Virginia now permanently lets a spouse be paid as a caregiver for extraordinary care. Add consumer-directed pay for most relatives, respite grants, and VA benefits.
If you are caring for an aging parent, a spouse, or an adult child with a disability in Virginia, the hard part is rarely whether help exists. It is knowing what is there and where to start. This guide maps every major caregiver program in the Commonwealth for 2026.
You don't have to figure this out alone, and you don't have to fund all of it from your savings.
In This Guide
- Virginia Caregiver Programs at a Glance
- Programs That Pay Family Caregivers
- Respite Care Programs
- Support, Training, and Area Agencies
- VA Caregiver Benefits in Virginia
- Taxes for Virginia Caregivers
- Frequently Asked Questions
- Learn More
Virginia Caregiver Programs at a Glance
| Program | What It Offers | Who Qualifies | Cost to You |
|---|---|---|---|
| Consumer Direction (CCC Plus / DD waivers) | Member hires and directs a paid attendant, including most relatives | CCC Plus or DD waiver members choosing consumer direction | Free (paid by Medicaid) |
| LRI (spouse / parent) extraordinary care | Spouse or parent of a minor paid for extraordinary care, up to 40 hrs/week | Waiver members whose LRI provides documented extraordinary care | Free (paid by Medicaid) |
| NFCSP respite grants | Free in-home respite, adult day vouchers, training, counseling | Caregivers of adults 60+ or person with ADRD; no income test | Free |
| VA PCAFC | Monthly tax-free stipend; pays spouses | Veteran with 70%+ disability in VA health care | Free (VA benefit) |
| VA Aid and Attendance | Pension up to $2,424/mo to veteran; caregiver paid from it | Wartime veteran or surviving spouse under net-worth limit | Free to apply (VSO help) |
Programs That Pay Family Caregivers
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.
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.
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.
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.
For the full guide to paid pathways: How to Get Paid as a Family Caregiver in Virginia.
Respite Care Programs
Medicaid Respite (CCC Plus and Cardinal Care)
The CCC Plus waiver under Cardinal Care authorizes in-home and facility respite as covered services for enrolled members. Respite can be added to the member's care plan and delivered by an agency or consumer-directed worker. Note that a spouse paid as an LRI cannot be paid for respite hours specifically. Ask the Cardinal Care plan care coordinator to authorize respite in the plan.
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) to 25 regional Area Agencies on Aging. Services include in-home respite, adult day vouchers, caregiver training, and counseling, with no income test for respite services. Call 1-800-552-3402 to reach your regional AAA.
Virginia also funds a dedicated Caregiver Services Program through DARS that provides in-home respite specifically for caregivers of people with Alzheimer's disease and related dementias.
For the full respite guide: Respite Care in Virginia.
Support, Training, and Area Agencies
Virginia's 25 Area Agencies on Aging are the front door for most caregiver support that is not tied to a Medicaid waiver. They deliver NFCSP services, the Virginia Caregiver Services Program, adult day referrals, caregiver training, and counseling.
Call DARS at 1-800-552-3402 to be connected with your regional AAA, or dial 211 for the broader social-services network. These calls are free. A counselor will identify what is available in your area and help you start an application.
VA Caregiver Benefits in Virginia
With one of the largest veteran populations in the country, Virginia veterans enrolled in VA health care have access to caregiver support programs that are separate from Medicaid and often more generous.
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 is calculated from the federal GS-4, Step 1 annual rate for the veteran's locality, divided by 12, then multiplied by a level factor. It is federal tax-free and allows paid spouses. To qualify, the veteran needs a service-connected disability rating of 70 percent or higher, a need for in-person personal care for at least six continuous months, and enrollment in VA health care.
Veteran-Directed Care (VDC) is also available in Virginia, letting the veteran direct a flexible budget toward caregiver pay, including a spouse. Ask the VA Caregiver Support Coordinator whether VDC is offered at your VA medical center.
Virginia VA facilities: The Hunter Holmes McGuire VA Medical Center in Richmond, the Hampton VA Medical Center, and the Salem VA Medical Center are the main VA medical centers, with the Washington DC VA serving Northern Virginia.
VA Aid and Attendance Pension
Wartime veterans and surviving spouses who meet the functional criteria and have countable assets and income under the net-worth limit ($163,699 in 2026) may receive the Aid and Attendance pension. A single veteran with Aid and Attendance receives up to $2,424 per month ($29,093/year); a veteran with one dependent up to $2,874 per month. The pension goes to the veteran, who typically pays a family caregiver from it.
The Virginia Department of Veterans Services and county Veterans Service Officers help file at no cost.
VA Caregiver Support Line: 1-855-260-3274
Taxes for Virginia Caregivers
IRS Notice 2014-7
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 IRS Notice 2014-7. This applies to many Virginia consumer-directed arrangements. Talk to a tax preparer familiar with the rule before filing.
Virginia State Income Tax
Virginia has a graduated individual income tax. For tax years beginning on or after January 1, 2026, the rates top out at 5.75% on taxable income above the highest bracket threshold. Wages a family caregiver earns through a Virginia paid-caregiver program are generally subject to Virginia income tax in addition to federal tax. Because Virginia starts from federal adjusted gross income, the IRS Notice 2014-7 exclusion generally flows through to the Virginia return.
VA PCAFC Stipend
The PCAFC monthly stipend is federal tax-free and is not reported on a W-2.
Not sure which Virginia caregiver program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's Medicaid enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.
Frequently Asked Questions
Yes, for extraordinary care. As of July 1, 2025, Virginia permanently allows a spouse (a legally responsible individual) to be paid as a consumer-directed attendant for care that is "extraordinary in nature," capped at up to 40 hours per week. The care must be documented during person-centered planning. Instrumental ADLs, supervision, and respite are not reimbursable to a spouse.
Most family members: adult children, siblings, grandchildren, nieces, nephews, and other relatives, as well as friends and neighbors. The waiver member hires and directs them, and a fiscal/employer agent handles payroll.
It is care above and beyond the personal-care assistance a spouse is otherwise legally obligated to provide. The specific ADL tasks must be documented during person-centered planning, with evidence that the task is not typical for the individual's age and development.
Yes. The National Family Caregiver Support Program provides free respite through Virginia's 25 Area Agencies on Aging with no income test, and Virginia funds a dedicated Caregiver Services Program for dementia caregivers. Call DARS at 1-800-552-3402.
Call DARS at 1-800-552-3402, or dial 211 for the broader social-services network. Virginia has 25 AAAs serving every locality; they handle NFCSP respite grants, the Virginia Caregiver Services Program, adult day referrals, and caregiver training.
Learn More
- How to Get Paid as a Family Caregiver in Virginia
- Respite Care in Virginia
- Caregiver Burnout: Signs, Stages, and How to Get Support
- VA Aid and Attendance in Virginia
- Medicaid Planning Strategies
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.