Virginia caregiver programs include Medicaid consumer direction, respite grants, VA benefits, and, under 2025 DMAS rules, limited pay for a spouse or parent of a minor.,

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.

You don't have to figure this out alone.

Virginia Caregiver Programs at a Glance

Program What It Offers Who Qualifies Cost to You
Consumer Direction (CCC Plus and other HCBS waivers) Member or representative hires, trains, and manages a paid attendant HCBS waiver members choosing consumer direction Free (paid by Medicaid)
LRI (spouse / parent) extraordinary care Under DMAS's 2025 rules, spouse or parent of a minor paid for extraordinary personal care, up to 40 hrs/week Waiver members whose extraordinary-care need is documented; DMAS ties it to members under 18, and the CCC Plus regulation still bars a spouse, so spouses should get DMAS's answer in writing Free (paid by Medicaid)
DD waivers (Community Living, Family and Individual Support) Personal assistance, respite, companion services; approved relatives may be paid Autism, intellectual or developmental disability at an ICF/IID level of care; waiting list Free (paid by Medicaid)
NFCSP respite grants Respite at home, in adult day care, or in a facility, plus training and counseling Caregivers of an adult 60+, or of a person of any age with dementia; respite requires the older person to be "frail" Set by your Area Agency on Aging
VA PCAFC Monthly stipend; can pay a spouse Veteran with a 70%+ rating, a military discharge, a 6+ month in-person care need, and VA health care enrollment, then VA's application review Free (VA benefit)
VA Aid and Attendance Pension ceiling of $29,093/year for a single veteran with A&A, minus countable income Veteran or surviving spouse on a VA pension (for a veteran, one based on wartime service) who meets one of VA's need tests (such as needing help with daily activities), under the net-worth limit, may be eligible Free to apply (VSO help)

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 can be yes. Virginia Medicaid, administered by the Department of Medical Assistance Services (DMAS), offers consumer-directed (CD) services under its home and community-based services (HCBS) waivers, including the Commonwealth Coordinated Care Plus (CCC Plus) waiver.

Consumer Direction

Under consumer direction, the member or their designated representative performs all of the employer responsibilities, including hiring, training, managing, and if necessary, terminating the attendant. A Services Facilitator helps the member and family learn the responsibilities of a CD employer of record. The services a member can direct are personal care, respite, and companion services, and members may choose consumer-directed care, agency-directed care, or both.

DMAS's consumer-directed services page says the attendant is paid through a Fiscal/Employer Agent: Public Partnerships LLC (PPL) for CCC Plus members in the Aetna, Anthem, and United Health Care plans, and Consumer Direct Care Network (CDCN) for fee-for-service CCC Plus waiver members and the Molina and Sentara plans. Aetna uses both. 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 a Humana member should ask the plan which agent pays the attendant.

Adult Children and Other Relatives

Virginia's CCC Plus regulation, 12VAC30-120-935, bars pay only when the provider is the individual's spouse or the parent or legal guardian of a minor child. It does not name adult children, and approved family members must meet the same qualifications as any aide or attendant. A relative who lives under the same roof is paid only with objective written documentation of why no other person or provider is available, a call the nurse supervisor or Services Facilitator makes and records. The employer of record cannot also be the paid attendant or the Services Facilitator, and one attendant is reimbursed for at most 16 hours a day.

Spouses and Parents: LRI Extraordinary Care

Virginia Medicaid allows legally responsible individuals (LRIs), defined as parents or legal guardians of minors or the participant's spouse, to be paid as the aide or attendant for the personal care service under the Community Living (CL), Family and Individual Supports (FIS), and CCC Plus waivers. DMAS received approval from CMS for these waiver amendments on April 17, 2025, and the rules governing when an LRI is the paid aide or attendant were finalized effective July 1, 2025.

If you are a husband or wife who has been providing care without pay, read the conditions closely. Personal care provided by an LRI must be "extraordinary in nature," above and beyond what the LRI is obligated to provide, and DMAS states that it may only be used to meet the extraordinary needs of the member under the age of 18 due to their disability. DMAS's page states no separate extraordinary-care standard for the spouse of an adult, so a spouse should confirm with DMAS before assuming payment is available.

Virginia's official statements also disagree. The CCC Plus regulation, 12VAC30-120-935 B (last amended effective June 19, 2024), still says DMAS shall not reimburse waiver services a spouse provides, and DMAS's Employer of Record Manual (August 2021, still posted) says the attendant cannot be the spouse. Until the regulation matches the 2025 LRI rules, ask DMAS or the health plan to confirm a spouse's pay in writing.

