How to Get Paid as a Family Caregiver in Virginia (2026)

One Virginia paid family caregiver route runs through Medicaid, and it does not come as a check from the state. Instead, the person you care for qualifies for Virginia Medicaid long-term care, chooses the consumer-directed option, and employs their own attendant. A separate company called a Fiscal/Employer Agent pays the attendant.1

The rule that decides whether many families can do this at all is the spouse-and-parent rule. Under rules Virginia finalized effective July 1, 2025, a spouse, or the parent of a minor child, can be paid as the personal care aide or attendant under the CCC Plus waiver and two of the developmental-disability waivers, but only for care that is "extraordinary in nature," and for up to 40 hours per week.2 DMAS describes extraordinary care in terms of a member under 18, so a spouse of an adult should confirm with DMAS before counting on pay.2

This guide lays out every legitimate way to be paid as a family caregiver in Virginia for 2026: who can be hired under each program, how the pay works, and how to pick the route that fits your family.

The Short Version

If you are an adult child, sibling, grandchild, or other relative, DMAS's spouse-and-parent limits do not apply to you, because they cover only a spouse or the parent or legal guardian of a minor.2 For someone who qualifies for Virginia Medicaid long-term care, the route to ask about is consumer direction under the CCC Plus waiver, where the member employs their own attendant, a Services Facilitator helps the member learn the employer role, and a Fiscal/Employer Agent pays the attendant. Confirm with the Services Facilitator that the member can hire you before you plan around the pay.1

If you are a spouse, or the parent of a minor child, you can be paid as the personal care aide or attendant only for "extraordinary" care, for up to 40 hours per week.2 A spouse of an adult should confirm with DMAS first, because DMAS describes extraordinary care in terms of a member under 18.2

If your loved one is a veteran, check the VA programs too. The VA caregiver stipend is open to a spouse, and Veteran-Directed Care lets a veteran hire workers who may include a family member.4,5

If your family has enough private assets, a written personal services contract can pay a caregiver now, but under Virginia's 60-month look-back DMAS may treat contract payments as an uncompensated transfer if the contract does not meet its conditions.6

What Makes Virginia Different: Consumer Direction and the LRI Rule

Virginia Medicaid, administered by the Department of Medical Assistance Services (DMAS), offers consumer direction under its home and community-based services (HCBS) waivers. The member, or their designated representative, performs all of the employer responsibilities, including hiring, training, managing and, if necessary, terminating the attendant. The services that can be consumer-directed are personal care/personal assistance, respite, and companion services, and members may choose consumer-directed care, agency-directed care, or both.1

For older adults, this guide focuses on the CCC Plus waiver, which serves all ages.3 A Fiscal/Employer Agent (F/EA) pays the attendant. Public Partnerships LLC serves CCC Plus waiver members enrolled with the Aetna, Anthem, and United Health Care plans; Consumer Direct Care Network has served fee-for-service CCC Plus waiver members since January 1, 2019 and serves the Molina and Sentara plans; and for Aetna, both are used as the F/EA. Because the F/EA follows the member's plan, confirm the current agent with that plan.1

The rule families most need to understand is the legally responsible individual (LRI) rule. DMAS defines an LRI as the participant's spouse, or the parent or legal guardian of a minor. DMAS received CMS approval for waiver amendments on April 17, 2025, and the rules for when an LRI is the paid aide or attendant for personal care under the CCC Plus, Community Living, and Family and Individual Supports waivers were finalized effective July 1, 2025.2

The catch: an LRI can be paid only for care that is "extraordinary in nature," above and beyond what the LRI is already obligated to provide. Providers must document the need for extraordinary care during person-centered planning, and DMAS has developed a guide based on the person's chronological age and needs beyond those typically required. Reimbursement is available for up to 40 hours per week (up to 40 hours per week for each child when an LRI assists more than one child). A paid LRI's services are limited to help with activities of daily living (ADLs). Instrumental activities of daily living (IADLs) and supervision are not reimbursed, and respite services are not available while a paid LRI is providing personal care.2

If you are the spouse of an adult, read this before you plan around LRI pay. DMAS states that this personal care may only be used to meet the extraordinary needs of a participant under the age of 18 due to their disability, and its page states no separate extraordinary-care standard for the spouse of an adult participant. Confirm with DMAS that payment is available before you count on it.2

One more practical limit: under 12VAC30-120-924, the Services Facilitator cannot be the member, a consumer-directed attendant, the member's spouse, the parent or legal guardian of a minor member, or the Employer of Record who employs the attendant.2

