Arizona’s Division of Developmental Disabilities (DDD) and the Parents as Paid Caregivers (PPCG) program are under attack—fueled by misinformation and political gamesmanship.
(The information on this page was compiled using this data shared by caregiver & disability advocate Brandi Coon. You can follow Brandi Coon by visiting her linktree.)
Parent caregivers have been advocating and pushing Democrats and Republicans since January to work with them and other stakeholders to develop guardrails to resolve this crisis in funding as soon as possible. Requested bill language can be read here.
This page outlines the most common myths, and provides clear, fact-based responses grounded in law, policy, and data.
At its core, PPCG allows families to safely care for loved ones with high medical and behavioral needs in their homes—especially when Arizona faces a massive caregiver shortage and many provider agencies are unable to staff cases.
Families are not asking for special treatment. They’re doing the job no one else will—and saving the state additional costs in the process.
We need gap funding in May and June, reasonable oversight, and bipartisan collaboration with stakeholders.
This guide is organized into five key sections:
This section addresses how the Parents as Paid Caregivers (PPCG) program was created, who qualifies, and how it is administered and overseen.
Truth: While PPCG began as a temporary COVID-era flexibility, Arizona made it permanent in 2023 through a formal amendment to its Medicaid 1115 Waiver. It received over 10,000 public comments and was federally approved by CMS in February 2024 because it addressed urgent workforce shortages—not by expanding services or diagnoses, but by expanding who could provide authorized care. PPCG is now a fully authorized and permanent part of Arizona’s Medicaid system. It is also subject to the same oversight as all Medicaid services.
Truth: Arizona’s open enrollment for DDD and ALTCS applies to all members. This is a requirement of our 1115 waiver with the federal government which operates our entire AHCCCS system. While Arizona does not have a wait list for ALTCS and DDD we have a massive provider shortage which causes DDD members to wait on the vendor call list for months to years to receive services that are medically necessary and urgently needed.
Truth: PPCG is only available to families whose children qualify for Arizona Long Term Care Services (ALTCS) through DDD. This includes meeting strict criteria for developmental disability and institutional level of care. PPCG serves a limited, high-need population.
Truth: AHCCCS did not delay the hour cap—it accelerated it. The original federal plan proposal suggested a gradual reduction in weekly hours from no cap to 40 hours within 1 year. AHCCCS fast-tracked that schedule, implementing the 40-hour limit starting July 1, 2024
Truth: PPCG is only available to members who already meet the institutional level of care required under federal Medicaid rules. Services are authorized through standardized assessments—not based on the caregiver’s identity. In some cases, biased DDD case managers were denying care improperly, leading to complaints and prompting AHCCCS to intervene to ensure proper access—not bypass oversight.
Truth: The increase in PPCG hours is directly tied to the state’s provider shortage—not program abuse. PPCG is often the only reliable option for DDD families. Just 12% of DDD members (around 7,000 out of 56,000) use PPCG—a reflection of workforce collapse, not excessive expansion.
Truth: PPCG and the DDD funding crisis have galvanized a broad coalition—including therapists, provider agencies, adults with disabilities, law firms and advocacy organizations. Hundreds have rallied at the Capitol and filed recall petitions against lawmakers who blocked funding. This is not a fringe concern.
Truth: Reasonable guardrails—including data tracking standards, and PPCG limitations—have been proposed by parents and advocates. GOP leadership has rejected these thus far in favor of punitive restrictions that cut hours and threaten to dismantle PPCG entirely. .
These myths focus on cost drivers, PPCG’s fiscal impact, and the real reasons behind Arizona’s DDD funding shortfall.
Truth: While DDD costs have risen in recent years, the increases are tied to inflation, minimum wage mandates, provider rate adjustments, and enrollment growth due to legislative changes. These investments are necessary to keep people with developmental disabilities safely supported at home and in their communities. Home and Community-Based Services (HCBS), including PPCG, are significantly more cost-effective than institutional care. Without HCBS, many individuals would require placement in hospitals, group homes, or long-term care facilities—at a much higher cost to taxpayers. Maintaining a strong HCBS system isn’t overspending; it’s a proven savings strategy that also honors individual rights and family stability.
Truth: PPCG did not create the $122M shortfall. DDD and AHCCCS have explained that the gap was caused by several factors, including inflation, voter-approved minimum wage increases, rising provider rates, a growing number of eligible members with Autism and Down Syndrome (added by the Legislature), and policy changes like PPCG.
