The live-in caregiver attestation form is a state-issued document that certifies you share a home with the person you care for under a Medicaid Home and Community-Based Services waiver. Filing it does two things: it stops federal (and usually state) income tax from being withheld on your waiver payments under IRS Notice 2014-7, and it exempts you from Electronic Visit Verification check-in and check-out tracking. Each state runs its own version of the form through its Medicaid or social services agency, so the title, layout, and submission process vary by state.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
Who Can Sign It
The threshold question is whether the care recipient’s home is genuinely your home. The IRS defines the provider’s home as the place where you live and carry out the routines of your private life: sharing meals, keeping personal belongings there, sleeping there regularly, and spending holidays there.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income Showing up for scheduled shifts does not meet this test. If you keep a separate residence where you spend significant time, you risk losing the exclusion.
You do not need to be related to the care recipient. Many participants are family members, but the IRS looks at the living arrangement, not the family tree. More than one provider can claim the exclusion for the same household, as long as each one actually resides there.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income Section 131 does cap the number of people you can care for and still exclude the pay — up to ten who are under 19, and up to five who are 19 or older — but this cap rarely matters for a caregiver looking after a single family member.2Office of the Law Revision Counsel. 26 U.S.C. 131 – Certain Foster Care Payments
What to Have Ready Before You Fill It Out
Fields vary by state, but most attestation forms ask for the same core information. Gather these before you start:
- Your full legal name as it appears on your government ID.
- The last four digits of your Social Security number. Most state forms ask only for the last four.
- The care recipient’s name and Medicaid ID or case number, which links your attestation to their authorized plan of care.
- The physical address where you and the care recipient both live.
- The name of the provider agency or fiscal management service that handles your waiver payroll.
Some states fold the EVV live-in exemption into the same form and ask whether you live at the address permanently (seven days a week, no other home) or for an extended period (typically at least five days or 120 hours per week). Others use a separate EVV attestation. If your state uses two forms, file both.
You will sign under penalty of perjury, certifying that everything on the form is true. Submitting false information can carry a federal perjury charge with a fine and up to five years in prison.3GovInfo. 18 U.S.C. 1621 – Perjury Generally
Where to Get the Form and How to Submit It
Your state’s Medicaid agency or social services department distributes the form. The fastest route is the agency’s website; look under the HCBS waiver or in-home supportive services section for a downloadable PDF. If you can’t find it, call your caseworker or the program office listed on your plan of care and ask them to mail or email a blank copy.
Submit the completed form to the agency or payroll entity your state designates. Many programs offer a digital upload portal that confirms receipt on the spot. If you mail a paper copy, use certified mail with a return receipt. Some states also require supporting documents proving the shared address:
- A driver’s license or state photo ID showing the shared address.
- A utility bill, bank statement, or voter registration card in your name at that address.
- A federal or state tax return listing the shared address.
Even if your state does not ask for proof at submission, keep copies. An agency audit of your live-in status can happen later, and you will need them.
What Happens After You File
Processing time varies by state and caseload. Some programs finish within a few weeks; others take up to 30 days from the date they receive a complete submission. Check your pay stubs afterward to confirm that federal and state income tax withholdings have stopped. If they haven’t stopped within the expected window, contact your caseworker or payroll office. A missing signature or an incomplete field is the most common cause of delay.
The change should also show up on your W-2 at the end of the year. Excludable amounts belong in Box 12 with Code II, not in Box 1 (Wages, tips, other compensation). If all of your annual pay qualifies, Box 1 should be blank or zero.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income If your W-2 still shows excludable wages in Box 1, ask your employer or payroll agent for a corrected W-2c. Don’t ignore the mismatch; the IRS matches W-2 data against your return and can send a notice.
The EVV Side of the Attestation
The 21st Century Cures Act required states to implement Electronic Visit Verification for Medicaid-funded personal care services, but the law exempts live-in caregivers. Because you already live with the care recipient, there is no arrival or departure to verify. The attestation is how you document your eligibility for that exemption.
States define “live-in” for EVV in slightly different ways. A common framework distinguishes permanent residence (in the home seven days a week, with no other home) from extended-period residence (present at least five days or roughly 120 hours per week). Your state’s form will ask you to pick one. If the tax attestation and the EVV attestation are separate forms in your state, filing one does not cover the other.
Keeping the Attestation Current
The attestation is not a set-and-forget filing. If you move out of the care recipient’s home, or the care recipient moves without you, the shared-residence requirement no longer holds and the exclusion stops applying. Report any change in your living arrangement to your state agency or caseworker promptly. If you don’t, you can lose the tax-exempt treatment and end up owing taxes that should have been withheld.
Many states also require annual renewal. The agency may ask you to re-sign the form each year and provide updated proof of the shared address. Even if you don’t get an automatic renewal notice, confirm with your caseworker at the start of each calendar year that your live-in status is on file and current. A lapsed attestation can trigger withholding to restart on your next paycheck with no warning.
What the Form Does Not Cover
The attestation handles income tax withholding and the EVV exemption. It does not settle Social Security and Medicare (FICA) taxes, which are a separate question that depends on your employment relationship — agency employee, employee of the care recipient, or independent contractor. Family-relationship rules can eliminate FICA in some households (for example, when a parent is employed by their child), but those rules apply independently of the attestation.4Internal Revenue Service. Publication 15 (Circular E), Employer’s Tax Guide
Excluding your waiver payments also lowers the earned income figure the IRS uses for the Earned Income Tax Credit and the Additional Child Tax Credit. If those credits would help you more than the exclusion, you can elect to include all of your excludable Medicaid waiver payments in earned income when calculating the EITC or ACTC, even while excluding them from gross income. The election is all-or-nothing; you cannot split the amount.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
If You Paid Tax on Waiver Income in Prior Years
If you were a live-in caregiver in earlier years and paid income tax on waiver payments that should have been excluded, you can file Form 1040-X to claim a refund. The general deadline is three years from the date you filed the original return, or two years from the date the tax was paid, whichever is later.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
In Part III of the 1040-X, explain that the payments are excludable under Notice 2014-7. To speed processing, include the care recipient’s full name and Social Security number if available, documents proving you shared the same home during the tax year (driver’s license, utility bill, or bank statement showing the shared address), and evidence that the recipient was enrolled in a state Medicaid waiver program.1Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income Refunds for several years of incorrectly taxed waiver income can add up.