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Subsidized Child Care Assistance Program Policy Manual Chapter 8. Parent fee REVISED 04/27/2026 16

benefit directly to the child care facility/provider. The child care worker must document this information in NC FAST and add an explanation in the comments section of the voucher or action notice.

D. Parent fee Adjustments for High Medical Expenses

An applicant/recipient with large medical expenses may find the payment of a parent fee more of a hardship than other applicants/ recipients of similar size and income. To help in this situation, the family’s gross income upon which the parent fee is assessed will be reduced by subtracting the amount of documented medical expenses paid in excess of 10% of that gross income. Medical expenses are considered only in relation to the payment of Parent fee, not in determining basic income eligibility. Information provided by the applicant/recipient about the family’s medical expenses must be verified and documented in the case record.

1. One-Time Medical Adjustment

A one-time medical adjustment can be given when a applicant/recipient pays a high medical expense for one month. The excess medical expenses are deducted from the gross monthly income and the Parent fee for the upcoming month is reduced. Thereafter, the Parent fee goes back to the amount assessed prior to the adjustment.

Example: One Time Medical Adjustment. The applicant/recipient has household income of $3000 per month. The 10% Parent fee would be $300 effective 1/1/2023. The applicant/recipient has a one-time medical expense of $400 that she will pay in full in January 2023. $400 - $300 Parent fee = $100. For the month of January 2023, $100 is reduced from her $3000 income = $2900 x .10 = $290 Parent fee for January 2023 and then Parent fee goes back to $300 for February 2023 and ongoing.