The real issue is how past budgets were built. They were based on how many hours of care were actually used—not how many hours members were approved to receive. But because of the ongoing caregiver shortage, many families couldn't find providers to use all the hours they were eligible for. Now that more families are using those approved hours through PPCG, the system is finally meeting those needs—but it appears more expensive. It's not new spending, it's long-overdue care finally being delivered.
Truth: PPCG was added through a formal 1115 Medicaid waiver amendment in 2023, which received over 10,000 public comments (including legislative buy-in) and was approved by the Centers for Medicare & Medicaid Services (CMS) in February 2024. It was included in the FY24 state budget passed by the Legislature because the PPCG did not remove or add a service, it expanded a workforce.
Truth: PPCG growth reflects a deepening direct care workforce crisis—not overuse. Only 7,000 of 56,000 DDD members (about 12%) use the program. Families stepped in where no providers could be found, keeping children out of foster care, group homes, hospitals, and institutions. These hours are pre-authorized based on medical necessity and do not add on the surface new expenditure to the system.
Truth: DDD funding supports medically and behaviorally fragile children and adults. Meanwhile, legislators have delayed funding since January 2025 while fast-tracking proposals to increase their own salaries. Arizona has a multi-billion dollar rainy day fund. Protecting life-sustaining services is not overspending—it’s a moral and legal obligation.
Truth: This claim is false. Arizona State Treasurer Kimberly Yee (page 1 and page 2) confirmed there is no record of lost federal dollars. No agency has reported a clawback. This myth was promoted as a distraction from legislative inaction on DDD funding Yes, Fund DDD offers tax consulting services to help businesses navigate complex tax laws and regulations. Our team of experts can assist with everything from tax planning to tax preparation and filing.
Truth: Lawmakers were warned repeatedly—since fall 2023—by AHCCCS, the Governor’s Office, and through formal JLBC briefings that DDD would run out of money without a supplemental. Families, providers, and advocates tried to testify in hearings, met privately with legislators, and proposed reasonable program guardrails. Legislative inaction was not due to confusion or lack of information—it was a calculated political decision to use vulnerable families as leverage in an attempted power grab over the entire AHCCCS system.
This section addresses who is responsible for the DDD funding crisis, how political maneuvering has delayed solutions, and the truth behind recent legislation and negotiations.
Truth: Legislators were informed last fall through JLBC reports. The Governor’s Office and AHCCCS repeatedly issued warnings through budget documents, JLBC meetings, and public hearings.
Truth: A clean supplemental bill (HB2816) has been available since January but was never given a committee hearing by Chair Livingston despite massive public requests for it to be heard since January. Instead, Republican leadership prioritized unrelated bills—like diamondback stadium funding and legislative pay raises—while families lost access to care due to non-family providers quitting due to job instability. This delay was a political choice, not an accident.
Truth: House GOP leadership blocked bipartisan amendments and stacked the Appropriations Committee in April to kill compromise. That’s obstruction—not compromise.
Truth: HB2945 and SB1734 are not a funding fix—it’s a power play. It reduces PPCG hours from 40 to 20, seizes Medicaid waiver control from AHCCCS, and introduces restrictions that could permanently eliminate PPCG. It creates instability and undermines integrated care. Advocates have been suggesting program safeguards to legislators since January. If they were serious about improving the PPCG program or cost savings these bills would have reflected those discussions
Truth: The PPCG workforce expansion was approved by CMS in February 2024. It was implemented legally by AHCCCS and DES under existing Executive Medicaid authority. The only failure was the Legislature’s refusal to appropriate spending for the DDD budget in FY2024 in order to ensure medically necessary services are appropriately delivered based on workforce availability.
Truth: That’s simply not true. The Governor and AHCCCS have been asking the Legislature to pass a clean, bipartisan funding bill for over four months. In March 2025, the Governor also announced several cost containment measures already in motion—proving that her team is focused on sustainability. These include:
These solutions were developed through AHCCCS and DDD before this political saga began—and they haven’t even had time to show results yet. It’s not a lack of action—it’s a lack of patience from lawmakers trying to dismantle the program before real data can speak for itself.
Truth: Hobbs is using her legal authority to withhold new bill signings until lawmakers meet their moral obligation to fund life-sustaining care. This strategy has precedent—and purpose.
