If you live in the same home as the Medicaid client you care for, you qualify for a live-in caregiver exemption from EVV, but in most states you have to ask for it. That means submitting proof of your shared address and a signed attestation to your state Medicaid agency, managed care organization, or fiscal intermediary, and continuing to clock in through the electronic visit verification system until they confirm the exemption is in place.
Why Living Together Removes the EVV Requirement
Electronic visit verification exists to confirm that a caregiver actually traveled to a client’s home and delivered a specific service during a specific window. The 21st Century Cures Act requires every state Medicaid program to run an EVV system for personal care and home health services, and CMS addressed the live-in situation head-on in its 2019 guidance: “EVV requirements do not apply when the caregiver providing the service and the beneficiary live together. PCS or HHCS rendered by an individual living in the residence does not constitute an ‘in-home visit.'”1Centers for Medicare & Medicaid Services. CMS Additional Electronic Visit Verification Guidance
The logic is simple. There is no arrival to log and no departure to timestamp when the caregiver already sleeps at the address. The exemption applies whether the caregiver is a family member or an unrelated worker hired through an agency or self-direction program.
What Counts as Living Together
CMS does not set an hourly threshold. It uses the ordinary meaning: you keep the client’s home as your own residence, sleep there, keep your belongings there, and do not maintain a separate primary home somewhere else. Programs look for an arrangement that is continuous, not a few nights a week and not a temporary stay during a health crisis.
If you move out, or start splitting time between the client’s home and a place of your own, the exemption ends and EVV tracking has to resume. Agencies are expected to verify that the living arrangement is genuine before waiving EVV, because payments made without proper verification or a valid exemption can be flagged as overpayments during an audit.
Documents That Prove Shared Residence
Before a state program or managed care organization will lift the EVV requirement, you need to show the shared address is real. Programs commonly accept:
- A driver’s license or state ID card showing the same address as the care recipient
- Utility bills (electric, water, or internet) from the last 60 days listing you at the client’s address
- A lease or mortgage document that names both you and the client
- Voter registration at the shared address
- A signed letter from the landlord or property manager confirming you reside at the property
Not every program accepts every document. Some ask for at least two forms of proof; others accept a single government-issued ID. Ask your managed care organization or the state Medicaid agency that administers your program which items count and how many they want.
The Attestation Form
Most programs also require a Live-In Caregiver Attestation Form. It is a signed declaration that you live with the care recipient and do not maintain a separate primary residence. Expect it to ask for the date the shared living arrangement began, your relationship to the client, and both parties’ signatures. The form is usually posted on the website of your managed care organization, fiscal intermediary, or state Medicaid agency.
Fill it out carefully. Providing false information exposes you to a fraud investigation and possible termination from the program. Keep a personal copy of everything you sign.
When Notarization Is Required
Some programs require the attestation, or a landlord statement, to be notarized. Notary fees for a standard signature vary by state; they typically run around $5 to $10, with a maximum of $25 in the most expensive jurisdictions. A handful of states set no statutory cap, so ask the notary’s price before you sign.
Submitting the Exemption Request
How you send the package depends on how your program is structured. Many agencies and managed care organizations have an online EVV portal where you can upload scanned copies. Where no portal exists, email to the compliance officer at the home health agency or fiscal intermediary is the usual alternative. If you mail the paperwork, use certified mail with a return receipt so you have proof of delivery.
Keep using EVV in the meantime. Processing times vary by state and program, and stopping your GPS or telephony check-ins before the exemption is recorded in the billing system can lead to rejected claims and delayed pay. Once the system is updated, you will not need to check in electronically for your shifts.
If Your Request Is Denied
Denials usually happen for fixable reasons: a missing document, an ID that still shows an old address, an incomplete attestation. Read the denial notice, correct the gap, and resubmit. Most programs treat this as a resubmission rather than an appeal. A formal grievance process may exist under your state’s Medicaid managed care rules if you believe the denial was wrong even after resubmission, but the fastest route in almost every case is just supplying the missing paperwork.
Record-Keeping After Approval
Being exempt from EVV does not mean being exempt from documenting your work. You still have to record every shift. Instead of an automated system capturing your location and timestamps, you use whatever manual method your program authorizes: paper timesheets, a web-based time entry tool, or another approved format. The hours you record must reflect the hours you actually worked and the services you actually provided, and they must match the care plan authorized for the client.
State Medicaid agencies and managed care plans audit these records. If an auditor finds that billed hours do not match the authorized plan of care, or that documentation is incomplete, the result is usually an overpayment recovery. Under federal rules, providers who identify an overpayment must return the funds within 60 calendar days and notify the managed care plan in writing of the reason.2eCFR. 42 CFR 438.608 – Program Integrity Requirements In practice, the agency often catches the overpayment first and deducts it from future payments.
Recertifying Each Year
The exemption is not permanent. Many state programs require annual recertification: updated residency proof and a fresh attestation confirming you still live with the care recipient. Put the renewal date on your calendar. If your recertification lapses, the exempt status can be revoked and EVV check-ins will restart until you finish the renewal.
What Happens If You Claim the Exemption Falsely
Claiming the live-in exemption while actually keeping a separate primary residence is Medicaid fraud. At the federal level, the False Claims Act allows penalties of up to three times the program’s loss plus over $11,000 per false claim filed.3HHS Office of Inspector General. Fraud and Abuse Laws State Medicaid Fraud Control Units investigate these cases and can pursue criminal charges that carry prison time and restitution orders.
Sloppy documentation causes problems even without intent. If an audit shows your residency proof was outdated, or that you moved out months ago without reporting it, the state can recoup every payment made during the period the exemption was invalid. Managed care plans are required to recover overpayments and may offset them against future checks.2eCFR. 42 CFR 438.608 – Program Integrity Requirements Report a change in your living situation as soon as it happens. Switching back to EVV is an inconvenience. Owing back thousands in recouped payments is not.