Caregiver Programs in Virginia: Paid, Respite, Support (2026)

Virginia caregiver programs now include permanent pay for a spouse who provides extraordinary care, on top of consumer-directed pay for most other relatives, respite grants, and VA benefits.1

If you are caring for an aging parent, a spouse, or an adult child with a disability, the hardest part is rarely whether help exists. It is knowing what is there and where to start. This guide maps every major caregiver program in Virginia for 2026: who qualifies, what it pays, and the first call to make.

You don't have to figure this out alone.

Virginia Caregiver Programs at a Glance

Which Virginia Caregiver Programs Pay Family Members?

For a lot of families, this is the real question: can the person already doing the caregiving get paid for it? In Virginia, the answer is often yes. Virginia Medicaid, administered by the Department of Medical Assistance Services (DMAS), offers consumer-directed (CD) services under its 1915(c) home and community-based waivers, including the Commonwealth Coordinated Care Plus (CCC Plus) waiver under Cardinal Care and the developmental-disability waivers.2

Consumer Direction (Most Relatives)

Under consumer direction, the waiver member (or their representative) hires, trains, schedules, and directs their own paid attendant. The member may hire most family members, including adult children, siblings, grandchildren, nieces, nephews, and other relatives, as well as friends and neighbors. A fiscal/employer agent handles payroll and taxes.1

Spouses and Parents: LRI Extraordinary Care (Now Permanent)

Virginia permanently allows legally responsible individuals (LRIs), defined as the parent or legal guardian of a minor or the participant's spouse, to be paid as consumer-directed attendants under the Community Living (CL), Family and Individual Supports (FIS), and CCC Plus waivers. CMS approved the waiver amendments on April 17, 2025, effective July 1, 2025, making this permanent rather than a temporary pandemic flexibility.1

If you are a husband or wife who has been providing care without pay, this is a real change. The catch: the care an LRI provides must be "extraordinary in nature," meaning above and beyond the personal-care assistance the LRI is otherwise legally obligated to provide. It is documented during person-centered planning, with the specific ADL tasks and evidence that the task is not typical for the individual's age and development. LRI reimbursement is capped at up to 40 hours per week (40 hours per week per child when an LRI assists multiple children). Instrumental ADLs, supervision, and respite are not reimbursable to an LRI.1

For a side-by-side of every paid pathway, see How to Get Paid as a Family Caregiver in Virginia.

How Do I Get a Break? Respite Options in Virginia

Every caregiver needs to step away sometimes. Virginia funds respite through several doors, and one of them does not require Medicaid at all.

Medicaid Respite (CCC Plus Waiver)

The CCC Plus waiver covers respite as a waiver service for enrolled members. It can be delivered through either an agency-directed or a consumer-directed model, and respite is one of the services a member may choose to self-direct. Note that a spouse paid as an LRI cannot be paid for respite hours specifically. Ask your Cardinal Care health plan care coordinator to authorize respite in the care plan.4

NFCSP Grants Through Virginia's 25 Area Agencies on Aging

The National Family Caregiver Support Program (NFCSP), funded by Title III-E of the Older Americans Act, flows through Virginia's Department for Aging and Rehabilitative Services (DARS), the Commonwealth's designated State Unit on Aging, to 25 regional Area Agencies on Aging. The AAAs' caregiver programs provide respite, caregiver support groups, and individual counseling, and NFCSP respite can be delivered at home, in adult day care, or in an institutional setting. How much respite you can get, and any per-caregiver cap, is set at the state and agency level rather than federally, so ask your AAA what it currently funds. Call the DARS Division for Aging Services at 1-800-552-3402 to reach your regional agency.3,4

Two Virginia-Funded Respite Programs for Dementia Caregivers

Virginia also runs two respite programs of its own through DARS, and neither one is Medicaid:

