d. Definition of Family Caregiver

Section 1902(xx)(9)(A)(ii)(III) of the Act includes a “family caregiver (as defined in section 2 of the RAISE Family Caregivers Act) of a dependent child 13 years of age and under or a disabled individual” as a specified excluded individual.

The RAISE Family Caregivers Act directed the Secretary of the U.S. Department of Health and Human Services (HHS) to develop and make ( printed page 33368) publicly available a family caregiving strategy that identified recommended actions for recognizing and supporting family caregivers. To guide the development of this strategy, Section 2 of the RAISE Family Caregivers Act defined “family caregiver” as an adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other health condition, disability, or functional limitation. This definition encompasses a broad range of caregiver relationships and assistance provided to capture the full landscape of caregiving in the U.S. to inform the national caregiving strategy.

Section 1902(xx)(9)(A)(ii)(III) of the Act requires CMS to use the RAISE Family Caregivers Act definition of family caregiver when determining whether an individual qualifies as a specified excluded individual, but it also limits care recipients to “a dependent child 13 years of age and under or a disabled individual” (both of which are defined later in this section). Because the care recipients specified in section 1902(xx)(9)(A)(ii)(III) of the Act differ from those referenced in the RAISE Family Caregivers Act definition, it is necessary to establish a definition of “family caregiver” for purposes of identifying specified excluded individuals that incorporates applicable components of the RAISE Family Caregivers Act definition while aligning with the care recipients specified in 1902(xx)(9)(A)(ii)(III) of the Act. As such, at new § 435.554(a), we define family caregiver as an adult family member or other individual who has a significant relationship with, and who provides care within a broad range of assistance to, a dependent child or a disabled individual. This definition of family caregiver largely aligns with the RAISE Family Caregivers Act definition but includes modifications to support implementation of section 1902(xx)(9)(A)(ii)(III) of the Act, as further discussed below.

We are generally incorporating the significant relationship and activity-based components of the RAISE Family Caregivers Act definition into the definition of family caregiver at § 435.554(a), recognizing that a family caregiver is not limited to legally recognized relatives or members of the same household and that providing a “broad range of assistance” (as specified in the RAISE Family Caregivers Act definition) to an individual may consist of any number of activities necessitated by individual health status. However, the RAISE Family Caregivers Act definition encompasses caregiving for a broad range of individuals including those with a chronic health condition, disability, or functional limitation while section 1902(xx)(9)(A)(ii)(III) of the Act expressly limits the exclusion to family caregivers “of a dependent child age 13 years and under or a disabled individual.” We do not interpret the statutory cross-reference to the RAISE Family Caregivers Act definition of family caregiver in section 1902(xx)(9)(A)(ii)(III) of the Act as authorizing expansion of the community engagement exclusion beyond the care recipient populations expressly specified in that section of the Act. In addition, because “a dependent child 13 years of age and under” is specified in section 1902(xx)(9)(A)(ii)(III) but is not referenced in the RAISE Family Caregivers Act definition, we are adding this cohort of individual to the set of care recipients included in our definition of family caregiver at § 435.554(a).

Together, these modifications appropriately harmonize the RAISE Family Caregivers Act definition of family caregiver with the scope of care recipients specified at section 1902(xx)(9)(A)(ii)(III) of the Act and ensure that the exclusion is applied only to family caregivers who provide assistance to a dependent child or a disabled individual. (Notably, as outlined further in this section, there is no upper age limit for the “disabled individual” referenced in section 1902(xx)(9)(A)(ii)(III) of the Act, meaning that individuals of any age with a disability would qualify under that term.)

Additionally, to reflect the varied and individualized nature of caregiving arrangements, we opted to modify the RAISE Family Caregivers Act definition slightly in § 435.554(a) to refer to “ care within a broad range of assistance” to ensure that States do not require that a family caregiver provide multiple forms of assistance to a dependent child or a disabled individual to qualify as a specified excluded individual. For additional details about the criteria a family caregiver must meet to qualify as a specific excluded individual, see section II.E.3.h. of this IFC.