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

Virginia pays family members to provide in-home care through Medicaid, but you do not get a check from the state. Instead, the person you care for qualifies for Virginia Medicaid long-term care, chooses the consumer-directed option, and hires you as their paid attendant. A separate company called a Fiscal/Employer Agent runs the payroll and issues your paycheck.

The rule that decides whether many families can do this at all is the spouse-and-parent rule, and Virginia changed it. As of July 1, 2025, a spouse, or the parent of a minor child, can be paid as a consumer-directed attendant under the CCC Plus and two of the developmental-disability waivers, but only when the care is "extraordinary," with reimbursement capped at 40 hours per week.

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 of someone who qualifies for Virginia Medicaid long-term care, the fastest route is to become their paid consumer-directed attendant through the CCC Plus waiver. Their health plan assigns a Services Facilitator, the care needs are assessed, monthly attendant hours are authorized, and you deliver those hours while a Fiscal/Employer Agent pays you.

If you are a spouse, or the parent of a minor child, Virginia opened a door in July 2025. You can be paid as a consumer-directed attendant under the LRI policy, but only for "extraordinary" care above what you are already legally expected to provide, capped at 40 hours per week.

If your loved one is a veteran, check the VA programs first. The VA's caregiver stipend and Veteran-Directed Care often pay as well as or better than Medicaid, and they allow paid spouses without the LRI restrictions.

If your family has enough private assets, a written personal services contract can pay a caregiver now while documenting the arrangement for later Medicaid planning. Virginia enforces a 60-month look-back, so the contract format matters.

The rest of this guide walks through each pathway in detail.

What Makes Virginia Different: Consumer Direction and the LRI Rule

Virginia delivers much of its Medicaid in-home care through consumer direction, a model in which the person receiving care (or a representative acting as their Employer of Record) hires, trains, schedules, and can dismiss their own attendant rather than relying on a home-care agency. That attendant is very often a family member. Virginia Medicaid, administered by the Department of Medical Assistance Services (DMAS), offers consumer direction for personal care, respite, and companion services under its 1915(c) home and community-based waivers.

The waiver that matters most for older adults is the CCC Plus waiver, now delivered under the Cardinal Care managed-care umbrella. You do not run a household payroll yourself. A Fiscal/Employer Agent (F/EA) does that: Public Partnerships LLC serves CCC Plus members on the Aetna, Anthem HealthKeepers Plus, and UnitedHealthcare Community Plan health plans, while Consumer Direct Care Network serves fee-for-service members and the Molina and Sentara plans. Because the F/EA assignment follows the member's plan and can change with contract cycles, confirm the current agent with the member's health plan.

The piece that sets Virginia apart from many states is the legally responsible individual (LRI) rule. An LRI is the participant's spouse, or the parent or legal guardian of a minor. For years a spouse could not be paid to provide a husband's or wife's personal care. That changed: CMS approved Virginia's waiver amendments on April 17, 2025, effective July 1, 2025, making the LRI paid-caregiver provision permanent rather than a temporary pandemic flexibility.

The catch worth understanding up front: an LRI can only be paid for care that is "extraordinary in nature," meaning above and beyond the personal-care assistance the LRI is otherwise legally obligated to provide. The specific tasks have to be documented during person-centered planning, with evidence that the task is not typical for the person's age and development. Reimbursement is capped at 40 hours per week (40 hours per week per child when an LRI assists more than one child). Instrumental tasks like housekeeping and shopping, general supervision, and respite are not reimbursable to an LRI. So a spouse can be paid for hands-on personal care that goes beyond the ordinary, but not for the household help a spouse would normally provide anyway.

One more practical wrinkle: the person who serves as the member's Employer of Record or as their Services Facilitator cannot also be the paid attendant. When a spouse is the paid LRI attendant, families typically name a different person as the Employer of Record.

The Virginia Paid Family Caregiver Pathways

1. CCC Plus / Cardinal Care Consumer-Directed Personal Care and Respite

Who pays: Virginia Medicaid (DMAS), through the CCC Plus waiver delivered under Cardinal Care managed care.

Who can be paid: Adult children, siblings, grandchildren, nieces, nephews, and other relatives, as well as friends and neighbors, hired as the member's consumer-directed attendant. A spouse or the parent of a minor can be paid only under the LRI policy described above.

What it is: The CCC Plus waiver is Virginia's integrated managed long-term services and supports program. Under consumer direction the member hires and directs their own worker for personal care/personal assistance, respite, and companion services. Because CCC Plus is the integrated managed program rather than a capped slot system, it does not operate a statewide waiting list.

