Virginia pays family members to provide care through its Medicaid CCC Plus Waiver, using an option called Consumer-Directed Services. Under this option, a person who qualifies for the waiver hires their own caregiver, sets the schedule, and directs the work — and that caregiver can be an adult child, sibling, grandchild, niece, nephew, or other relative. The waiver has no waiting list, so eligible families can start the process right away rather than waiting years for a slot. Getting paid to care for a family member in Virginia comes down to three things: the care recipient qualifying for Medicaid, a screening that confirms they need nursing-facility-level care, and enrollment with a state-contracted payroll company that issues the caregiver’s paychecks.
Who the Person Receiving Care Has to Be
The caregiver’s pay depends entirely on the care recipient qualifying. Two separate tests apply, and both must be met.
Financial Eligibility
The CCC Plus Waiver uses Virginia’s income and asset rules for aged, blind, and disabled Medicaid. The income cap is 300 percent of the federal SSI benefit rate. For 2026, with the SSI federal benefit rate at $994 per month, that cap works out to $2,982 per month for an individual.1Social Security Administration. What’s New in 2026? Countable assets are limited to $2,000 for a single applicant, or $4,000 for a married couple with both spouses applying. Personal belongings, one vehicle, and the primary home (up to a set equity value) are typically excluded from the asset count. These thresholds adjust each year, so confirm the current figures with your local Department of Social Services or the DMAS website before applying.
Functional Eligibility
Meeting the income and asset limits is not enough on its own. The applicant also has to show they need care equivalent to what a nursing facility provides. Virginia measures this using the Uniform Assessment Instrument, an in-person evaluation that scores how much help the person needs with activities like bathing, dressing, eating, toileting, and transferring.2Virginia Medicaid. CCC Plus Waiver A Community Based Screening Team, usually a social worker paired with a health department nurse, comes to the home to conduct the assessment.
Which Family Members Can Be Paid
Consumer-Directed Services allow a broad range of relatives to be paid: adult children, siblings, grandchildren, nieces, nephews, and other family members. Every prospective caregiver has to be at least 18, have a valid Social Security number and government-issued photo ID, pass a criminal history record check (plus a child protective services registry check if the care recipient is a minor), and be physically capable of the care tasks and able to read and write in English enough to handle the documentation.
Spouses have historically been barred from acting as paid personal care assistants under Virginia’s Medicaid rules. At least one DMAS provider manual explicitly prohibits a personal care assistant from being the spouse of the person receiving services.3Virginia.gov. EPSDT Personal Care Services Provider Manual Supplement B Because policies are administered through multiple managed care organizations and can change, a spouse hoping to be paid should verify current rules directly with the assigned MCO.
The Employer of Record Rule
Every Consumer-Directed arrangement needs an Employer of Record. This is the person who officially hires, trains, supervises, and if necessary fires the caregiver. The Employer of Record can be the care recipient, a family member, or another trusted person. One rule matters most: the Employer of Record cannot also be the paid caregiver or the services facilitator for the same person.4Virginia Code Commission. Virginia Administrative Code Title 12 Agency 30 Chapter 120 Part IX – Commonwealth Coordinated Care Plus Waiver So if you plan to be the paid caregiver for your mother, someone else needs to take the Employer of Record role — another sibling, a cousin, or a family friend.
What the Caregiver Does and How Many Hours Are Covered
Consumer-directed personal care covers hands-on help with daily living: bathing, dressing, grooming, eating, toileting, and transferring. It also covers monitoring self-administered medications, tracking health status, and helping with community access. When the care plan calls for it, the caregiver can also help with light housekeeping and meal preparation alongside the hands-on care.5Virginia Code Commission. Virginia Administrative Code 12VAC30-120-924 – Covered Services; Limits On
Virginia caps how many hours Medicaid will cover:
- Personal care: up to 56 hours per week, 52 weeks per year
- Respite care: up to 480 hours per calendar year
- Supervision services: up to 8 hours per day when included in the care plan
These are ceilings, not entitlements. Actual authorized hours depend on the person’s assessed needs and their approved care plan.5Virginia Code Commission. Virginia Administrative Code 12VAC30-120-924 – Covered Services; Limits On Someone who needs help only with bathing and dressing will be authorized for far fewer hours than someone who needs help throughout the day.