The Virginia Paid Family Caregiver Pathways

1. CCC Plus Waiver Consumer-Directed Personal Care and Respite

Who pays: Virginia Medicaid (DMAS), through the CCC Plus waiver; Cardinal Care members can call the DMAS Managed Care Helpline for help selecting a different health plan.3,7

Who can be paid: The attendant the member hires. A spouse, or the parent or legal guardian of a minor, is a legally responsible individual and can be paid only under the LRI rules above; an adult child, sibling, grandchild, or friend is outside DMAS's LRI definition.2

What it is: The CCC Plus waiver is a home and community-based services waiver. Under consumer direction the member hires and directs their own worker for personal care/personal assistance, respite, and companion services. CCC Plus serves all ages and does not have a waiting list.3,1

Eligibility, recipient: The member must meet both a functional test and a financial test. Functionally, they must require the level of care provided in a nursing facility, long-stay hospital, or specialized care nursing facility. That call is made through an LTSS screening, which the person can request through their local Department of Social Services and which looks at three things: how much help the person needs with activities of daily living, their medical or nursing needs, and their risk of entering a nursing facility within 30 days. The functional rating is documented on Virginia's Uniform Assessment Instrument (UAI). Financially, waiver applicants are treated as if institutionalized. The countable income limit is 300% of the Supplemental Security Income (SSI) payment amount for an individual, which at the 2026 SSI Federal Benefit Rate of $994 per month works out to roughly $2,982 per month, but that is not a hard ceiling: Cover Virginia says people over it may still qualify if the private cost of long-term care is greater than their income, so apply and be screened rather than assume you are over. The countable-resource limit is $2,000 for one person ($3,000 for two people in the same eligible group); the home, one automobile, and household goods are excluded, and special rules let a married applicant whose spouse lives in the community leave that spouse some assets for their support. Once enrolled, members contribute some countable income toward the cost of care (the patient pay) after allowances for their own needs and a spouse or child at home; someone whose only income is SSI does not contribute.3

Eligibility, caregiver: Be hired by the member or their representative. A paid LRI must meet the same requirements as other personal care aides or attendants, and a consumer-directed attendant cannot also serve as the member's Services Facilitator.2

How you get paid: A Fiscal/Employer Agent (PPL or CDCN, depending on the plan) pays you; the member stays your employer.1

Best for: An older adult who qualifies for CCC Plus, needs help with daily activities, and wants to hire and direct their own attendant.

2. Developmental Disability Waivers (CL and FIS)

Who pays: Virginia Medicaid, which administers the developmental-disability (DD) waivers jointly with the Virginia Department of Behavioral Health and Developmental Services.1

Who can be paid: A spouse or the parent of a minor can be paid as the personal care aide or attendant under the LRI rules on the Community Living (CL) and Family and Individual Supports (FIS) waivers.2

What it is: Virginia operates three 1915(c) developmental-disability waivers, Community Living, Family and Individual Supports, and Building Independence, for people with autism, intellectual disabilities, or developmental disabilities who meet an ICF/IID level of care. Personal assistance, respite, and companion services are covered under CL and FIS, and CL also covers consumer-directed services facilitation. The Building Independence waiver, for adults 18 and older, does not include personal assistance, respite, or companion services. To apply, contact your local Community Services Board (CSB).1

The key difference from CCC Plus: There is a waiting list for the DD waivers, and slots are assigned based on urgency of need.1

Best for: A family caring for a relative with a developmental disability who has a CL or FIS waiver slot, or who is on the waiting list and planning ahead.

3. VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Who can be paid: A designated Primary Family Caregiver, who must be at least 18 and either a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or someone who lives full time with the veteran (or is willing to if VA designates them). A veteran may have one Primary and up to two Secondary Family Caregivers, and the stipend goes to the Primary.8

2026 stipend: The PCAFC stipend starts from the federal General Schedule GS-4, Step 1 annual rate for the locality pay area where the veteran lives, divided by 12. That monthly figure is then multiplied by a factor set in 38 CFR 71.40(c)(4)(i), and which factor applies depends first on whether the veteran is in the current program or is a legacy participant or legacy applicant:8

