Do paid family caregivers under Medicaid waivers need OIG exclusion screening?

Yes. Under 42 CFR 1001.1901, no federal healthcare program payment may be made for services furnished by an excluded individual, and nothing in the regulation exempts a caregiver based on their family relationship to the participant. A family member enrolled as a paid caregiver through a Medicaid waiver program is subject to the identical exclusion screening obligation as any other billing provider.

What must be completed before a paid family caregiver's first billable visit?

Before the first billable visit: an OIG LEIE exclusion screen, a SAM.gov debarment screen, a Georgia Medicaid state exclusion list cross-reference, a Sandata EVV profile created for the caregiver as an identifiable individual provider, required training documentation on file, and employer-of-record and payroll compliance documentation for self-directed arrangements.

What ongoing monthly compliance checks apply to paid family caregivers?

Ongoing monthly requirements include a monthly LEIE re-screen (OIG guidance calls for screening at hire and monthly thereafter, with no exemption for family caregivers), an EVV exception review for the caregiver's visits since same-address visit patterns can trigger false-positive location exceptions, and a service authorization alignment check confirming billed units still match the current authorization.

Paid Family Caregiver Compliance Checklist

Self-directed and participant-directed Medicaid waiver programs allow family members to serve as paid caregivers — but paid family caregivers carry the exact same compliance obligations as any W-2 employee or contracted caregiver. Agencies and fiscal intermediaries administering these arrangements are often the ones left holding the exposure when a family caregiver relationship isn't documented to the same standard as a traditional hire. This checklist walks through what needs to be in place.

Why Do Paid Family Caregivers Carry the Same Obligations as Any Other Caregiver?

42 CFR § 1001.1901

"No federal healthcare program payment may be made for any item or service furnished, ordered, or prescribed by an excluded individual or entity." Nothing in the regulation exempts a caregiver based on their relationship to the participant. A family member enrolled as a paid caregiver through a Medicaid waiver program is subject to the identical exclusion screening obligation as any other billing provider.

Onboarding Compliance Checklist

Before the first billable visit

OIG LEIE exclusion screen completed and documented — run before enrollment as the paid caregiver of record, not after the first claim is submitted.
SAM.gov debarment screen completed — required alongside the LEIE check for any individual who will bill a federal healthcare program.
Georgia Medicaid state exclusion list cross-referenced — particularly important for MCO-enrolled participants.
Sandata EVV profile created for the caregiver — the caregiver must be set up as an identifiable individual provider in the EVV system before any visit is logged, not billed retroactively under a generic identifier.
Required training documentation on file — caregiver training requirements vary by waiver program, but documentation of completion should be maintained regardless of the caregiver's family relationship to the participant.
Employer-of-record and payroll compliance documentation — for self-directed arrangements, confirmation of who serves as the employer of record and that payroll tax obligations are being met.

Ongoing, monthly

Monthly LEIE re-screen — OIG guidance calls for exclusion screening at hire and monthly thereafter; this obligation does not lapse because the caregiver is a family member.
EVV exception review for the caregiver's visits — family caregiver visit patterns (same address as participant, consistent visit timing) can trigger false-positive location exceptions that still need review and documentation.
Service authorization alignment check — confirming billed units continue to match the current authorization.

What Happens If a Family Caregiver Is Excluded and Wasn't Screened?

The liability runs to the agency or fiscal intermediary that submitted the claim, not just to the individual caregiver. Under 42 CFR § 1001.1901, payment liability applies regardless of whether the submitting entity knew about the exclusion at the time. A documented, monthly screening process is the only practical protection against this exposure — and it's a materially stronger position in any subsequent audit than attempting to demonstrate a caregiver "seemed fine" at the time of enrollment.

Need to screen a roster that includes self-directed family caregivers?

Our Caregiver Roster Screening runs your full roster against OIG LEIE, SAM.gov, and Georgia Medicaid exclusion lists and issues a branded compliance certificate — from $99/month.

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