• The Respite Care Initiative, funded with state general funds and organized by the Area Agencies on Aging, provides respite to caregivers of people 60 and older who have Alzheimer's disease or a related dementia.4
• The Virginia Lifespan Respite Voucher Program (VLRVP), run by the DARS Division for Aging Services on federal Administration for Community Living grant funding, reimburses unpaid caregivers of people with disabilities or chronic conditions at any age, dementia included. The voucher is $595 per household per year; 424 caregivers received one in 2025.4 Its funding is limited, and the window DARS published has now passed: the voucher application caps funding at $595 per household, says it runs through June 30, 2026 or until funds are exhausted, and warns that not all eligible applicants will be approved. Call DARS at 1-800-552-3402 to confirm the voucher is still funded before you count on it.4

Both run on limited grant and general-fund dollars rather than an entitlement, so ask your Area Agency on Aging whether funds are open before you count on either one.

For the full breakdown, see Respite Care in Virginia.

Where to Get Help in Virginia

When you are ready to make calls, these are the front doors, and every one of them is free.

VA Caregiver Benefits in Virginia

If your loved one served, do not skip this section. With one of the largest veteran populations in the country, Virginia routes veterans enrolled in VA health care to caregiver support that is separate from Medicaid and often more generous, and it is the one place a spouse can almost always be paid.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran. The stipend starts from the federal General Schedule (GS) grade 4, step 1 annual rate for the veteran's locality pay area, 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:5

• 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."5
• 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 0.25.5

Two rules sit on top of that. 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 your Caregiver Support Coordinator which schedule your stipend is being paid on, because the rating-sum route can reach the full 1.00 factor without any self-sustain finding.5

The stipend is federal tax-free and can pay a spouse. To qualify, the veteran needs a VA disability rating of 70 percent or higher, a need for at least six months of continuous, in-person personal care, and enrollment in VA health care.5

Veteran-Directed Care (VDC) is also available in Virginia, letting the veteran direct a flexible monthly budget toward caregiver pay, including a spouse. It is not offered at every VA medical center, so ask your VA social worker or Caregiver Support Coordinator whether it is available where you are.7

Virginia is served by several VA medical centers. Find the one nearest you, and its Caregiver Support Coordinator, through VA's facility locator at va.gov/find-locations.

VA Aid and Attendance (A&A) Pension

Wartime veterans and surviving spouses who meet the functional criteria and fall under the net-worth limit ($163,699 in 2026) may receive the Aid and Attendance (A&A) pension. The VA sets these as annual maximums: a single veteran with A&A can receive up to $29,093 a year; a veteran with one dependent up to $34,488 a year. Each is a ceiling, not a payment: VA pays it minus the veteran's countable income, so someone with income receives less, and any monthly figure is just that annual ceiling divided by 12. The pension goes to the veteran, who often pays a family caregiver from it.8

The Virginia Department of Veterans Services and county Veterans Service Officers help file at no cost, so there is no reason to pay a for-profit consultant.

Will I Owe Taxes on Caregiver Pay in Virginia?

Getting paid to care for someone you love raises a practical worry: will a tax bill eat into it? Here is the short version, though a tax preparer who knows caregiver pay is worth a call before you file.

IRS Notice 2014-7 (Federal Exclusion)

If you live in the same home as the person you care for and are paid through a Medicaid program, your wages may be excluded from federal gross income under an IRS rule called Notice 2014-7. This applies to many Virginia consumer-directed arrangements and can be a meaningful benefit, so raise it with your preparer before filing.

Virginia State Income Tax

Virginia levies a graduated individual income tax. The rates run up to 5.75% on taxable income above $17,000. Most family-caregiver wages fall in the 5.75% range. Because Virginia starts from your federal adjusted gross income, the IRS Notice 2014-7 exclusion generally flows through to your Virginia return, so income excluded federally is generally not taxed by Virginia either.6

The PCAFC Stipend

The PCAFC monthly stipend is federal tax-free and is not reported on a W-2.5

Learn More

Find personalized help navigating Virginia caregiver programs 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.