• Current program (the veteran meets 38 CFR 71.20(a)): the factor is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."8
• Legacy participant or legacy applicant (the veteran meets 38 CFR 71.20(b) or (c)): the factor comes from the sum of the veteran's 2019 clinical ratings instead, and no self-sustain determination is required. A sum of 21 or higher pays 1.00, a sum of 13 to 20 pays 0.625, and a sum of 1 to 12 pays 0.25.8

A veteran who meets both the current-program and the legacy requirements is paid whichever of the two amounts is higher, and a legacy participant's stipend cannot fall below what the caregiver was eligible to receive the day before October 1, 2020, so long as the veteran stays at the address on record. The legacy schedule runs for eight years beginning October 1, 2020 and lapses October 1, 2028, after which the current-program factors govern alone. If your household was in the program before October 1, 2020, ask which schedule you are being paid on, because the rating-sum route can reach the full 1.00 factor with no self-sustain finding at all.8

Because the base follows the locality pay area where the veteran lives, look up the GS-4, Step 1 rate for that area rather than assuming one Virginia figure. The stipend is paid only once the caregiver is enrolled in direct deposit through the VA customer engagement portal. Confirm your exact stipend with your VA Caregiver Support Coordinator.8

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:4

• A VA disability rating, individual or combined, of 70 percent or higher.4
• Discharge from the U.S. military, or a date of medical discharge.4
• A need for at least six months of continuous, in-person personal care services.4
• Enrollment in VA health care.4

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:4

• Participating in the program is in the veteran's best interest.4
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.4
• The veteran receives care at home, or will do so if VA designates a family caregiver.4
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.4

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.4

Why it stands out: VA, in its 2020 proposed PCAFC rule, described the monthly stipend as a nontaxable benefit, and a spouse can serve as the caregiver.4 Primary and Secondary Family Caregivers can receive caregiver education and training and mental health counseling, and a Primary Family Caregiver may also receive CHAMPVA health care benefits (if not already covered under another health care plan), at least 30 days of respite care per year, and free legal and financial planning assistance.8

Best for: Families of an eligible veteran where one person provides substantial daily care.

4. VA Veteran-Directed Care (VDC)

Who can be paid: Workers the veteran or their representative hires, which VA says might include a family member or neighbor. VA's page does not say whether a veteran may hire a spouse as a paid worker, so a veteran who wants a spouse paid should confirm with the VA medical center serving them.5

How it works: Veteran-Directed Care gives a veteran a budget for home and community-based services, managed by the veteran or their representative, who hires their own workers with the help of a counselor. Enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and the program is available.5

Availability in Virginia: VA says services may vary by location. The Administration for Community Living's list of current VDC programs places four VA medical centers under its Virginia heading: Hunter Holmes McGuire VA Medical Center in Richmond, Hampton VA Medical Center and Salem VA Medical Center, each with Bay Aging as the agreement holder, and the Washington DC VA Medical Center, with the Prince William Area Agency on Aging. Around Hampton, VirginiaNavigator lists the Peninsula Agency on Aging as the local partner, providing Options Counseling and Financial Management Services for Hampton, James City County, Newport News, Poquoson, Williamsburg and York County. VA's own advice is to talk with your VA social worker and find out if it is available in your location.5

Best for: A Virginia veteran with daily-living needs who wants to direct their own care and hire their own workers.

5. VA Aid and Attendance Pension

Who is paid: Aid and Attendance is added to the monthly VA pension of a qualified veteran or survivor, so the money goes to them rather than to the caregiver. Under 38 CFR 3.352(c), the fact that a relative or household member provides the needed care does not prevent VA from granting the allowance.9

2026 maximums (December 1, 2025 through November 30, 2026), which VA publishes as annual ceilings: a single veteran with Aid and Attendance receives up to $29,093 per year; a veteran with one dependent up to $34,488 per year; two veterans married to each other, both with Aid and Attendance, up to $46,143 combined. A surviving spouse with Aid and Attendance receives up to $18,697 per year. VA pays the difference between the maximum and the claimant's income for VA purposes, and unreimbursed medical expenses above 5% of the maximum can reduce that income, so someone with income receives less. The 2026 net-worth limit is $163,699. Confirm figures on the VA pension rate page.10

Eligibility: Aid and Attendance is added to a monthly VA pension, so the veteran or survivor must first qualify for pension. For a veteran, that means qualifying wartime service (for example, starting active duty before September 8, 1980 and serving at least 90 days with at least 1 day during wartime), no dishonorable discharge, and being at least 65, permanently and totally disabled, a nursing-home patient because of a disability, or getting SSDI or SSI. On top of pension, at least one of these must be true: the person needs another person's help with daily activities like bathing, feeding, and dressing; has to stay in bed for much of the day because of illness; is a nursing-home patient because of a disability; or has limited eyesight that meets VA's vision standard.9 VA pension also carries a 36-month look-back on asset transfers for less than fair market value.10

How caregivers get paid: Any pay to a family caregiver comes from the veteran or survivor under a private arrangement, ideally a written one. The Virginia Department of Veterans Services offers free claims help, including with pensions, through its benefit service offices.11

Best for: A wartime veteran or surviving spouse with income and net worth under the limits who needs help with daily activities.

