What is the ADvantage Waiver and CD-PASS?
The ADvantage Program is Oklahoma's largest Medicaid Home and Community-Based Services (HCBS) waiver, authorized under Section 1915(c). It provides in-home long-term care so that people who would otherwise need a nursing facility can stay in their own homes. Services include personal care, home-delivered meals, respite, adult day health, skilled nursing, therapies, home modifications, and case management. It is administered by Oklahoma Human Services (OKDHS) Community Living, Aging and Protective Services, with SoonerCare (Oklahoma Medicaid) paying the bills.
Within the ADvantage Waiver, families who want to be paid should focus on CD-PASS -- Consumer-Directed Personal Assistance Services and Supports. CD-PASS is the waiver's self-directed service option. Instead of an agency assigning an aide, CD-PASS lets the member become the employer: they recruit, hire, train, schedule, supervise, and if needed fire their own personal services assistant (PSA). The person they hire can be a relative, friend, or neighbor they already trust.
Because the member directs the care, no formal certification is required. An adult daughter who has quietly cared for her mother for years can finally be paid for that work, as long as her mother is enrolled in the ADvantage Waiver and CD-PASS. The member (with help from their case manager) builds an individual budget and decides how much to pay their caregiver per hour, subject to a minimum and a maximum set by the program.
A Financial Management Service (FMS) -- in Oklahoma this is Acumen Fiscal Agent -- handles the paperwork of employment: it runs payroll, withholds and files taxes, purchases workers compensation coverage, and issues paychecks by direct deposit. The FMS does not choose the caregiver, set the schedule, or supervise care. Those decisions stay with the member and their authorized representative.
ADvantage Waiver eligibility requirements
To use CD-PASS, the person receiving care must first qualify for the ADvantage Waiver. That means meeting Oklahoma SoonerCare (Medicaid) financial rules and needing a nursing-facility level of care. The caregiver does not need to meet any income or asset test -- only the member does.
Who can -- and cannot -- be paid through CD-PASS
CD-PASS lets the Medicaid member choose their own personal services assistant, and most family members qualify. Oklahoma treats a spouse or legal guardian differently: they can be paid only when the state approves a documented exception, and the person who directs the care legally cannot also collect the paycheck.
- Adult children (age 18 or older) of the member
- Siblings, grandchildren, nieces, nephews, aunts, uncles, and cousins
- In-laws, step-relatives, and other relatives who are not the spouse
- Close friends, neighbors, or members of your faith community
- A qualified caregiver the member recruits and trains themselves
- A spouse or legal guardian ONLY if the state approves a documented policy exception
- The member's spouse in ordinary circumstances (allowed only by rare, documented exception)
- The member's legal guardian in ordinary circumstances (same exception rule as a spouse)
- The member's Authorized Representative, Power of Attorney, or health care proxy (they direct care but cannot be the paid PSA)
- Anyone the member does not choose to hire, since CD-PASS is fully consumer-directed
CD-PASS pay, hours, and overtime
Under CD-PASS the member sets the caregiver's hourly wage, but within limits the program controls. Oklahoma reimburses CD-PASS at a share of the standard agency personal-care rate, and that single amount has to cover the wage plus employer taxes and workers compensation -- so the take-home hourly wage is lower than the gross rate the state pays.
Hourly pay
The member chooses the caregiver's pay rate on the Individual Budget Allowance (IBA) worksheet, prepared with the case manager. The floor is the federal (or state) minimum wage -- currently $7.25 -- and the ceiling is a maximum wage the IBA calculates. In practice most Oklahoma CD-PASS caregivers earn roughly $10 to $16 per hour in take-home wages in 2026. That range reflects that the state's standard ADvantage personal care rate is about $26.32 per hour (T1019, effective Oct 1, 2024), that CD-PASS is reimbursed at 80% to 95% of the comparable agency rate, and that this gross amount must also fund payroll taxes and workers comp before the caregiver's wage. Skilled (advanced / APSA) tasks can be budgeted at a higher wage than basic PSA tasks. Caregivers are W-2 employees of the member, and Acumen Fiscal Agent withholds and files their taxes.
Hours and scheduling
Authorized hours are set by the member's ADvantage service plan based on the assessment of need -- the plan states how many PSA and APSA hours per week are approved. The member schedules those hours. No single employee may work more than 40 hours in a week, more than 8 hours in a day, or more hours than the plan authorizes. Members who need more than that must hire more than one caregiver -- for example, two adult children splitting the week -- so all authorized care is covered without one person exceeding the limits.
