In Washington state, if you're the parent of a disabled child under 18, you can't receive Medicaid compensation for providing their care. If you're their grandparent, aunt, or uncle, you can. If you're a professional agency worker, the state will pay them. But if you're the parent, the answer is no.

That exclusion isn't unique to Washington. Most states bar parents of minor children from receiving payment through Medicaid self-directed care programs, even when the parent has quit their job to provide full-time care and the state has no paid workers available to deliver the services the child qualifies for. In April 2026, families in Washington filed a class-action lawsuit in federal court challenging that policy, arguing that the state is failing to provide the nursing and personal care services children with developmental disabilities are entitled to under Medicaid.

The lawsuit doesn't claim the parent exclusion itself is discriminatory. It argues that when the state excludes parents but can't provide alternative workers to deliver the care, it's violating the Medicaid Act. For families across the country watching labor shortages shrink the pool of available caregivers, this case could set a precedent that changes how states are required to meet their obligations when no one else is available to do the work.

Why States Exclude Parents From Caregiver Programs

Medicaid allows states to run self-directed care programs where recipients can choose and pay their own caregivers, including family members. The programs go by different names: Consumer Directed Personal Assistance Program (CDPAP) in New York, In-Home Supportive Services (IHSS) in California, Community First Choice in other states. Most of them include an explicit exclusion for parents of minor children.

The rationale isn't about capability. States exclude parents to control costs and avoid creating what they see as perverse incentives. If parents could be paid for care they're already providing unpaid, the logic goes, states would face unlimited budget exposure as every family with a disabled child applied for compensation. The exclusion draws a line: parents have a legal duty to care for their children without pay, so Medicaid won't cover it.

That logic holds as long as the state can provide professional nursing or personal care workers when a child needs more than a parent can deliver while also working. But when labor shortages mean those workers aren't available, the legal theory shifts. Medicaid isn't optional. States are required to provide the services listed in a child's plan. If a child qualifies for nursing care or personal assistance and the state can't deliver it because no workers are available, the state may be in violation of federal Medicaid law regardless of whether parents could be paid as an alternative.

What the Washington Lawsuit Argues

The plaintiffs are families whose children qualify for nursing and personal care services under Washington's Developmental Disabilities Administration (DDA) waiver. According to court filings, those families say they've been unable to access the professional services their children are entitled to because of widespread labor shortages. Some parents report quitting their jobs to provide full-time care themselves after the state couldn't find workers to deliver the services listed in their child's plan.

The lawsuit doesn't ask the court to force Washington to pay parents. It asks the court to find that Washington is failing to ensure children with developmental disabilities receive the Medicaid services they qualify for. If the state can't recruit enough workers and won't pay parents, children are going without care the state promised to provide.

Washington's Health Care Authority, the defendant, declined to comment while litigation is pending. In court filings, the state has argued that the plaintiffs "received services appropriate to their factual and medical situations." That framing suggests the state may contend that the services children are receiving, whether from unpaid parents or reduced hours with available workers, meet federal adequacy standards.

The legal question isn't whether the parent exclusion is fair. The question is whether a state can exclude parents, fail to provide alternative workers, and still meet its Medicaid obligation to deliver promised services.

How Widespread Is This Exclusion?

The parent exclusion is common but not universal. According to a 2023 analysis by the National Health Law Program, the majority of states that allow family members to be paid caregivers under Medicaid exclude parents of minor children. A few states allow it under limited circumstances, such as when the child's care needs are so intensive that a parent can't work. Some states have no exclusion at all.

New York's CDPAP allows parents to be paid caregivers for minor children. California's IHSS program generally excludes parents but has exceptions for children with extraordinary care needs. Florida excludes parents entirely. The specifics vary by state and by program, and many states run multiple programs with different eligibility rules.

If you don't know your state's policy, you're not alone. The exclusion often isn't explained in program materials, and families learn about it only after they apply and are told they don't qualify.

What This Means for Families in Other States

If the Washington lawsuit succeeds, it won't automatically change other states' policies. But it could establish a legal precedent that families and advocates in other states can use to challenge similar exclusions, particularly in states where labor shortages are making it difficult to access professional care.

The argument is portable: if a state excludes parents but can't deliver the services children qualify for, it may be violating the Medicaid Act. That legal theory doesn't depend on Washington's specific waiver structure. It applies anywhere the gap between promised services and delivered services is wide enough to constitute a failure of federal adequacy standards.

For families in states with parent exclusions, the case is worth following even if you're not in Washington. The legal framework it tests could shape whether states are required to either pay parents or guarantee access to professional workers when one or the other is necessary to deliver care.

What Families Should Do Right Now

You don't need to wait for a court ruling to protect your position. Here's what you can do regardless of where you live.

Document everything. If your child qualifies for nursing or personal care services under Medicaid and you can't access those services because workers aren't available, document it. Keep copies of your child's care plan, records of attempts to hire workers, emails or calls with the state or managed care organization about service availability, and logs of hours you're providing care yourself because no one else is available.

If the issue escalates to a grievance, appeal, or lawsuit, contemporaneous documentation is what makes your case credible. Retrospective claims that workers weren't available six months ago are harder to prove than emails you saved at the time showing the state or MCO couldn't find anyone.

Check your state's specific rules. Don't assume you know whether your state allows parents to be paid caregivers. The rules vary by program, and some states have exceptions for children with high medical complexity or other qualifying factors. Contact your state Medicaid office or the agency administering your child's waiver and ask directly: can parents of minor children be paid caregivers under this program? If yes, under what conditions?

If the answer is no, ask what alternatives exist when professional workers aren't available. The answer may clarify whether your state considers itself responsible for ensuring access to workers or whether it treats parental care as the default fallback.

Follow this case. The Washington lawsuit is in its early stages. No trial date has been set, and the state hasn't yet filed a full response to the complaint. If you're in Washington and your child receives services through DDA, you may be part of the potential class. If you're in another state, the outcome could still affect you.

Search for updates on the case by checking disability rights advocacy organizations such as Disability Rights Washington, the National Health Law Program, and The Arc. These organizations typically track litigation with national implications and publish updates when rulings are issued.

Consider whether you qualify for other programs. Some families assume Medicaid self-directed care is the only option for family caregiver payment. Depending on your state, other programs may exist with different eligibility rules. Some states offer respite care stipends, family caregiver support programs through Older Americans Act funding that sometimes extend to families of younger people with disabilities, or veterans' benefits for families of disabled veterans that include caregiver stipends.

None of these programs are Medicaid, so the parent exclusion doesn't apply. They're smaller, often capped, and not available everywhere. But if your state's Medicaid program won't pay you and you can't access professional workers, it's worth checking whether an alternative program exists.

What Happens Next

The Washington lawsuit will likely take months or years to resolve. Class-action litigation moves slowly, and Medicaid adequacy cases often involve disputes over what counts as "adequate" access to services. States have significant discretion in how they structure their programs, and courts are generally reluctant to micromanage state Medicaid administration unless the failure to deliver services is clear and sustained.

But the legal theory is straightforward enough that it doesn't require a novel interpretation of the Medicaid Act. States are required to provide the services listed in a recipient's plan. If they can't, they're in violation. The question is whether courts will find that Washington's current service delivery, including unpaid parental care, meets that standard or falls short.

For families in other states, the takeaway isn't that this lawsuit will immediately change your situation. The takeaway is that the parent exclusion isn't necessarily settled law when the state can't deliver the alternative. Document what you're experiencing. Know your state's rules. And if the gap between what your child qualifies for and what the state can deliver is wide enough that you've had to quit your job to fill it, that gap is a legal exposure for the state, not just a family hardship.