How to Get Paid to Care for Your Spouse in Virginia (2026)

You can get paid to care for your spouse in Virginia, but the path is narrower than the one open to an adult child or a sibling. In most states, and in Virginia until recently, the person who was legally hardest to pay for caregiving was the one doing the most of it: the husband or wife. That is because Medicaid treats a spouse as a "legally responsible relative," someone already expected to provide care, and often bars them from being the paid worker. Virginia opened a real door on July 1, 2025, and the VA has paid spouses for years. Which route fits depends above all on one thing: whether your spouse is a veteran.

In This Guide

• Key Takeaways
• Can You Get Paid to Care for Your Spouse in Virginia?
• The Medicaid Self-Directed Route
• When Virginia Says No: The Legally Responsible Relative Rule
• The VA Route: PCAFC and Veteran-Directed Care
• Aid and Attendance for a Veteran or Surviving Spouse
• How to Get Paid to Care for Your Spouse in Virginia: How to Apply and Who to Call
• Frequently Asked Questions
• Learn More

Can You Get Paid to Care for Your Spouse in Virginia?

The honest short answer: yes, but through a specific door, and only for a specific kind of care.

If you are caring for a husband or wife in Virginia, you have essentially three ways to be paid, and they do not all treat a spouse the same way:

1. Virginia Medicaid consumer direction, under the LRI rule. A spouse can be the paid attendant, but only for "extraordinary" hands-on care, capped at 40 hours per week.1
2. The VA, if your spouse is a veteran. The PCAFC caregiver stipend and Veteran-Directed Care both allow a spouse to be paid, and neither uses Medicaid's "extraordinary care" limit.3,4
3. VA Aid and Attendance, an increased pension a veteran or surviving spouse can use to help pay for care at home.

The one route that is almost never a fit for a spouse: a private personal-services contract used for Medicaid planning. Because Medicaid treats money moved between married spouses differently from what an aging parent pays an adult child, the personal-contract approach that can work for other relatives usually does not help a husband or wife. If you are weighing one, get advice from an elder-law attorney first.

Which door fits depends on one question above all others: is your spouse a veteran? If yes, start with the VA. If no, your route runs through Virginia Medicaid, and the LRI rule below decides whether you qualify.

The Medicaid Self-Directed Route

Virginia does not mail a caregiver a check. Instead, the person who needs care qualifies for Virginia Medicaid long-term care, chooses the consumer-directed option, and hires their own attendant. That attendant can be a family member. A separate company called a Fiscal/Employer Agent runs the payroll and issues the paycheck. Virginia Medicaid, run by the Department of Medical Assistance Services (DMAS), offers consumer direction for personal care, respite, and companion services under its home and community-based waivers.5

Consumer direction, called self-direction nationally, is the model that makes paid family caregiving possible at all. It gives the person receiving care (or a representative acting as their Employer of Record) the authority to hire, train, schedule, and dismiss their own worker, and to pay a family member for the job.6

For a spouse, the waiver that usually matters is the Commonwealth Coordinated Care Plus (CCC Plus) waiver, now delivered under the Cardinal Care managed-care umbrella. To use it, your spouse first has to qualify:

• Functionally, they must need a nursing-facility level of care, measured by Virginia's Uniform Assessment Instrument.7
• Financially, the waiver uses the institutional income standard of 300% of the Supplemental Security Income (SSI) Federal Benefit Rate. With the 2026 SSI individual rate of $994 per month, that works out to roughly $2,982 per month for a single applicant, with a countable-asset limit of $2,000. Confirm the current limits with DMAS.7

A point in your favor: CCC Plus is Virginia's integrated managed long-term services and supports program, so it does not operate a statewide waiting list, unlike the developmental-disability waivers.7

Once your spouse is enrolled and consumer direction is set up, a Fiscal/Employer Agent becomes your payer of record. Public Partnerships LLC serves CCC Plus members on the Aetna, Anthem HealthKeepers Plus, and UnitedHealthcare Community Plan health plans; Consumer Direct Care Network serves fee-for-service members and the Molina and Sentara plans; for Aetna members, both are used. The agent runs payroll, withholds taxes, and reports your income. Because the assignment follows the health plan and can change, confirm the current agent with your spouse's plan.5

But being enrolled is not the same as being allowed to pay a spouse. That turns on the rule below.

When Virginia Says No: The Legally Responsible Relative Rule

Here is why a spouse is treated differently from an adult child in the first place.

Federal Medicaid rules treat a spouse as a legally responsible relative, a person the law already expects to care for the other. Under Medicaid's state-plan personal care benefit, the paid provider must be someone "who is not a member of the individual's family," and for that benefit "family" is defined as a legally responsible relative. So under that benefit, a spouse is flatly excluded from being the paid worker. The one place the rules bend is self-direction: the federal self-directed personal assistance authority defines "legally liable relatives" to expressly include a spouse, and lets each state choose, at its option, whether to let participants hire them. That is why the answer is state-specific, and why so many states still say no to spouses even while paying other relatives.2

