Choosing an EPSDT Personal Care Agency

If your child has Medicaid and needs help with daily care, an EPSDT personal care agency can send a caregiver to your home. In many cases, that caregiver can be a relative, a friend, or, with approval, a parent. Families often ask which agency is best. The honest answer is that it depends on how well an agency staffs your hours, pays and supports its caregivers, handles parent-caregiver requests, and communicates with you. This guide explains how EPSDT personal care works, what to compare, and what to do if an agency isn't working out.

The short answer

• What it is: EPSDT personal care is medically necessary personal care for Medicaid members under 21, provided through the Early and Periodic Screening, Diagnostic, and Treatment program.
• Who sets it up: Your health plan's care coordinator. At Blue Cross Blue Shield, for example, the care coordinator submits the request, and the family chooses a personal care agency before it's submitted.
• Who can be the caregiver: Only legally responsible relatives, such as parents of a minor child, are limited by the state rule, so other relatives and friends can be hired through an agency. A parent of a minor child may also be a paid caregiver in extraordinary circumstances, with health plan approval.
• What you can compare: caregiver pay, experience with parent-caregiver requests, how caregivers clock in, nurse supervision, scheduling, and how the agency handles problems.
• If it isn't working: talk to your care coordinator, and know that you can file a grievance about a provider with your health plan.

What EPSDT personal care covers

State rules say Medicaid pays for medically necessary personal care for a member under 21 when it's part of their treatment plan to correct, improve, or prevent a medical or behavioral health condition from getting worse. Covered services include:

• bathing, care of teeth, hair, and nails, dressing, and toileting
• help with eating when medically necessary
• cognitive help, such as prompting or cueing

There's no cost to your family: EPSDT services are provided at no cost to the member.

If your child is on the DD Waiver: EPSDT personal care comes through your Turquoise Care health plan, not the waiver. DD Waiver services are carved out of Turquoise Care, so they're separate benefits managed by different people.

Who can be your child's caregiver

Many families can choose someone they already know and trust. How it works depends on that person's relationship to your child.

• Grandparents, aunts, uncles, adult siblings, and friends: The state rule limits only legally responsible relatives, which it describes as parents of a minor child or a stepparent who is legally responsible for the child. Other relatives and friends can be hired by an agency, as long as they meet the agency's hiring and training requirements like any other caregiver.
• Parents of a minor child (and legal guardians): Parents can be paid, but it takes an extra approval. New Mexico has permanent federal approval to pay legally responsible individuals for personal care under the EPSDT benefit (see Expenditure Authority 7 in the approval). The state and all four health plans define legally responsible individuals to include parents of a minor child, and they say a parent of a minor child may be a paid caregiver in extraordinary circumstances. Blue Cross Blue Shield's process for approving these requests names EPSDT personal care specifically.
• Young adults 18 to 20: Parents or other relatives who aren't legally responsible for the young adult may provide personal care through an approved agency.

How parent approval works

• What "extraordinary circumstances" means: Blue Cross Blue Shield describes it as situations such as not being able to find and keep other qualified caregivers, so the parent has to stay home to keep the child healthy and safe.
• Who starts the request: The agency makes the request with the family's input and permission, after talking with the care coordinator. Under the 2025 guidance, request forms go to the child's care coordinator and are processed within five to seven business days.
• What the request has to show: The agency and family must show that other caregiver options were considered first, and each request must be specific to your child, not a template.
• Renewals: Approval has to be renewed every year, lined up with your child's personal care authorization. Parents must be approved before they start providing care and must meet the same hiring and training requirements as any caregiver.
• Paperwork: Parents don't need a birth certificate to show their relationship, but guardians do need their guardianship papers.

What to compare between agencies

How clocking in works (app vs. phone)

New Mexico's EVV system is called AuthentiCare. Caregivers can use a toll-free phone number, the AuthentiCare app on a cell phone, or the app on a tablet or computer, and if the family allows it, they can call in from the member's landline, home phone, or cell phone. The state also approved a connection that lets agencies send visit data from their own EVV systems into AuthentiCare, scheduled to begin January 1, 2026.

That's why one agency may use an app and another a phone line. Each is an approved way to record visits, so what matters is whether the method works reliably in your home and how quickly the agency fixes problems.