Truth: The Legislature created the crisis by holding onto a funding solution until the 11th hour, blocking bipartisan amendments, and turning disability services into a political battle. Hobbs has repeatedly proposed solutions, while Republican leadership chose conflict over compromise.
This section addresses common misconceptions about the care workforce, how services are delivered, and the role of parents in filling critical care gaps.
Truth: Arizona is facing a severe workforce shortage in home and community-based care. With agencies freezing hiring processes or turning away new clients, many families have no available providers. In some areas, particularly rural Arizona, parents are the only option. PPCG isn’t replacing a functioning system—it’s filling the void left by one that is collapsing.
Truth: That workforce has already been tapped—and exhausted. Agencies are struggling to recruit and retain non familial staff. Many families wait months or years without finding a single provider. Parents aren’t choosing to replace others—they’re stepping in when no one else will.
Truth: All Direct Care Workers—whether parents of minors or agency staff—must meet the same requirements: training, fingerprint clearance, and background checks. In fact, many parents have more hands-on experience with medical devices, seizure response, behavioral care, and complex needs than the providers agencies are struggling to hire. PPCG FAQ can be viewed here.
Truth: PPCG hours are determined through a standardized assessment by DDD. Parents cannot assign themselves hours. They must follow an approved care plan, follow all geolocation requirements with EVV systems, and submit timesheets and documentation. Any deviation is Medicaid fraud.
Truth: All caregiving hours—regardless of who provides them—come from the same authorized service plan individualized for each member. If a member qualifies for 35 hours, that’s the limit. There’s no separate pool or bonus funding for Parents as Paid Caregivers.
Truth: Becoming a paid parent caregiver requires the member to meet the standard of institutionalization through an ALTCS application, separately apply for and receive admittance to DDD, employment registration, training, background checks, article 9, CPR/First Aid, and ongoing documentation. It is a regulated Medicaid program—not a loophole or blank check.
Truth: PPCG is only available to children who qualify for ALTCS under Arizona’s Medicaid system. These children must meet strict criteria, including a documented developmental disability and an institutional level of care. PPCG is reserved for a small group with the most intensive needs.
This section addresses concerns about fraud, abuse, "double-dipping," and whether proper guardrails exist within the PPCG program
Truth: There is no verified or publicly reported evidence of widespread fraud in the PPCG program. Parents must undergo fingerprinting, training, background checks, and adhere to Medicaid documentation rules—just like any other provider. They are filling care gaps in a system, not exploiting it.
Truth: Transportation to medical appointments, school, community outings or therapies is an authorized and necessary part of caregiving. Non-parental providers are also paid for this. These services are assessed and approved by DDD—not chosen by families. Every hour must be documented and submitted under state-monitored guidelines.
Truth: PPCG and other DDD services are based strictly on medical necessity. Each service must be assessed, authorized, and documented. Programs are coordinated to prevent overlap. According to a 2023 and 2025 study the PPCG has enabled families to come off of other welfare services and maintain housing stability independently.
Truth: Increased PPCG hours reflect workforce collapse, not abuse. As providers became harder to find, parents stepped in to prevent service disruptions. Only 12% of DDD members use PPCG, and all hours are pre-authorized by a state employee. Growth is a symptom of the system’s failure to hire staff—not misuse.
Truth: Parents and advocates have long supported ethical, commonsense guardrails. What they oppose are punitive restrictions that aim to drastically reduce or eliminate PPCG, adding bureaucracy to an already complicated system and inserting politics into the management of our Medicaid system which prides itself on being cost-containing.
Truth: The Governor’s Office and AHCCCS have welcomed accountability proposals and acted to correct real issues—such as biased support coordinators denying needed care. What they’ve rejected are policy proposals that would strip away services, force out of home placements, and destabilize families. Yes, Fund DDD offers tax consulting services to help businesses navigate complex tax laws and regulations. Our team of experts can assist with everything from tax planning to tax preparation and filing.
Truth: No. DDD is a Medicaid waiver under federal law. States are legally required to provide services to eligible members who meet institutional care criteria. Creating a waitlist would violate the ADA, our 1115 waiver, and the Olmstead decision and put Arizona at risk of civil rights lawsuits and federal penalties.
Truth: DDD is already operating under financial strain. Provider agencies are facing hiring freezes, layoffs, and service cuts. Many services are legally required under Arizona’s 1115 Medicaid waiver. Cutting them would violate federal law and put lives at risk. Ultimately costing Arizona more long term.
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