For families and caregivers

Consumer directed care in Virginia: how relatives are paid to give care through CCC Plus

By the CaregiverConnect team · Updated 2026-10-26 · Sources checked on the same date and listed at the end.

If you hope to be paid for looking after a family member in Virginia, the main route is consumer direction under the Commonwealth Coordinated Care Plus Waiver (CCC Plus), a Medicaid program inside Cardinal Care. The member, or someone acting for them, employs the attendant, and that attendant can be a relative. Spouses face tighter limits than other family members. Below are the steps, the rules and the 2026 rates as the Department of Medical Assistance Services (DMAS) publishes them.

A younger man supporting an older man's arm as they walk through a bright living room

How consumer directed care works in Virginia

The CCC Plus Waiver, a federal 1915(c) home and community-based services waiver, covers personal care and respite in two forms. In the agency-directed model, a personal care agency hires the aide, a nurse supervises, and the agency handles every employer task. In the consumer-directed (CD) model, the member or a designated representative is the employer of record (EOR) who hires, trains, manages and, if needed, dismisses the attendant. Members can choose either model or a mix of both.

Three parties support a CD employer:

Services Facilitator (SF). Assesses the member's needs for each CD service, helps draw up the plan of care and trains the EOR in the employer role.
Fiscal/Employer Agent (F/EA). Runs pre-employment background checks, processes shift entries and payroll, and files and pays state and federal employer taxes on the EOR's behalf.
The health plan or DMAS. All Medicaid members are in Cardinal Care. Since July 1, 2025 the managed care plans are Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans and UnitedHealthcare Community Plan; members not in a plan are fee-for-service.

A minor, or a member who cannot handle the employer duties, must have another person serve as EOR.

Who qualifies for the CCC Plus Waiver (Cardinal Care)

DMAS describes three groups the waiver serves: older adults, people with a physical disability, and people who are chronically ill or severely impaired after losing a vital body function and need substantial, ongoing skilled nursing. The 2025 fact sheet adds that the person must meet nursing facility level of care criteria (or depend on technology and need ongoing skilled nursing), be at imminent risk of nursing facility placement, and be able to stay safely at home when the aide or nurse is not there. The person must also qualify for Medicaid, which local departments of social services determine.

How to apply: screening, Medicaid, then choosing consumer direction

Request an LTSS Screening through your local department of social services. The Community Based Screening Team, made up of a local social worker plus a nurse from the health department, visits the person and, if available, a family member. In a hospital, a discharge planner can do the screening.
Apply for Medicaid online at CommonHelp.virginia.gov, by phone through the Cover Virginia Call Center at 1-833-522-5582 (TDD 1-888-221-1590), or on a paper application from the local department of social services, asking for Appendix D, the long-term services and supports section.
Choose services. Once Medicaid and the waiver are approved, the member picks services and providers, with help from the screening team. Ask for consumer-directed personal care and name the relative you want to hire.
Pick a Services Facilitator. Consumer direction requires one; the SF assesses the need for each CD service and trains the employer of record.

To choose or switch a Cardinal Care plan, call the managed care helpline, 1-800-643-2273 (TTY 1-800-817-6608).

Can a spouse or relative be paid? Virginia's legally responsible individual rules

Virginia calls a spouse, or the parent or legal guardian of a minor, a legally responsible individual (LRI). Under rules DMAS finalized effective July 1, 2025, an LRI can be the paid attendant only for care that is "extraordinary", meaning beyond what they are already obligated to provide:

Pay is limited to 40 hours a week (40 hours per child where a parent cares for more than one child).
Only help with activities of daily living, such as bathing, dressing, toileting, transfers and eating, is paid. Household tasks (instrumental activities) and general supervision are not.
Respite is not available while an LRI is paid, because respite exists to relieve an unpaid caregiver.
The LRI must meet the same requirements as any attendant and record every task for each shift through a DMAS-approved method. Anyone convicted of a barrier crime under Virginia law cannot be a paid provider.
Under consumer direction, the EOR approves shifts for payment and may be another LRI, such as the other parent. The SF or agency nurse and the care coordinator monitor services at least every 90 days.

The current DMAS pages set out these special limits only for spouses and for parents or guardians of minors. They do not list adult children, siblings or other relatives as restricted, but they do not spell out the rule for them either, so confirm with your Services Facilitator before the first shift.

Fiscal agents and hour limits for consumer-directed attendants

The CD services page names Public Partnerships LLC (PPL) as the F/EA for members in the Aetna, Anthem and UnitedHealthcare plans, with Aetna also using Consumer Direct Care Network (CDCN). Sentara uses CDCN, and CDCN has been the F/EA for fee-for-service CCC Plus members since January 1, 2019. That page still mentions Molina, which left the plan list when Humana took over on July 1, 2025, so Humana members should ask their care coordinator which F/EA applies.

The 2025 fact sheet sets these CCC Plus service limits:

Personal care: a soft cap of 56 hours a week, with exceptions based on criteria.
Respite: 480 hours per state fiscal year (July 1 to June 30).