Questions to ask before you choose

1. Are you contracted with our health plan for EPSDT personal care?
2. What do you pay caregivers per hour, and how often do you give raises?
3. Can a relative or friend we choose be hired as our caregiver? How long does hiring take?
4. If I want to be my child's paid caregiver, have you done parent-caregiver requests before, and how do you help with them?
5. How do caregivers clock in, and who helps when a clock-in doesn't go through?
6. Who is our supervising nurse, and how often will they check in with us?
7. How do you handle schedule changes and caregiver absences?
8. Who do I call with a concern, and how quickly will someone get back to me?

If it isn't working

• Start with your care coordinator. The care coordinator handles your child's EPSDT personal care request, and families choose the agency before the request is submitted. UnitedHealthcare calls the care coordinator your "go-to person". Ask them how to move to a different agency.
• If you're a parent caregiver, plan ahead. Parent approvals are specific to your child and line up with the personal care authorization. Ask your care coordinator how a new agency would handle your approval before you switch.
• File a grievance. If you're unhappy with the care you're getting, you or someone acting for you can file a grievance with your health plan. UnitedHealthcare says members can file a complaint about the health plan or a provider at any time, and Blue Cross Blue Shield says there's no time limit to file a grievance. The Health Care Authority lists each plan's grievance contacts in one place.

Frequently asked questions

Can I get paid to care for my own child through EPSDT?

Yes, with approval. New Mexico's federal approval covers payment to legally responsible individuals for EPSDT personal care, and the state's guidance says that includes parents of a minor child in extraordinary circumstances, with approval renewed every year. Your agency and care coordinator handle the request. If your child is also on the DD Waiver or Mi Via, you may have other options. Our guide on getting paid as a family caregiver in New Mexico explains them.

Can a grandparent or other relative be my child's caregiver?

Yes. The state rule's limits apply only to legally responsible relatives, such as parents of a minor child. Other relatives can be hired through an agency, as long as they meet the same hiring and training requirements as any caregiver.

Does it matter if an agency uses an app or a phone line?

Not for compliance. Phone, the AuthentiCare app, and a tablet or computer are all ways to clock in, and the state approved a way for agencies to connect their own EVV apps. Choose the agency whose method works smoothly for your family.

Is EPSDT personal care the same as DD Waiver services?

No. EPSDT is a Medicaid benefit for members under 21 that runs through your Turquoise Care health plan. DD Waiver services are carved out of Turquoise Care and run separately. To learn more about the waivers, see our DD Waiver vs. Mi Via guide.

Sources

• NMAC 8.320.2.18, EPSDT Personal Care Services and 8.320.2 NMAC, EPSDT Services (full rule)
• CMS: New Mexico Turquoise Care Section 1115 Demonstration Approval, through December 31, 2029: Expenditure Authority 7 and Section 2 (December 15, 2023 amendment)
• NM Health Care Authority and Turquoise Care MCOs: 2025 Agency-Based Community Benefits Provider Newsletter: Legally Responsible Individual FAQ and EVV data aggregator
• NM Human Services Department: Letter of Direction #108, Expanded Legally Responsible Individuals as Caregivers and Blue Cross Blue Shield of New Mexico: New Process Regarding Legally Responsible Individuals as Caregivers
• NM Human Services Department: Turquoise Care MCO Model Contract (definitions)
• NM Health Care Authority: Turquoise Care MCO Systems Manual (January 29, 2025)
• Blue Cross Blue Shield of New Mexico: Turquoise Care training, EPSDT Services: Where to Go
• Molina Healthcare of New Mexico: LTSS provider training (EVV) and Blue Cross Blue Shield of New Mexico: EVV Home Health training (2022)
• KRQE News 13: New Mexico at-home caregivers' wages set to increase (2026)
• NM Health Care Authority: Grievances and Appeals
• Plan member materials: UnitedHealthcare Turquoise Care, UnitedHealthcare glossary, Blue Cross Blue Shield Member Handbook, Blue Cross Blue Shield Appeals and Grievances

This guide summarizes state rules for families and isn't legal or benefits advice. Rules and health plan processes change. Confirm current details with your care coordinator or the Health Care Authority.