The Steps to Get Enrolled and Paid
The process runs in three phases, and they generally have to happen in order. Expect several weeks at minimum from first application to first paycheck.
1. Apply for Virginia Medicaid
The care recipient needs active Medicaid before anything else moves forward. Virginia accepts applications online through CommonHelp at commonhelp.virginia.gov, by phone through the Cover Virginia Call Center at 1-855-242-8282 (weekdays, 8 a.m. to 7 p.m.), or on paper at a local Department of Social Services office.6Department of Medical Assistance Services. How to Apply – CoverVA Have proof of identity, proof of Virginia residency, the Social Security number, recent bank statements, and documentation of all income sources ready before starting.
2. Complete the Functional Needs Screening
After the Medicaid application is submitted, contact the local Department of Social Services or local health department to request a long-term services and supports screening. The Community Based Screening Team schedules the Uniform Assessment Instrument visit.2Virginia Medicaid. CCC Plus Waiver Have current medical records ready, and if possible have a family member sit in on the assessment so the evaluators see the full picture of the person’s needs.
3. Choose Consumer-Directed Services and Enroll With a Fiscal Agent
Once Medicaid coverage and CCC Plus Waiver enrollment are approved, the care recipient (or their representative) tells the MCO care coordinator that they want the consumer-directed model rather than agency-directed. From there, enrollment moves to a Fiscal/Employer Agent, a state-contracted company that runs payroll, withholds taxes, and pays the caregiver. Virginia uses two Fiscal/Employer Agents depending on the member’s managed care organization: Public Partnerships LLC and Consumer Direct Care Network.7Virginia Medicaid. Consumer Directed Services
The caregiver completes enrollment paperwork with the assigned agent, providing a Social Security card and government-issued photo ID. After that, the caregiver submits timesheets to the agent for payment, and the Employer of Record reviews and approves each timesheet before submission.8Virginia Code Commission. Virginia Administrative Code 12VAC30-122-150 – Requirements for Consumer-Directed Model Of
Clocking In: Electronic Visit Verification
Virginia requires Electronic Visit Verification for consumer-directed personal care and respite services.9Virginia Medicaid. Electronic Visit Verification Each visit has to log six data points electronically: the service type, who received it, who provided it, the date, the location, and the start and end times. In practice, the caregiver clocks in and out through a phone app or similar system. Getting comfortable with the system during enrollment is worth the time, because problems with verification can hold up payment.
Taxes on What You’re Paid
Under IRS Notice 2014-7, Medicaid waiver payments for personal care can be excluded entirely from a caregiver’s gross income when the caregiver lives in the same home as the care recipient and has no separate residence. The IRS treats these as “difficulty of care” payments under Section 131 of the Internal Revenue Code.10Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income
The test is where you actually live. If you moved into your parent’s home to care for them and that address is where you eat, sleep, and conduct daily life, the payments qualify. If you keep a separate home and return to it on weekends and holidays, the payments don’t qualify even if you spend most nights at the care recipient’s house.10Internal Revenue Service. Certain Medicaid Waiver Payments May Be Excludable From Income More than one caregiver in the same household can each claim the exclusion. Caregivers who keep a separate residence will owe federal income tax on the payments and should plan accordingly. Either way, confirm with the Fiscal/Employer Agent that your withholding matches your actual tax situation.
Estate Recovery: What Families Should Know Before Enrolling
Federal law requires Virginia to seek recovery of Medicaid payments from the estate of any member who was 55 or older when they received services. Home and community-based waiver services are included, which means the care payments received now can become a claim against the care recipient’s estate after death.11Virginia Medicaid. Estate Recovery Fact Sheet
Virginia will not pursue estate recovery if the member is survived by a spouse who was not a Medicaid member, a child under 21, or a child of any age who is blind or disabled. DMAS can also waive all or part of a claim when enforcement would cause undue hardship on dependents or heirs, and it gives special consideration to estates made up of a family farm, family business, or modest homestead.11Virginia Medicaid. Estate Recovery Fact Sheet Recovery applies only to services paid after age 55, and only after death. If the care recipient owns a home, an elder law attorney can help the family plan around the potential claim before enrollment rather than being surprised by it later.