(1) Verifying Hours for Certain Caregivers

States will also need to consider how to verify hours for certain caregivers who provide assistance to a dependent child or disabled individual. (Please refer to § 435.554(a) and sections II.E.3.e. and f. of this IFC for the definitions of dependent child and disabled individual for the purpose of community engagement.) Consistent with section 1902(xx)(9)(A)(ii)(III) of the Act, as implemented at § 435.554(c)(3), a family caregiver as defined at § 435.554(a) is a specified excluded individual if he or she meets one of the following implementing criteria established at § 435.554(c)(3)(i)(A) through (C): (1) the individual primarily resides with a dependent child or disabled individual for whom he or she provides assistance that occurs on a regular basis and is not solely incidental in nature, (2) the individual is a relative (as specified in the “caretaker relative” definition at § 435.554(a), without regard to the requirements to live with or to assume primary responsibility) of a dependent child or disabled individual for whom he or she provides assistance that occurs on a regular basis and is not solely incidental in nature, or (3) the individual does not reside with and is not a relative (as specified in the “caretaker relative” definition at § 435.554(a), without regard to the requirements to live with and to assume primary responsibility) of a dependent child or disabled individual for whom he or she provides not less than 80 hours of assistance that is not solely incidental in nature per month. This means that States must verify the number of hours of care provided if the family caregiver does not reside with and is not related to the dependent child or disabled individual for whom he or she provides assistance to determine whether that individual is a specified excluded individual under the family caregiver component of section 1902(xx)(9)(A)(ii)(III) of the Act.

If the family caregiver does not live with and is not related to the dependent child or the disabled individual for whom he or she provides assistance, and provides less than 80 hours of care per month, the family caregiver does not meet the criteria for the exclusion and must demonstrate or be deemed to demonstrate community engagement (provided they are not a specified excluded individual on another basis). However, the hours of assistance by such an individual would count as unpaid work under § 435.552(b) and the individual would only need to engage in additional activities sufficient to reach the 80-hour threshold to demonstrate community engagement, as permitted under § 435.552(a)(5). For example, if the family caregiver provides 55 hours per month of assistance to a non-relative whom he or she does not live with, those 55 hours would count towards compliance with the community engagement requirement, and the caregiver would need 25 additional hours of engagement in the activities listed at § 435.552(a)(1) through (4), including but not limited to other paid, unpaid, or in-kind work, to demonstrate community engagement. The applicable individual could also demonstrate community engagement on the basis of income, as specified at § 435.552(a)(6) and (7). See section II.I.6.e. of this IFC and § 435.552(e) for further details about the requirement to aggregate hours of engagement in different qualifying activities.

Where possible, States must use reliable information available to the State to verify hours of assistance provided by a family caregiver. (See section II.I.7.c. of this IFC for more discussion about using reliable information available to the State to verify an individual's status as a specified excluded individual under the family caregiver component of the exclusion at section 1902(xx)(9)(A)(ii)(III) of the Act.) However, we recognize that caregiving of this nature is unique and unlikely to be reflected in reliable information available to the State. In the absence of reliable information available to the State, the State must seek information from the individual to verify caregiving hours, including the number of hours of assistance provided by a family caregiver and any other information needed to substantiate the State's determination regarding the individual's status as a family caregiver, status as a specified excluded individual under the family caregiver exclusion, or number of caregiving hours counted as work. Beginning on January 1, 2028, when States are unable to verify family caregiver status or hours using reliable information available to the State, or the reliable information is not reasonably compatible with the information provided by or on behalf of the individual, States must require documentation if documentation is reasonably available. In the absence of reasonably available documentation, the State must accept other information that is sufficient to verify eligibility, as described in section II.I.3. of this IFC.