Overtime rules
CD-PASS is built to avoid overtime: the 40-hour weekly and 8-hour daily caps per employee mean members are directed to add a second or third caregiver rather than run one person into overtime. Wages can only be raised at the annual service-plan reassessment, though the member may budget a periodic bonus for a caregiver who stays in the role. The member is responsible for staying inside the approved budget and hours, and can be removed from CD-PASS for repeatedly exceeding them.
How to apply for the ADvantage Waiver and CD-PASS in Oklahoma
- Start the ADvantage application. Complete the online Application for In-Home Assistance on the Oklahoma Human Services site, or call the Medicaid Services Unit at 1-800-435-4711 to request help applying.
- Complete the level-of-care assessment. An Oklahoma Human Services nurse or case manager conducts the UCAT assessment to confirm the applicant needs a nursing-facility level of care.
- Be ready to describe ADL needs (bathing, dressing, transfers, toileting, eating)
- Gather medical records that document the need for daily help
- The assessment also confirms the member can be served safely at home
- Confirm SoonerCare financial eligibility. Provide proof of Oklahoma residency, identity, income, and assets so the state can verify the 2026 income limit ($2,982/month) and asset limit ($2,000). If income is too high, ask about a Medicaid income (Miller) trust.
- Choose CD-PASS as your self-directed service option. Tell your case manager you want to self-direct through CD-PASS so you can hire your own caregiver rather than use an agency. Your case manager helps you build your service plan and Individual Budget Allowance.
- Enroll with Acumen Fiscal Agent and onboard your caregiver. Acumen sets up the member as an employer and the caregiver as a W-2 employee.
- Federal I-9 employment verification and W-4 tax forms
- Caregiver background check and required enrollment paperwork
- Direct deposit setup and electronic visit verification (EVV) enrollment
- Acumen customer service: (877) 594-0966 or AcumenOK@acumen2.net
- Submit and approve time each pay period. The caregiver clocks in and out through the Acumen app, portal, or phone EVV; the member approves the hours; Acumen issues payment on the published twice-monthly pay schedule.
- Reassess every year. ADvantage authorizations and the CD-PASS budget are renewed at an annual reassessment, which is also the point at which the caregiver's hourly wage can be increased.
ADvantage Waiver CD-PASS frequently asked questions
Can my spouse be paid to care for me through CD-PASS?
Usually no -- but there is a narrow exception. Oklahoma normally will not pay a legally responsible spouse (or a legal guardian) to be the caregiver under CD-PASS. The state can authorize it only when the member is offered a choice of providers and the record documents one of three situations: no certified agency has staff available in the area; the member's needs are so complex that their risk would rise unless the spouse provides care; or a qualified clinician documents that it is mentally or physically detrimental for anyone other than the spouse to provide the care. When a spouse is approved, the case manager must visit at least monthly to confirm the exception still applies. The pay cannot exceed what a similar provider earns, and it cannot cover tasks a spouse would ordinarily do anyway. If you need a spouse paid routinely, ask about VA Veteran-Directed Care instead, which does allow spouses in many cases.
How much does CD-PASS pay a caregiver in 2026?
The member sets the caregiver's hourly wage on the Individual Budget Allowance worksheet, so there is no single fixed rate. The floor is the federal or state minimum wage ($7.25), and the ceiling is a maximum the budget worksheet calculates. In practice, most Oklahoma CD-PASS caregivers take home roughly $10 to $16 per hour in 2026. The reason it is not higher is that Oklahoma reimburses CD-PASS at 80% to 95% of the standard agency personal-care rate (about $26.32 per hour as of October 2024), and that single amount also has to pay for the caregiver's payroll taxes and workers compensation before their wage. Skilled (advanced / APSA) tasks can be budgeted at a somewhat higher wage than basic personal care. Caregivers are W-2 employees, so Acumen Fiscal Agent withholds their federal and state taxes and issues paychecks by direct deposit on the published twice-monthly schedule.
How long does ADvantage Waiver and CD-PASS approval take?
