I believe DMAS should restore the exemption that allowed live-in attendants providing Consumer-Directed Services to be exempt from clocking in and out.

A live-in attendant is not simply an employee who arrives at a consumer’s home for a scheduled shift and leaves at the end of the day. A live-in attendant resides in the same home as the individual receiving services and is already present to provide ongoing support when needed. Requiring a live-in attendant to clock in and out can create unnecessary administrative burdens and does not accurately reflect the reality of live-in care.

The purpose of Consumer-Directed Services is to give individuals more control over who provides their care and how their services are delivered. Live-in attendants are often family members or trusted individuals who have made a commitment to live with and support the consumer. The live-in arrangement provides stability, continuity, and immediate access to assistance.

Clocking in and out can also create confusion about when a live-in attendant is considered "on the clock," particularly when the attendant is providing services throughout the day while also living in the home. It can make an already complicated system more difficult for consumers, attendants, and Employers of Record to manage.

Restoring the live-in exemption would not mean that live-in attendants should be allowed to bill unlimited hours. DMAS can continue to use approved service plans, authorized hours, timesheets, documentation, and other safeguards to prevent fraud and ensure Medicaid funds are used appropriately. The exemption would simply recognize that a live-in arrangement is fundamentally different from a traditional hourly employment arrangement.

Most importantly, policies should support the consumer rather than create unnecessary barriers to receiving care. For many consumers, having a dependable live-in attendant is what allows them to remain safely in their own home instead of requiring a more restrictive or expensive setting.

I respectfully ask DMAS to reconsider the clock-in requirement for live-in attendants and restore the live-in exemption, while maintaining appropriate safeguards for accountability and program integrity.

Live-in care should be recognized for what it is: a unique caregiving arrangement that requires flexibility, trust, and policies that reflect the reality of providing care in the home.