Providers must document the need for extraordinary care during the person-centered planning process, and DMAS has developed a guide based on the individual's chronological age and needs beyond those typically required. Reimbursement may be made for up to 40 hours per week, and up to 40 hours per week for each child when the LRI is reimbursed for providing assistance to multiple children. Tasks that are not extraordinary will not be approved or reimbursed: LRI caregivers will not be reimbursed for instrumental ADLs or supervision, and respite services are not available when there is a paid LRI providing personal care.

Developmental Disability Waivers (Community Living and Family and Individual Support)

Virginia runs three developmental disability (DD) waivers, Community Living, Family and Individual Support, and Building Independence (adults 18 and older), for people with autism, intellectual disabilities, or developmental disabilities who meet an ICF/IID level of care. Medicaid runs them jointly with the Department of Behavioral Health and Developmental Services. Personal assistance, respite, and companion services are covered under Community Living and Family and Individual Support, not Building Independence. Apply through your local Community Services Board; there is a waiting list, and slots go by urgency of need.

The DD regulation, 12VAC30-122-120 B, says providers shall not be the parents or guardians of an enrolled minor or an enrolled adult's spouse. Other approved family members must meet the same requirements as all other licensed providers, and one living under the same roof is paid only with objective, written documentation that no one but the unpaid family caregiver in the home is available. DMAS's 2025 LRI rules also cover these two waivers, but the regulation has not been amended to match, and neither source addresses a guardian of an adult or a power of attorney, so confirm in writing.

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. Ask your Medicaid health plan about adding respite. One trade-off to weigh first: respite services are not available when there is a paid LRI, such as a spouse, providing personal care.

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, makes grants to states. In Virginia it flows through the Department for Aging and Rehabilitative Services (DARS), the Commonwealth's designated State Unit on Aging, which works with 25 local 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.,

Federal law attaches a condition to respite. For a family caregiver of an older person, NFCSP respite and supplemental services are available only when that person is "frail": unable to perform at least two activities of daily living without substantial human assistance, or needing substantial supervision because a cognitive or other mental impairment makes their behavior a serious health or safety hazard. Information, help getting services, counseling, support groups, and training carry no such condition. Ask your AAA how much respite it currently funds, and call the DARS Division for Aging Services at 1-800-552-3402 to reach your local agency.,

Two DARS Respite Programs for Dementia Caregivers

Virginia also runs two respite programs through DARS, and neither one is Medicaid-funded:

  • The Respite Care Initiative, funded with state general funds, provides respite to caregivers of people 60 and older who have Alzheimer's disease or a related dementia. Services come from eight Area Agencies on Aging and one adult day center, and the respite is limited to planned (not emergency), intermittent, part-time instances of no more than 40 hours per month per client, so it is not a source of emergency cover.
  • The Virginia Lifespan Respite Voucher Program (VLRVP) provides financial support to unpaid caregivers of people with disabilities or chronic conditions at any age, dementia included, at $595 per household per year; 424 caregivers received respite vouchers in 2025. Its published funding period has ended: DARS operated it with a five-year federal ACL grant running July 1, 2021 to June 30, 2026, and the voucher application says funding continues until June 30, 2026 or when funds are exhausted and warns that not all eligible applicants will be approved. Call DARS at 1-800-552-3402 to confirm whether vouchers are available after June 30, 2026 before you count on 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.

DARS and Area Agencies on Aging DARS works with Virginia's 25 local Area Agencies on Aging. Call for NFCSP respite, caregiver support groups, and counseling, and to ask about the Respite Care Initiative and the Virginia Lifespan Respite Voucher Program. Dial 211 for the broader social-services network. 1-800-552-3402
Virginia Medicaid (DMAS) Ask about consumer-directed services under the CCC Plus waiver or another HCBS waiver, and about a Services Facilitator to help you learn the employer role. www.dmas.virginia.gov
VA Caregiver Support Line Reaches VA caregiver support about the PCAFC stipend. For Veteran-Directed Care, VA says to talk with your VA social worker. 1-855-260-3274 www.caregiver.va.gov

VA Caregiver Benefits in Virginia

If your loved one served, do not skip this section. VA's PCAFC stipend can pay a spouse who serves as the Primary Family Caregiver when the veteran qualifies.

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:

  • 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."
  • 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.

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.

The stipend can pay a spouse: a Family Caregiver must be at least 18 and be the veteran's spouse, son, daughter, parent, stepfamily member, or extended family member, or live (or be willing to live) full time with the veteran. VA lists four requirements for the veteran, and all of them must be true: 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 6 months of continuous, in-person personal care services; and enrollment in VA health care.