Eligibility, recipient: The member must meet both a functional test and a financial test. Functionally, they must require a nursing-facility (or hospital) level of care as determined by Virginia's Uniform Assessment Instrument (UAI). Financially, the waiver uses the institutional/HCBS income standard of 300% of the SSI Federal Benefit Rate; with the 2026 SSI individual rate of $994 per month, that standard works out to roughly $2,982 per month for a single applicant, with a countable-asset limit of $2,000. Applicants over the income limit may have options; confirm the current limits with DMAS.

Eligibility, caregiver: Be hired by the member, complete the F/EA's enrollment paperwork and required screenings, and not also be the member's Employer of Record or Services Facilitator.

How you get paid: A Fiscal/Employer Agent (PPL or CDCN, depending on the plan) is the payer of record. You submit time worked, and the F/EA pays you with taxes withheld and reported.

Best for: A non-spouse relative or friend caring for an older adult who qualifies for CCC Plus and needs help with daily activities.

2. DD Waivers (CL, FIS, BI) Consumer Direction

Who pays: Virginia Medicaid, through the three developmental-disability waivers.

Who can be paid: The same broad set of relatives, friends, and neighbors as CCC Plus. A spouse or parent of a minor can be paid under the LRI policy on the Community Living (CL) and Family and Individual Supports (FIS) waivers.

What it is: Virginia's three 1915(c) developmental-disability waivers, Community Living, Family and Individual Supports, and Building Independence, serve people with a developmental disability and offer consumer-directed personal assistance, respite, and companion services. Eligibility is screened through the person's local Community Services Board (CSB) or Behavioral Health Authority.

The key difference from CCC Plus: Unlike CCC Plus, the DD waivers run a statewide waiting list. Being found eligible does not guarantee a slot; slots are allocated periodically and prioritized by need, and wait times vary by region.

Best for: A family caring for a relative with a developmental disability who has a DD-waiver slot, or who is on the waitlist and planning ahead.

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

Who can be paid: A designated Primary Family Caregiver of an eligible veteran, which can be a spouse, adult child, parent, or other family member.

2026 stipend: The PCAFC stipend 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 a level factor (Level 1 is 0.625; Level 2 is 1.00 and applies when the veteran cannot self-sustain in the community). Because Virginia spans more than one federal locality-pay area, the stipend differs between the Washington-Baltimore-Arlington locality covering Northern Virginia and the Rest of U.S. locality covering much of the state. Confirm your exact stipend with your VA Caregiver Support Coordinator.

Veteran eligibility: A service-connected disability rated at 70 percent or higher, a need for in-person personal care for at least six continuous months, and enrollment in VA health care.

Why it stands out: The stipend is federal tax-free, it allows paid spouses without the Medicaid LRI "extraordinary care" test, and the Primary Family Caregiver also receives CHAMPVA health coverage (if otherwise uninsured), mental health counseling, and at least 30 days of respite care per year.

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

4. VA Veteran-Directed Care (VDC)

Who can be paid: Almost any caregiver the veteran chooses, including a spouse. VDC has the most permissive family-hire rules of any program in this guide.

How it works: Veteran-Directed Care 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 family member. A financial management service handles the payroll.

Availability 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.

Best for: A Virginia veteran with daily-living needs who wants to pay a spouse, or to set their caregiver's schedule and rate directly.

5. VA Aid and Attendance Pension

Who is paid: The veteran or surviving spouse receives the pension directly, and a family caregiver is typically paid out of it under a private arrangement.

2026 maximums (effective December 1, 2025 through November 30, 2026): a single veteran with Aid and Attendance receives 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); two married veterans both receiving Aid and Attendance up to $3,845 per month combined. A surviving spouse with Aid and Attendance receives up to $1,558 per month ($18,697 per year). The 2026 net-worth limit is $163,699. Confirm current figures on the VA pension rate page before applying.

Eligibility: A wartime veteran (90 days of active duty including at least one day during a recognized wartime period) or a surviving spouse, who also meets the Aid and Attendance functional criteria (needs help with daily activities, is housebound, is in a nursing facility, or is legally blind), and whose countable income and assets fall under the limit. VA pension also carries a 36-month look-back on asset transfers for less than fair market value.

How caregivers get paid: The pension goes to the veteran, who then pays the family caregiver, ideally under a written caregiver agreement. Virginia's county and city Veterans Service Officers and the Virginia Department of Veterans Services help file at no cost; avoid for-profit pension consultants who charge a fee.