How much consumer-directed attendants are paid in Virginia

DMAS publishes its CCC Plus rates. For consumer-directed personal assistance or attendant care (code S5126) and consumer-directed respite (S5150), the rates effective July 1, 2026 are:

Area	CD personal care rate	CD respite rate
Northern Virginia (NOVA)	$17.97 an hour	$17.97 an hour
Rest of State (ROS)	$13.88 an hour	$13.88 an hour

These are DMAS fee-for-service rates for the service. Managed care plans may use different guidelines under their contracts, and the take-home amount after payroll taxes comes from your F/EA, so ask it to confirm the hourly figure for your area. For comparison, other official reference points (not program rates):

Virginia's state minimum wage, set by DOLI for calendar 2026, is $12.77 an hour.
BLS reports a May 2025 median of $14.57 an hour, and a mean of $15.69, for Virginia's 70,070 home health and personal care aides.

Illustrative calculation: 40 paid hours a week, the LRI maximum, at the Rest of State rate is 40 × $13.88 = $555.20 a week before deductions. Inputs: the DMAS SFY 2027 rate file and the LRI hour limit.

Other routes: VA caregiver programs, taxes and Virginia paid leave

PCAFC stipend. For a relative who served in the military, PCAFC, VA's comprehensive family caregiver program, includes a monthly stipend for whoever VA names as Primary Family Caregiver. VA's tests for the veteran: a disability rating at or above 70%, discharge from service, enrollment in VA health care, plus a need for hands-on personal care expected to last half a year or longer. Caregivers must be adults who are related to the veteran or share the veteran's home full time, and the two of them file the application jointly.
Veteran Directed Care. A veteran-managed budget pays helpers the veteran picks, and relatives can be among them. Not every VA site runs it.
Federal income tax. CCC Plus is a 1915(c) waiver, so Notice 2014-7 from the IRS may allow an attendant to leave waiver pay out of taxable income if the care takes place where the attendant actually lives. Under the IRS Q&A, a parent's home counts for an adult child who moved in and has no separate home; a provider who returns to another residence on weekends does not qualify. Ask the F/EA how it reports the wages.
Private hires. IRS Topic 756 sets a 2026 threshold of $3,000 in cash pay to one household employee; at or above it, a family hiring privately generally owes FICA and files Schedule H with the 1040.
Virginia Paid Family and Medical Leave. Newly enacted and run by the Virginia Employment Commission, it will allow up to 12 weeks of paid leave a year, with caring for a seriously ill relative among the qualifying reasons, at up to 80% of average weekly wage. Benefits start December 1, 2028.

Local aging agencies and adult abuse reports in Virginia

The Department for Aging and Rehabilitative Services (DARS) lists 25 Area Agencies on Aging on its locator, each covering named counties and cities. In the Shenandoah Valley, for example, Seniors First, the Shenandoah Area Agency on Aging, at 207 Mosby Lane in Front Royal (540-635-7141), covers Warren, Clarke, Frederick, Page and Shenandoah plus Winchester; see our Front Royal caregiver jobs page.

Adult Protective Services takes reports about adults 60 or older, and adults 18 to 59 who are incapacitated. Report through the APS online portal, to your local department of social services, or on the 24-hour toll-free hotline at (888) 832-3858.

Where CaregiverConnect fits

CaregiverConnect has no role inside CCC Plus or Cardinal Care: it is not a Medicaid provider, Services Facilitator, F/EA or agency, and it cannot enroll a member. Households in Virginia that self-fund care, or that want someone for the hours the waiver leaves uncovered, can list the job on CaregiverConnect at no cost and choose a caregiver themselves; whoever hires becomes that worker's household employer. Caregivers in Virginia can put their availability and experience in a profile, also free, and reach out to families. Start with how it works, check pricing for the optional plans, and see the guides on private hiring and profile writing. To compare neighbors and peers, read about Missouri's CDS program or West Virginia's family caregiver options.

Frequently asked questions

What is consumer directed care in Virginia?

It is the option, available under the CCC Plus Waiver and some other Virginia waivers, in which the member or a representative acting as employer of record hires and manages their own attendant. Under CCC Plus it covers personal care and respite. A Services Facilitator trains the employer, and the F/EA handles background checks, payroll and employer taxes.

Can I get paid to look after my mom in Virginia?

Usually, yes, if she is approved for the CCC Plus Waiver and chooses consumer direction. She needs Medicaid, an LTSS Screening showing nursing facility level of care, and an employer of record. The special limits in DMAS rules apply to spouses and to parents of minors; for an adult child, confirm with the Services Facilitator.

Can a spouse be a paid caregiver in Virginia?

Yes, within limits. Virginia classes a spouse as a legally responsible individual, so pay is possible only for extraordinary help with activities of daily living, up to 40 hours a week. Household tasks and supervision are not paid, and respite is not available while the spouse is the paid attendant.

How much does Virginia Medicaid pay a family caregiver?

The DMAS fee-for-service rate for consumer-directed personal care from July 1, 2026 is $17.97 an hour in Northern Virginia and $13.88 elsewhere in the state. Managed care plans may follow different guidelines, and your fiscal agent can confirm what you will receive.

Is CCC Plus the same as Cardinal Care?

No. Cardinal Care is the name for all of Virginia's Medicaid and FAMIS coverage, whether through a managed care plan or fee-for-service. CCC Plus is one home and community-based services waiver within it, for older adults and people with disabilities who meet nursing facility level of care.

Who is the fiscal agent for consumer directed services in Virginia?

It depends on the plan. DMAS lists PPL for Aetna, Anthem and UnitedHealthcare members (Aetna also uses CDCN), and CDCN for Sentara and for fee-for-service members. Humana joined the plan list in July 2025, so its members should ask their care coordinator.

Sources

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