Key takeaway
Virginia's Commonwealth Coordinated Care Plus (CCC Plus) program and its Consumer-Directed (CD) services option make it relatively straightforward for family members to be paid as caregivers.
- Medicaid: CCC Plus is the primary managed long-term services and supports program in Virginia.
- Consumer-Directed services: Lets the care recipient hire, train, and supervise their own attendants, including most family members.
- Veterans: Aid & Attendance and Veteran Directed Care can fund family caregivers; VDC may pay spouses.
- Private: Long-term care insurance may reimburse family caregivers if the policy permits.
Overview
Virginia's Department of Medical Assistance Services (DMAS) and the Department for Aging and Rehabilitative Services (DARS) administer the state's long-term care system. Commonwealth Coordinated Care Plus, commonly called CCC Plus, is Virginia's managed long-term services and supports program for older adults and adults with disabilities.
Within CCC Plus, the Consumer-Directed (CD) services option allows the care recipient to hire and manage their own attendants, including most family members. Adult children, grandchildren, and other relatives can typically be paid. Spouses and legal guardians face restrictions under Medicaid but may be eligible under Veteran Directed Care for eligible veterans.
Programs that pay family caregivers in Virginia
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Commonwealth Coordinated Care Plus (CCC Plus) (Medicaid managed LTSS) | Older adults and adults with disabilities who need nursing-facility level of care; income up to ~300% of SSI; assets generally ≤ $2,000 for an individual. | Funds personal care, attendant services, respite, and adult day. Family members can be hired under Consumer-Directed services; spouses and legal guardians are not allowed. |
| Consumer-Directed (CD) Services (CCC Plus option) | CCC Plus members who can direct their own services or have an authorized representative. | Participant chooses and hires their own attendants — usually family members — and a fiscal/employer agent handles payroll. |
| Developmental Disabilities (DD) Waivers (Medicaid HCBS) | Individuals with developmental disabilities meeting institutional level of care; specific waiver depends on level of need (Family and Individual Supports, Community Living, Building Independence). | Funds personal supports and services. Family members other than spouses and legal guardians may serve as paid staff. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with daily living and meets VA pension income/asset rules. | Increases pension to fund in-home care; can pay adult children or relatives. Spouses cannot be paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veteran in VA health care who needs nursing-home level care and lives near a participating VAMC (e.g., Richmond, Hampton, Salem). | Provides a flexible monthly budget to hire caregivers, including spouses. |
| Long-Term Care Insurance (Private) | Policy must cover in-home personal care and pay benefits to the policyholder or chosen provider. | May reimburse a family caregiver if terms allow. Otherwise a licensed agency may be required. |
Virginia Medicaid programs
Virginia Medicaid funds long-term services through CCC Plus and DD waivers. The Consumer-Directed option within CCC Plus is the main way a family member can be paid as a personal care attendant.
Commonwealth Coordinated Care Plus (CCC Plus)
CCC Plus is Virginia's managed long-term services and supports program. It serves older adults, adults with disabilities, and certain other Medicaid populations through health plans.
- Must meet nursing-facility level of care for LTSS benefits.
- Income up to ~300% of the SSI federal benefit rate; assets generally ≤ $2,000.
- Each member chooses a CCC Plus health plan with a care coordinator.
- Family caregivers may be hired under Consumer-Directed services.
Consumer-Directed (CD) Services
CD services let the participant act as the employer of record. They choose, hire, train, and supervise their attendants while a state-contracted fiscal/employer agent handles payroll.
- Participant or authorized representative directs care.
- Most adult relatives may serve as paid attendants.
- Spouses and legal guardians are not eligible to be paid.
State-funded and aging network options
Virginia also funds limited state programs through DARS and local Area Agencies on Aging. These programs help residents who are not yet Medicaid-eligible or who need short-term respite.
Provides respite, training, and supportive services to family caregivers under the Older Americans Act framework.
State-funded companion, homemaker, and adult day services administered through local Area Agencies on Aging.
Who qualifies
- Virginia residents 60 or older or adults with disabilities who need help with daily activities.
- Households above strict Medicaid thresholds but with documented care needs.
- Family caregivers seeking respite or training.
Veterans' programs
Veterans in Virginia and their surviving spouses can use VA benefits to fund in-home care and pay family caregivers. The main paths are Aid & Attendance and Veteran Directed Care.
Aid & Attendance Pension
A&A increases a qualifying veteran's (or surviving spouse's) monthly pension to fund care needs. The benefit is paid to the veteran, who can use it to pay a family caregiver.
- Wartime service, income/asset limits, and documented care needs required.
- Adult children and other relatives can be paid.
- A spouse cannot be paid directly because household income is combined.
Veteran Directed Care (VDC)
VDC provides a VA-funded monthly budget that the veteran manages. Several Virginia VAMCs (Richmond, Hampton, Salem) participate, though local capacity determines availability.
- Requires nursing-home level of care and VA health care enrollment.
- Self-directed model with a financial management services provider.
- Spouses may be paid caregivers under VDC.
Long-term care insurance
A qualifying long-term care insurance policy may pay benefits the care recipient can use to compensate a family caregiver. Coverage details vary widely by policy.
What to check in the policy
- Confirm coverage includes in-home personal care, not only facility care.
- Determine whether benefits are paid to the policyholder (cash/indemnity) or only to licensed agencies.
If the policy only reimburses licensed providers, some families establish a small licensed home care agency under Virginia's licensing rules so benefits can flow to a family caregiver.
How to apply in Virginia (step-by-step)
- Identify the likely path: CCC Plus with Consumer-Directed services, DD waiver, state-funded aging services, VA benefits, or LTC insurance.
- Gather documents: ID, Social Security number, proof of income and assets, medical records, medication list, and military service records if applicable.
- Contact the right agency:
- CCC Plus / CD services: apply through Cover Virginia or your local Department of Social Services and request CCC Plus.
- DD waivers: contact your local Community Services Board (CSB).
- State-funded supports: call your local Area Agency on Aging or 2-1-1 Virginia.
- VA paths: contact the Richmond, Hampton, or Salem VAMC, or a Virginia Veteran Service Officer.
- LTC insurance: call the insurer to confirm caregiver-payment rules.
- Complete the functional assessment and financial eligibility review.
- Choose Consumer-Directed services, select your family caregiver, complete background checks and training, and enroll with the fiscal/employer agent.
- Begin services. Submit time sheets, keep care logs, and prepare for annual reassessment.
Virginia paid caregiver FAQs
What is CCC Plus and how does it relate to paid family caregiving in Virginia?
Commonwealth Coordinated Care Plus (CCC Plus) is Virginia's managed long-term services and supports program. Through its Consumer-Directed services option, the participant can hire family members as paid attendants.
What is Consumer-Directed (CD) services?
CD services let the care recipient or their authorized representative act as the employer of record for their attendants. A state-contracted fiscal/employer agent handles payroll while the family selects, hires, and supervises the caregiver.
Can a spouse be paid as a caregiver in Virginia?
Not through CCC Plus or DD waivers. Veteran Directed Care, however, can pay spouses for eligible veterans.
How long does CCC Plus approval take?
Typical timelines run 45 to 90 days from application to start of services, depending on the assessment and how quickly the health plan completes enrollment.
Do I need certification to be a paid family caregiver in Virginia?
Formal certification is not required for CD attendants, but background checks, basic training (including orientation through the fiscal/employer agent), and Medicaid enrollment are mandatory.