6. Private Personal Services Contract

Who can be paid: A family member such as an adult child or sibling, under a written contract. Virginia's look-back rules except transfers to a spouse, so this pathway matters for payments to other relatives.6

What it is: A contract between the care recipient (or their authorized representative) and the caregiver. DMAS says payments under a personal care contract may be considered an uncompensated transfer. It looks for a written contract (or written statements verifying the terms from all parties) that lists the types of services, the hourly rate, and the number of hours; an hourly rate at the fair market value for those services when they were provided; verification of payments and services; and a statement from the person's physician that the services were necessary to prevent entrance into long-term care. Any payment made before the contract was signed, any advance payment for services not yet performed, and any payment for care received after the person enters Medicaid long-term care counts as an uncompensated transfer.6

Why the format matters: Virginia applies a 60-month (five-year) look-back to asset transfers for nursing facility care and waiver services. An uncompensated transfer creates a penalty period equal to the uncompensated value transferred divided by the average monthly cost to a private patient of nursing facility care in Virginia at the time of application. One exception matters to many families: transferring the home to a son or daughter who lived there for at least two years immediately before the parent was institutionalized, and whose care let the parent stay home, does not cause ineligibility.6

Best for: Families with enough assets to private-pay a caregiver who also want to preserve eligibility for future Medicaid planning. Work with a Virginia elder-law attorney to draft the contract.

Comparing the Virginia Pathways

How to Choose a Virginia Pathway

Start with the care recipient's situation:

Where to Get Help in Virginia

Tax Considerations

How caregiver pay is taxed depends on the program.

• CCC Plus and DD-waiver consumer direction pay wages through the Fiscal/Employer Agent.
• VA PCAFC: VA, in its 2020 proposed PCAFC rule, described the monthly stipend as "a nontaxable benefit."4
• VA Aid and Attendance and personal services contracts: if the veteran or care recipient pays you out of their own money, ask a tax preparer how to report that pay.

Virginia state income tax: Virginia taxes "Virginia taxable income" at graduated rates from 2% up to 5.75% on income above $17,000. No source we rely on settles whether caregiver pay excluded from federal gross income under IRS Notice 2014-7 is included in Virginia taxable income, so confirm with the Virginia Department of Taxation or a tax preparer, including on whether your pay qualifies for that federal exclusion, before paying Virginia tax on it.13

Common Misconceptions

"As the member's spouse, I can be their Services Facilitator." No. The Services Facilitator cannot be the member's spouse, a consumer-directed attendant, or the Employer of Record who employs the attendant.2

"If Mom has Medicare, I can get paid through Medicare." Medicare does not pay family caregivers. It only covers short-term skilled home health through certified agencies. Paid family caregiving in Virginia comes through Medicaid, the VA, or a private contract.

"The state will send me a paycheck." No. A Fiscal/Employer Agent, Public Partnerships or Consumer Direct Care Network, depending on the health plan, pays you, not DMAS directly.1

"I can just start drawing on Dad's bank account for the care I provide." Not safely. DMAS may count payments for care as an uncompensated transfer, and it treats any payment made before all parties signed or agreed to the contract as one; under the 60-month look-back that can delay the parent's Medicaid long-term-care eligibility.6

Related Terms

• Consumer Directed Services (CDS): The national term for the self-directed model behind Virginia's consumer-directed attendant arrangement, where the care recipient directs their own worker.
• HCBS waiver: The Medicaid waiver authority behind the CCC Plus and developmental-disability waivers.
• Activities of Daily Living (ADLs): The functional basis for authorizing personal care hours across Virginia's programs.
• Nursing Facility Level of Care: The clinical threshold an LTSS screening tests for CCC Plus waiver eligibility, with the functional rating documented on the Uniform Assessment Instrument.

Learn More

Find personalized help getting paid as a family caregiver 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.