Plan on a few months. Oklahoma Human Services notes the Medicaid application process can take up to three months, and sometimes longer. The main steps are the SoonerCare financial determination, the UCAT nursing-facility level-of-care assessment, building your service plan and CD-PASS budget with a case manager, and then onboarding with Acumen Fiscal Agent as an employer. If the member is not yet on SoonerCare, add time for that determination. You can speed things up by gathering documents early: proof of Oklahoma residency, identification, Social Security card, proof of income and assets, and medical records showing the need for daily help. Because ADvantage has served large numbers of Oklahomans, there can also be periods when new enrollment is managed through a waiting list, so ask your case manager about current timelines when you apply.
What training or certification does a CD-PASS caregiver need?
None of the usual clinical credentials. A CD-PASS personal services assistant does not have to be a Certified Nursing Assistant (CNA), Home Health Aide (HHA), or licensed professional. Because the program is consumer-directed, the member (or their Authorized Representative) trains the caregiver on exactly the tasks and the way they want them done. There are still basic onboarding requirements handled through Acumen Fiscal Agent -- employment paperwork (I-9, W-4), a background check, enrollment in electronic visit verification so hours can be clocked and approved, and review of the CD-PASS employer materials. But there is no state skills exam or certification test. This is one of the biggest reasons families choose CD-PASS: a relative who has already been providing care informally can be hired and paid without going back to school or getting certified.
Which relatives can be paid, and can I hire more than one?
CD-PASS is flexible about relatives. The state's own materials list an adult child, niece, nephew, grandchild, or sibling as examples of caregivers a member can hire, and other relatives such as in-laws, cousins, aunts, and uncles are generally fine too, along with friends and neighbors. The main restrictions are that a spouse or legal guardian needs a documented exception, and the person acting as your Authorized Representative or Power of Attorney cannot also be your paid caregiver. You can absolutely hire more than one caregiver. In fact you often have to: because no single employee may work more than 40 hours a week or 8 hours a day, members with larger service plans commonly split the schedule between two or three relatives so every authorized hour is covered.
Who is the employer, and what does Acumen Fiscal Agent do?
Under CD-PASS the Medicaid member (or their Authorized Representative) is the employer. That means the member recruits, hires, sets the hourly wage within the budget, trains, schedules, supervises, and can fire the caregiver. Acumen Fiscal Agent is the Financial Management Service that handles the employer paperwork the member should not have to do alone: it runs payroll, withholds and files federal and state taxes, purchases workers compensation coverage, verifies employment eligibility, and issues paychecks by direct deposit or pay card. Acumen also runs the electronic visit verification tools (mobile app, web portal, and phone) the caregiver uses to clock in and out. Acumen does not choose the caregiver, set the schedule, or supervise the care -- those stay with the member. You can reach Acumen customer service at (877) 594-0966 or AcumenOK@acumen2.net.
Can I be paid to care for a parent who lives with me?
Yes. There is no rule against living in the same household as the person you care for, and many CD-PASS caregivers are adult children who live with an aging parent. What matters is that the person receiving care qualifies for the ADvantage Waiver, is enrolled in CD-PASS, and that you only bill for the personal care hours actually authorized on their service plan. You clock in and out through Acumen's electronic visit verification for the hours you work, and the member approves those hours each pay period. Keep in mind the daily and weekly caps -- no more than 8 hours a day or 40 hours a week per employee -- so if your parent needs more coverage than one person can provide within those limits, the plan is designed for you to add a second caregiver rather than exceed them.
How is CD-PASS different from a regular home care agency in Oklahoma?
With a traditional ADvantage agency, the agency hires the aide, assigns whoever is available, sets the schedule, and supervises the work -- you usually do not get to pick who shows up. CD-PASS flips that: you, the Medicaid member, are the employer. You choose the caregiver (typically a relative or friend you already trust), you decide their wage within the budget, you train them your way, you set the schedule, and you can replace them if it is not working. Acumen Fiscal Agent handles payroll and taxes, but it does not supervise care. Oklahoma requires that total Medicaid spending on CD-PASS stay below what the same services would cost through an agency, which is why the reimbursement is set at a share of the agency rate. For families who want continuity, trust, and control -- and who have a relative willing to serve -- CD-PASS is usually the better fit; if no one is available to hire, the standard agency option may make more sense.
See also: Oklahoma caregiver guide
For all the ways to get paid to care for a family member in Oklahoma — including ADvantage Waiver, VA programs, long-term care insurance, and more — read the full Oklahoma guide.