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

6. Private Personal Services Contract

Who can be paid: Any family member, including an adult child, sibling, or other relative, under a written contract. Spouses are generally not paid this way for Medicaid-planning purposes, because transfers between spouses are treated differently.

What it is: A written, arm's-length contract between the care recipient (or their legal representative) and the caregiver, signed before care begins. It should spell out the services, the schedule, a reasonable and customary hourly rate documented against local agency quotes, how and when the caregiver is paid, and a requirement that the caregiver keep daily logs and report the income on their taxes.

Why the format matters: Virginia applies the federal 60-month (five-year) Medicaid look-back. Without a written contract, money that flows from an aging parent to an adult child for care is presumed to be a gift and can create a penalty period of ineligibility when the parent later applies for long-term-care Medicaid. A properly drafted contract converts the payment into a documented exchange of value. The penalty is calculated by dividing the uncompensated transfer by a statewide transfer-penalty divisor that DMAS updates periodically, so confirm the current divisor with DMAS or a Virginia elder-law attorney before relying on it.

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:

1. Is your loved one a veteran? Check the VA pathways first. PCAFC pays a tax-free stipend, Veteran-Directed Care lets you pay a spouse without the LRI test, and Aid and Attendance can stack with a Medicaid program. Your county or city Veterans Service Officer helps for free.
2. Are you a spouse or the parent of a minor? Your Medicaid route is the LRI provision under CCC Plus or the CL/FIS waivers. Be ready to document that the care is "extraordinary," and remember the 40-hour-per-week cap and that someone other than you must serve as Employer of Record.
3. Are you a non-spouse relative or friend, and is your loved one on or likely eligible for Virginia Medicaid long-term care? Become their consumer-directed attendant through the CCC Plus waiver. Start with the member's Cardinal Care health plan or DMAS to request an assessment and a Services Facilitator.
4. Does your relative have a developmental disability? Ask the local Community Services Board about the CL, FIS, or BI waivers, and get on the waitlist early if a slot is not yet available.
5. Do you have substantial private assets and want to plan ahead? Talk to a Virginia elder-law attorney about a personal services contract before any money changes hands.

Tax Considerations

Most Virginia caregiver pay is reportable income, with one valuable federal exception.

• CCC Plus and DD-waiver consumer direction pay wages through the Fiscal/Employer Agent, with taxes withheld and reported.
• VA PCAFC is a federal tax-free stipend, not reported as wages.
• VA Aid and Attendance is tax-free to the veteran; when the veteran uses it to pay a caregiver, the caregiver receives ordinary taxable income.
• Personal services contracts pay taxable income to the caregiver, who should report it.

IRS Notice 2014-7: If you live in the same home as the person you care for and you are paid through a Medicaid program, your wages may be excluded from federal gross income. This applies to many Virginia consumer-directed arrangements and is a common, valuable benefit. Talk to a tax preparer familiar with the rule before filing.

Virginia state income tax: Unlike states with no income tax, Virginia taxes wages. For tax years beginning on or after January 1, 2026, Virginia's graduated rates top out at 5.75% on taxable income above $17,000, plus a new top bracket of 7.75% on income above $1,000,000; the 2026 standard deduction is $10,000 for single filers and $20,000 for married filers. Because Virginia starts from federal adjusted gross income, pay you exclude under IRS Notice 2014-7 generally is not taxed by Virginia either. Confirm your situation with a tax preparer.

Common Misconceptions

"Virginia still won't let me get paid to care for my husband." That was true before July 1, 2025. The LRI provision now lets a spouse be paid as a consumer-directed attendant under CCC Plus or the CL and FIS waivers, but only for "extraordinary" hands-on care, capped at 40 hours per week.

"As a paid spouse, I can also be the Employer of Record." No. The person who is the Employer of Record or the Services Facilitator cannot also be the paid attendant. Families usually name a different relative as Employer of Record when a spouse is the paid LRI caregiver.

"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, runs payroll and pays you, not DMAS directly.

"I can just start drawing on Dad's bank account for the care I provide." Not without a written personal services contract. An informal transfer of a parent's money to a child for care is treated as a gift under Virginia's 60-month look-back and can delay the parent's Medicaid eligibility later.

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 federal authority (Section 1915(c)) 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 the Uniform Assessment Instrument measures for CCC Plus waiver eligibility.

Learn More

• How to Get Paid as a Family Caregiver in Washington
• Caregiver Burnout: Signs, Stages, and How to Get Support
• VA Aid and Attendance in Virginia
• The Cost of Senior Care in Virginia
• Medicaid Planning Strategies

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.