Virginia used to be one of the states that said no. That changed. CMS approved Virginia's waiver amendments on April 17, 2025, effective July 1, 2025, making the paid-caregiver provision for legally responsible individuals (LRIs) permanent rather than a temporary pandemic flexibility. An LRI is defined as the participant's spouse, or the parent or legal guardian of a minor. Under the CCC Plus, Community Living, and Family and Individual Supports waivers, a spouse can now be a paid consumer-directed attendant.1

The limits are specific, and they matter:

• The care has to be "extraordinary in nature." That means care above and beyond the personal-care help a spouse is already legally expected to provide. The specific tasks must be documented during person-centered planning, with evidence that the task is not typical for the person's age and situation.1
• A paid spouse's consumer-directed hours are capped at 40 per week. Reimbursement for a spouse working as an LRI consumer-directed attendant stops at 40 hours per week.1
• Routine and household help does not count. Instrumental tasks like housekeeping and shopping, general supervision, and respite are not reimbursable to a spouse.1
• You cannot be your own boss. The person who serves as the member's Employer of Record or Services Facilitator cannot also be the paid attendant, and the Services Facilitator cannot be the member's spouse. In practice, families name a different relative as the Employer of Record when a spouse is the paid caregiver.1

So the accurate way to describe Virginia's rule: a spouse can be paid for the hands-on, above-and-beyond personal care that keeps a husband or wife safe at home, but not for the ordinary help spouses give each other anyway.

The VA Route: PCAFC and Veteran-Directed Care

If your spouse is a veteran, check the VA before Medicaid. The VA has paid spouses to provide care for years, and it does not impose the "extraordinary care" test Virginia Medicaid uses.

Program of Comprehensive Assistance for Family Caregivers (PCAFC). PCAFC pays an eligible veteran's approved Primary Family Caregiver a tax-free monthly stipend, and a spouse can serve in that role. To qualify, the veteran must have a VA disability rating (individual or combined) of 70% or higher, need at least six months of continuous, in-person personal care, and be enrolled in VA health care.3 The stipend is not a flat national figure: it is calculated from the federal General Schedule GS-4, step 1 pay rate for the locality where the veteran lives, divided by 12, then multiplied by 0.625 (or by 1.00 when the VA determines the veteran cannot self-sustain in the community). Because the stipend is tied to the veteran's local GS-4 pay rate, the amount can differ from one part of Virginia to another, so confirm your figure with your VA Caregiver Support Coordinator. A Primary Family Caregiver also receives caregiver training, mental health counseling, at least 30 days of respite care per year, and CHAMPVA health coverage if not otherwise insured.3

Veteran-Directed Care (VDC). VDC gives the veteran a flexible monthly budget, set by the VA care team based on assessed need, that the veteran (or their representative) uses to hire and pay their own workers, including a spouse. It has the most permissive family-hire rules of any program in this guide. The important caveat in Virginia: VDC is offered through participating VA medical centers in partnership with Area Agencies on Aging, and it is not statewide. The Peninsula Agency on Aging partners with the Hampton VA Medical Center to deliver it in the Hampton Roads area, for example. Ask your VA social worker or Caregiver Support Coordinator whether VDC is available at the facility serving your area.4

Between the two, PCAFC pays a defined stipend and adds benefits like respite and health coverage; VDC gives you a budget and the freedom to set a spouse's schedule and rate. Many veteran households qualify for one or the other, not always both, so ask about each.

Aid and Attendance for a Veteran or Surviving Spouse

VA Aid and Attendance is not a caregiver payment. It is an increased monthly pension for a wartime veteran, or a surviving spouse, who needs help with daily activities. The money goes to the veteran or surviving spouse, who can then use it to pay for care at home, including care a family member provides under a private arrangement. It requires that the person already qualify for a VA pension.3

For 2026 (effective December 1, 2025 through November 30, 2026), a single veteran with Aid and Attendance can receive up to $2,424 per month ($29,093 per year); a veteran with one dependent up to $2,874 per month ($34,488 per year). A surviving spouse with Aid and Attendance can receive up to $1,558 per month ($18,697 per year). The 2026 net-worth limit for both is $163,699, and VA pension carries a 36-month look-back on asset transfers for less than fair market value. Confirm current figures on the VA pension rate page before applying.8

Aid and Attendance is worth knowing about for two reasons. First, a veteran who does not qualify for PCAFC (for example, because the disability rating is under 70%) may still qualify for A&A.3 Second, a widow or widower can qualify as a surviving spouse, a group left out of most caregiver-pay programs. Virginia's county and city Veterans Service Officers, reached through the Virginia Department of Veterans Services, can help you file these claims; be wary of for-profit pension consultants who charge a fee for help an accredited officer may provide.

How to Get Paid to Care for Your Spouse in Virginia: How to Apply and Who to Call

Work through these steps in order. The first question, again, is whether your spouse is a veteran.

A note on taxes

If you are paid through Medicaid consumer direction and you live in the same home as your spouse, your caregiver wages may be excludable from federal gross income. The IRS treats certain Medicaid waiver payments to a co-resident caregiver as difficulty-of-care payments under Notice 2014-7. This is a common and valuable benefit for spouses, who by definition share a home. It applies to Medicaid waiver payments, not to a private-pay arrangement or the VA stipend (the PCAFC stipend is separately tax-free). Talk to a tax preparer familiar with the rule before you file.12

Learn More

Find personalized help getting paid to care for your spouse in Virginia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.