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

You may be able to 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. The basic Medicaid personal care benefit will not pay a "legally responsible relative," and under state law a husband or wife can be one. DMAS's rules for paying a spouse under its waivers took effect on July 1, 2025, though Virginia's CCC Plus regulation still says a spouse cannot be paid, and the VA caregiver stipend can pay a spouse as well.1,2 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?

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. DMAS's 2025 rules let a spouse be the paid attendant only for "extraordinary" hands-on care, up to 40 hours per week, but the regulation text still bars a spouse, so confirm with DMAS in writing first.1
2. The VA, if your spouse is a veteran. A spouse can serve as the paid Primary Family Caregiver under the PCAFC caregiver stipend.4 Veteran-Directed Care, where it is available, lets the veteran hire their own workers, but whether one of them can be a spouse is something to confirm with the VA medical center.5
3. VA Aid and Attendance, an increased pension a veteran or surviving spouse can use to help pay for care at home.

One route that rarely fits a spouse: a private personal-services contract used for Medicaid planning. If you are weighing one, get advice from an elder-law attorney first.

Is your spouse a veteran? If yes, start with the VA. If no, your route runs through Virginia Medicaid and the LRI rule below.

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 the member or their designated representative performs the employer responsibilities, including hiring, training, managing and, if necessary, terminating the attendant. 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.6

Nationally this is called self-direction, a way of delivering services, not a separate benefit. Whether a family member can be the paid worker is not a general feature of it; under the federal self-directed personal assistance option (section 1915(j)), it is left to each state. So the answer for a spouse turns on Virginia's own rules, below.7

For a spouse, the waiver that usually matters is the Commonwealth Coordinated Care Plus (CCC Plus) waiver. To use it, your spouse first has to qualify:

• Functionally, they must need the level of care provided in a nursing facility, long-stay hospital, or specialized care nursing facility. That is settled by an LTSS screening built on three components: functional capacity, meaning the help they need with activities of daily living; medical or nursing needs; and their risk of nursing-facility placement within 30 days without community-based services. The functional rating is documented on Virginia's Uniform Assessment Instrument (UAI), and the person may request the LTSS screening through their local Department of Social Services.8
• Financially, waiver applicants are treated as if institutionalized, and the countable income limit is 300% of the Supplemental Security Income (SSI) payment amount for an individual. With the 2026 SSI individual rate of $994 per month, that works out to roughly $2,982 per month for a single applicant in 2026; SSI amounts change in January, so the limit rises in January 2027. If your spouse's income is near or above that figure, ask your local Department of Social Services how it is counted before assuming they do not qualify.8
• Resources are limited to $2,000 for one person. The $3,000 figure in Virginia's manual is for two people in the same eligible group, so when only one spouse needs care, ask your local Department of Social Services how the couple's assets are counted.8

A Cover Virginia fact sheet dated March 2021 says CCC Plus, unlike the developmental-disability waivers, has no waiting list. That is the most recent official word, not a current guarantee, so ask your local Department of Social Services about any wait.6

Once your spouse is enrolled and consumer direction is set up, your pay comes through a Fiscal/Employer Agent. DMAS's consumer-directed services page says Public Partnerships LLC serves CCC Plus members on the Aetna, Anthem, and United Health Care plans; Consumer Direct Care Network serves fee-for-service members and the Molina and Sentara plans; for Aetna members, both are used.6 That list predates a plan change: Molina left Cardinal Care after June 30, 2025, and its members moved to Humana Healthy Horizons of Virginia, so confirm the current agent with your spouse's plan, especially on Humana.9

When Virginia Says No: The Legally Responsible Relative Rule

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 a family member "means a legally responsible relative." That exclusion is narrower than it looks. The section opens "Unless defined differently by a State agency" for a home and community-based waiver, so a state can write its own family-member rule for its section 1915(c) waivers. Self-direction uses a different term with its own rule: the federal self-directed personal assistance services regulation defines "legally liable relatives" as people with a duty under state law to care for another and says the category "may include" a spouse, and under that option a state may elect to let participants hire legally liable relatives as paid providers. So ask, in order: which Medicaid authority funds the service, how the state defines a family member or legally liable relative for it, and, for self-direction, whether the state lets participants hire one.3

Virginia has answered for its waivers. DMAS received CMS approval for its waiver amendments on April 17, 2025, and the rules governing when a legally responsible individual (LRI) is the paid aide or attendant were finalized effective July 1, 2025. 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, DMAS's rules say a spouse may be paid as the aide or attendant for the personal care service.1

Official Virginia sources disagree. The CCC Plus regulation, 12VAC30-120-935 B (amended effective June 19, 2024), still says DMAS shall not reimburse waiver services a spouse provides, DMAS's Employer of Record Manual (August 2021, still posted) says the attendant cannot be the spouse, and the DD waiver rule, 12VAC30-122-120 B, bars an enrolled adult's spouse. Until the regulations match the 2025 LRI rules, get DMAS's or the health plan's answer in writing.2,10

The limits are specific, and they matter:

• The care has to be "extraordinary in nature." That means care above and beyond what the LRI is already obligated to provide. Since July 1, 2025 providers must document the need for extraordinary care during person-centered planning, against a DMAS guide built on the individual's chronological age and needs beyond those typically required. DMAS describes that standard in terms of a member under 18 and states no separate standard for the spouse of an adult participant, so ask DMAS how it applies to your household before you count on payment.1
• Paid hours top out at 40 per week. Reimbursement may be made to an LRI for up to 40 hours per week.1
• Routine and household help does not count. A paid LRI's services are limited to support with Activities of Daily Living. Instrumental Activities of Daily Living and general supervision are not considered extraordinary care, so they are not reimbursed, and the paid spouse must meet the same requirements as other personal care aides or attendants.1
• Paying a spouse closes off respite. Respite services are not available when there is a paid LRI providing personal care, so weigh that trade-off before choosing this route.1
• A spouse cannot be the Services Facilitator. Under 12VAC30-120-924 the services facilitator cannot be the waiver individual, a CD attendant, a provider of other Medicaid-covered services, the spouse of the waiver individual, the parent or legal guardian of a minor waiver individual, or the Employer of Record employing the CD attendant. So plan for someone outside the couple in that seat, and in the Employer of Record seat too, since the EOR cannot also be the paid attendant.1,2

The VA Route: PCAFC and Veteran-Directed Care

If your spouse is a veteran, check the VA before Medicaid.

Program of Comprehensive Assistance for Family Caregivers (PCAFC). PCAFC pays an eligible veteran's approved Primary Family Caregiver a monthly stipend, and a spouse can serve in that role. VA lists four requirements that must all be true of the veteran: a VA disability rating (individual or combined) of 70% or higher, discharge from the U.S. military or a date of medical discharge, a need for at least six months of continuous, in-person personal care, and enrollment in VA health care. Those four are a first screen, not the whole test. You and the veteran apply together, and the regulation adds conditions VA assesses during the application: participation must be in the veteran's best interest, the veteran must receive care at home and ongoing care from a primary care team, and the personal care the Family Caregiver would provide must not be simultaneously and regularly provided by another person or program. That last condition matters if your household already receives regular personal care through Medicaid or an agency.4 The stipend is not a flat national figure: it is calculated from the federal General Schedule GS-4, step 1 annual rate for the locality where the veteran lives, divided by 12, then multiplied by one of the factors (0.625, 1.00, or 0.25) set in 38 CFR 71.40(c)(4)(i). Because the stipend is tied to the veteran's local GS-4 rate, the amount can differ from one part of Virginia to another, so confirm your figure with VA. Approval alone does not start the money: VA states you must be enrolled in direct deposit through the VA customer engagement portal to get the monthly stipend. A Primary Family Caregiver also receives caregiver education and training, mental health counseling, at least 30 days of respite care per year, and CHAMPVA health coverage if not otherwise covered.4

Which multiplier applies depends on the veteran's track:4

• Current program (38 CFR 71.20(a)): 0.625, or 1.00 when the VA determines the veteran is unable to self-sustain in the community.4
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)): set by the sum of the veteran's 2019 clinical ratings, at 1.00 if 21 or higher, 0.625 if 13 to 20, and 0.25 if 1 to 12. No self-sustain determination is required on this route. A veteran meeting both is paid whichever amount is higher, a legacy participant's stipend is held at no less than what the caregiver was eligible for the day before October 1, 2020 while the veteran stays at the address on record, and the legacy schedule lapses October 1, 2028.4

Veteran-Directed Care (VDC). VDC gives the veteran a budget for services, managed by the veteran or the veteran's representative, and with the help of a counselor the veteran hires their own workers, which VA says "might include their own family member or neighbor." VA's page does not state whether a veteran may hire a spouse as a paid worker; it neither permits nor bars it, so confirm with the VA medical center serving you before counting on it. VA says enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and it is available, and that services may vary by location, so talk with your VA social worker and find out if it is available in your location.5

Aid and Attendance for a Veteran or Surviving Spouse

VA Aid and Attendance is not a caregiver payment. It is an increased monthly pension: a veteran or survivor may be eligible if they get a VA pension and meet at least one of VA's listed requirements, such as needing another person's help with daily activities like bathing, feeding, and dressing.4 VA's Veterans Pension itself is for wartime veterans who also meet age-or-disability and income and net-worth limits.11

For 2026 (effective December 1, 2025 through November 30, 2026), a single veteran with Aid and Attendance can receive up to $29,093 per year; a veteran with one dependent up to $34,488 per year. A surviving spouse with Aid and Attendance can receive up to $18,697 per year. These are ceilings, not flat payments: VA pays the difference between countable income and the ceiling, so income lowers what's received. 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.12

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.4 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 a Virginia Medicaid waiver and your spouse lives in your home, your caregiver wages may be excludable from federal gross income. The IRS treats qualified Medicaid waiver payments for care of someone living in the provider's home as difficulty-of-care payments under Notice 2014-7, whether or not the provider is related. The test is where you actually live, the place you reside and carry on your private life, not who owns the house; the exclusion is lost if you keep a separate home you return to. It does not cover direct payments a care recipient makes from their own private funds. Talk to a tax preparer familiar with the rule before you file.16

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.