Maryland DDA Family as Staff Form: Eligibility, Filing, and Taxes

The Maryland DDA Family as Staff Form is how a participant in the Developmental Disabilities Administration’s Self-Directed Services program asks for approval to hire a relative, legally responsible person, or legal guardian as a paid caregiver under the Medicaid waiver. You get the current version from your Coordinator of Community Services or the DDA’s Self-Directed Services Guidance and Forms page, complete the identifying details and the narrative sections explaining how the hire benefits the participant, and submit it through your CCS for DDA review. Starting April 1, 2026, a legally responsible person must have this form approved before beginning work.¹

Who Counts as Family as Staff

The form covers three categories: relatives, legally responsible persons (typically a parent of a minor), and legal guardians. The DDA defines “relative” as a natural or adoptive parent, step-parent, grandparent, step-grandparent, child, stepchild, sibling, step-sibling, aunt, uncle, niece, or nephew.²

Spouses are the exception. A spouse may not provide any waiver service except Support Broker Services, and the waiver program will not pay them for that either.² The form applies to participants using the Self-Directed Services delivery model, which lets waiver participants choose their own employees, vendors, and providers.³

The Extraordinary Care Standard for Legally Responsible Persons

If the proposed worker is a legally responsible person, the care being paid for must be “extraordinary.” That means it goes beyond what someone would normally do for a family member of the same age who does not have a disability or chronic illness, and it is necessary to protect the participant’s health and welfare and avoid institutionalization.¹ A legally responsible person cannot be paid for services that do not meet this standard.

Relatives who are not legally responsible for the participant are not held to the extraordinary care test in the same way, but they still complete the Family as Staff Form and show that the arrangement benefits the participant.

Conditions That Must Be Documented in the Person-Centered Plan

Before a legally responsible person can be paid, the participant’s Person-Centered Plan must document each of the following:¹

Care needs that exceed what a legally responsible person would ordinarily handle for someone of the same age without a disability
The participant (or the authorized representative of a minor) chose this provider, and the team supports the decision
Qualified providers are unavailable to meet the participant’s needs
The relative or spouse is not also serving as the participant’s Support Broker or designated representative directing services
The legally responsible person will provide no more than 40 hours per week across all waiver services combined
The person has special skills or training, such as a nursing license, that make them particularly suited to the participant’s needs

Which Services a Family Member Can Provide

Not every waiver service is open to family members. Table 2 of the Self-Directed Services Manual lists what each category may perform. The approved services include Personal Supports and Personal Supports Enhanced, Community Development Services, Employment Services, Respite Care Services, Support Broker Services, Transportation Services, and Day-to-Day Administrative Supports.²

Some services are restricted by category. Legally responsible persons cannot provide Transportation Services. Respite Care may not be provided by the primary caregiver. Day-to-Day Administrative Supports is open to relatives only if they are not a legally responsible person or guardian. And payment for legally responsible persons is limited to Personal Supports, Community Development Services, and Respite, and only when the extraordinary care standard is met.¹ Check Table 2 for the exact service you plan to list before you finalize the form; a service that is not eligible for the proposed worker’s category will get flagged.

Rules That Can Disqualify a Request Before You File

The 40-hour weekly cap is absolute. No relative, legally responsible person, or legal guardian may work more than 40 hours per week for a participant across all waiver services combined, whether as an employee, independent vendor, or through another vendor or DDA provider. The Financial Management and Counseling Services provider will not process payment for hours beyond that.²

The Support Broker conflict rule forces a choice. If a relative, legally responsible person, or legal guardian is the participant’s Support Broker, no one else in those categories may work for the participant. The reverse also holds: if any relative or guardian already works in another role, none of them can then be hired as Support Broker.²

When someone with decision-making authority over provider selection (such as a legal guardian or legally responsible person) is also going to be the paid provider, the participant must have a signed Supported Decision Making Agreement, referred to as a Substitute Judgement document, to protect independent decisions about service delivery.¹

Completing the Form

Get the current version from your CCS or the DDA’s Self-Directed Services Guidance and Forms page.⁴ An updated version took effect on October 6, 2025, and applies to any Person-Centered Plan submitted on or after that date.²

The form asks who will work for the participant and the proposed wage and weekly hours. The narrative sections carry most of the weight. You are asked to explain:²

Why hiring this person is in the participant’s best interest
How having this person as staff will help the participant become more integrated in the community
How it will increase the participant’s independence
How it will expand the participant’s circle of support or natural supports

Reviewers use these answers to decide whether the arrangement genuinely serves the participant rather than being convenient for the family. Be specific. If the participant communicates through gestures only the family member reliably understands, say so. If no agency in the area has staff trained to manage the participant’s medical or behavioral needs, document that. Answers like “it would be easier” invite denial.

