to use electronic visit verification (EVV) for Medicaid-funded personal care.¹⁴ Minnesota’s state-selected system is HHAeXchange (HHAX), though your agency may use an approved alternative. In practice you’ll download the HHAX mobile app to your smartphone and use it to check in when a visit starts and check out when it ends.¹⁵ Skipping the app puts your agency’s compliance and your ability to keep working through them at risk.

Pay Rates

Minnesota sets minimum wage floors for PCA Choice and CFSS budget model workers, and the tier climbs with cumulative hours worked since July 1, 2017. As of January 1, 2025:¹⁶

0–1,000 hours: $20.00 per hour
1,001–2,000 hours: $20.50 per hour
2,001–6,000 hours: $21.00 per hour
6,001–10,000 hours: $21.70 per hour
10,001+ hours: $22.50 per hour

A revised Tiered Schedule 2 is set to take effect January 1, 2026, or within 30 days of federal approval, whichever is later; DHS will publish updated rates once approval comes through.¹⁶ In the agency model, the agency sets your rate. In the budget model, the recipient has more flexibility, but pay for a spouse or parent cannot exceed the established unit rate for CFSS services.⁵

The Tax Break for Live-In Family Caregivers

If you live in the same home as the person you care for, your Medicaid waiver payments may be fully excludable from federal gross income under IRS Notice 2014-7. The IRS treats qualifying payments under a state Medicaid Home and Community-Based Services waiver as difficulty-of-care payments under Section 131 of the Internal Revenue Code.¹⁷

The care has to be provided in “the provider’s home.” If you live with the recipient full-time and have no separate residence, the recipient’s home is your home for this purpose. If you keep a separate home where you carry on your regular private life, the exclusion generally does not apply even if you sleep at the recipient’s home part of the week.¹⁷ Vacation pay from the state is not excludable, and neither is any portion paid from the recipient’s private funds. When the exclusion does apply, the payments are also exempt from self-employment tax.

A Warning About Timecards

Once you’re enrolled, treat billing as a legal record. Under the federal Health Care Fraud statute, knowingly carrying out a scheme to defraud a health care program is punishable by up to 10 years in prison and fines up to $250,000. The False Claims Act adds civil liability of up to three times the government’s damages per fraudulent claim, and a conviction can permanently exclude you from all federal health care programs.¹⁸ Your role has to function as paid work under the service delivery plan, not ordinary family life logged as hours.

1
Minnesota Department of Human Services. Community First Services and Supports
2
Minnesota Department of Human Services. CFSS Budget Model Requirements
3
Minnesota Office of the Revisor of Statutes. Minnesota Code 256B.0659 – Personal Care Assistance Services
4
Minnesota Office of the Revisor of Statutes. Minnesota Statutes Section 256B.0659
5
Minnesota Department of Human Services. Paying a Spouse or Parent of a Minor for PCA/CFSS Services
6
Minnesota Department of Human Services. PCA/CFSS Worker Criteria, Requirements and Responsibilities
7
Minnesota Office of the Revisor of Statutes. Minnesota Statutes Section 256B.85
8
Minnesota Department of Human Services. Individual Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) Training
9
Minnesota Department of Human Services. Personal Care Assistance (PCA) and Community First Services and Supports (CFSS) Training and Tests
10
Minnesota Department of Human Services. Background Studies
11
Minnesota Department of Human Services. Consent and Disclosure FAQs
12
Minnesota Department of Human Services. Background Studies – For Entities
13
Minnesota Department of Human Services. Personal Care Assistance (PCA) Services – Section: Enrolling Individual PCAs
14
Medicaid.gov. Electronic Visit Verification
15
Minnesota Department of Human Services. Electronic Visit Verification
16
Minnesota Department of Human Services. PCA and CFSS Tiered Rates and Wage Floors
17
Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
18
Centers for Medicare & Medicaid Services. Laws Against Health Care Fraud Fact Sheet