Submitting Through Your CCS

Your Coordinator of Community Services is the point of contact throughout. The CCS facilitates the Person-Centered Plan, monitors service delivery, and confirms health and safety requirements are met.⁵ The CCS reviews the form for completeness before it moves to the DDA for a determination.

The DDA operates four regional offices covering Western Maryland, Central Maryland, the Eastern Shore, and Southern Maryland. Your CCS can tell you which regional office handles your case and what current turnaround times look like.⁶ Keep copies of everything you submit: the form, supporting documents, and your narrative answers.

Background Screening

Family members are not exempt from Maryland’s staff screening rules. Under COMAR 10.09.48.05, a person is ineligible for employment if they appear on the Maryland Medicaid exclusion list, the federal List of Excluded Individuals/Entities, or SAM.gov’s excluded parties list. A conviction for a crime of violence under Maryland Criminal Law Article §14-101, or a finding of guilt for a crime indicating potentially harmful behavior, also disqualifies an individual. Criminal history is verified through background checks under Health-General Article §19-1902 and COMAR 12.15.⁷ If the proposed worker has any criminal history, raise it with your CCS early rather than letting it surface after the paperwork is in.

What Happens After Approval

Once the DDA approves the request, the CCS updates the Person-Centered Plan to reflect the family member’s role, hours, and goals. The family member then enters the payroll system through one of Maryland’s Financial Management and Counseling Services providers. As of 2025, the three FMCS providers are GT Independence, Public Partnerships LLC, and Fello, each charging a 14 percent employer tax rate.⁸

The FMCS provider handles payroll, tax withholding, and reporting for the participant and their employees, and tracks spending against the participant’s budget.⁸ The DDA publishes Reasonable and Customary rate standards for self-directed employees, with the most recent schedule effective July 1, 2026.⁹ Family members hired as employees are not eligible for reimbursement of employee benefits and training costs through the waiver program.²

If Your Request Is Denied

A denial must come in writing and must state the specific reasons and the regulations that support the decision.¹ The letter will include an appeal deadline; missing it forfeits your right to challenge the decision.

You generally have three options: revise and resubmit with stronger documentation, file a formal Request for Reconsideration with the DDA, or request a Medicaid Fair Hearing under COMAR 10.01.04 and 42 CFR §431.210. You can represent yourself or bring an attorney or advocate. For terminations of existing services rather than initial denials, the deadline to file is typically 10 days from the date of the letter if you want services to continue during the hearing.

Federal Tax Rules Family Caregivers Should Know

Two federal tax provisions can meaningfully change what a paid family caregiver takes home.

The Difficulty of Care Exclusion

Under IRS Notice 2014-7, qualified Medicaid waiver payments to an individual care provider for nonmedical support services are treated as “difficulty of care” payments and can be excluded from gross income. The exclusion applies whether the provider is related or unrelated to the participant. The key requirement: the eligible individual must be living in the care provider’s home. Payments for care provided outside the provider’s home do not qualify.¹⁰

When the exclusion applies, the payor should not issue a Form W-2 or 1099-MISC for those payments. If you receive one anyway, contact the payor for a corrected form. The exclusion also applies retroactively; if you reported these payments as income in prior years, you can file an amended return (Form 1040-X), generally within three years of the original filing date or two years after paying the tax. There is a cap of 10 individuals under age 19 and five individuals age 19 or older per provider, which will rarely matter for someone assisting a single participant.¹⁰

FUTA and FICA for Family Employees

Federal unemployment tax rules exempt certain family arrangements. Payments for domestic work performed by a child for a parent are not subject to FUTA until the child reaches age 21, and payments for services performed by a parent for a child are not subject to FUTA regardless of the services provided.¹¹ The IRS also excludes wages paid to a spouse, a child under 21, or a parent from the household employer’s FUTA calculation.¹²

Most of this is handled by the FMCS provider, but if your living arrangement or relationship qualifies for the difficulty of care exclusion, raise it with the FMCS provider and a tax professional at the start. Correcting tax reporting after the fact is possible but slow.

1
Maryland Department of Health. Appendix C-1 and C-2 Amendment Proposal
2
Maryland Department of Health. DDA Self-Directed Services Manual
3
Developmental Disabilities Administration. DDA Self-Directed Services Manual
4
Maryland Department of Health. Developmental Disabilities Administration – Self-Directed Services Guidance and Forms
5
Maryland Department of Health. Partnering with CCS
6
Maryland Department of Health. Regional Offices
7
Legal Information Institute. COMAR 10-09-48-05 – Staff Requirements
8
Maryland Department of Health. Financial Management and Counseling Services
9
Maryland Department of Health. Rates
10
Internal Revenue Service. Internal Revenue Bulletin 2014-4
11
Internal Revenue Service. Family Employees
12
Internal Revenue Service. Employment Taxes for Household Employees