Those four are a first screen, not a decision. You and the veteran apply together, and the regulation, 38 CFR 71.20(a), adds conditions VA assesses during the application: participating must be in the veteran's best interest, the same personal care must not be simultaneously and regularly provided by another person or entity, the veteran must receive care at home, and the veteran must receive ongoing care from a primary care team. Once approved, the Primary Family Caregiver must be enrolled in direct deposit through the VA customer engagement portal to get the monthly stipend.

Veteran-Directed Care (VDC) gives veterans of all ages a budget for home and community-based services, managed by the veteran or the veteran's representative, who hires their own workers with a counselor's help; VA says those workers might include a family member or neighbor. VA's page does not state whether a spouse can be the paid worker, so confirm with your VA medical center. Eligibility is not automatic: enrolled veterans qualify if they are eligible for community care, meet the clinical criteria, and the service is available, and services vary by location.

If VDC seems right, ask your VA social worker whether it's available locally. In Virginia, the Administration for Community Living lists two VDC agreement holders: Bay Aging (Richmond, Hampton and Salem VA medical centers) and the Prince William Area Agency on Aging (Washington DC VA Medical Center). VirginiaNavigator lists the Peninsula Agency on Aging as the Hampton VA's local partner, serving Hampton, James City County, Newport News, Poquoson, Williamsburg and York County.

Find your nearest VA medical center and its Caregiver Support Coordinator through VA's facility locator at va.gov/find-locations.

VA Aid and Attendance (A&A) Pension

Aid and Attendance (A&A) is an increased pension: veterans and survivors may be eligible if they get a VA pension and meet at least one of VA's need tests: needing another person to help with daily activities like bathing, feeding, and dressing; having to stay in bed, or spend a large portion of the day in bed, because of illness; being a nursing home patient due to the loss of mental or physical abilities related to a disability; or having limited eyesight. VA's Veterans Pension itself is for wartime veterans who also meet age-or-disability and income and net-worth limits. The net-worth limit is $163,699 from December 1, 2025 to November 30, 2026.,

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 the difference between that limit and the veteran's income for VA purposes, and non-reimbursable medical expenses above 5% of the limit can reduce that income. The monthly payment is the limit minus countable income, divided by 12 and rounded down to the whole dollar.,

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?

Here is the short version; 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 taxes "Virginia taxable income" at graduated rates under Code of Virginia § 58.1-320: 2% on income up to $3,000, 3% from $3,000 to $5,000, 5% from $5,000 to $17,000, and 5.75% on income above $17,000. A family caregiver paid through a Virginia program owes Virginia tax on whatever part of those wages is included in Virginia taxable income.

Whether wages excluded federally under Notice 2014-7 are included is not settled here: the section of the Code of Virginia cited above imposes the tax on Virginia taxable income without defining that term, and the sources behind this guide do not state how Virginia treats the federal exclusion. Do not assume the wages are taxable or exempt. Confirm with the Virginia Department of Taxation or a tax preparer before you pay Virginia tax on them.

The PCAFC Stipend

In the preamble to its 2020 proposed PCAFC rule, VA described the monthly caregiver stipend as a nontaxable benefit.

Your next step Ready to start? To pay a family member through consumer direction, contact your loved one's Medicaid health plan, or Virginia Medicaid (DMAS) at dmas.virginia.gov, and ask to add consumer-directed services and a Services Facilitator.

Frequently Asked Questions

Can I get paid to care for my spouse in Virginia?

Possibly, but Virginia's official sources conflict, so get DMAS's answer in writing first. DMAS's rules finalized effective July 1, 2025 allow a spouse, as a legally responsible individual, to be paid as the aide or attendant for personal care that is "extraordinary in nature," for up to 40 hours per week. DMAS states that this care may only be used to meet the extraordinary needs of a member under 18 and gives no separate standard for the spouse of an adult. The need must be documented during person-centered planning, instrumental ADLs and supervision are not reimbursed, and respite is not available while an LRI is paid. Against that, the CCC Plus regulation and DMAS's 2021 Employer of Record Manual still say a spouse cannot be the paid provider.

Who else can be a paid consumer-directed attendant in Virginia?

The member or their designated representative hires, trains, and manages the attendant, who is paid through a Fiscal/Employer Agent. Spouses and parents of minors fall under the separate LRI rules above. An adult child or other relative is not in the CCC Plus regulation's barred group, but one who lives under the same roof is paid only with written documentation of why no other person or provider is available. The employer of record cannot also be the paid attendant.

Is there respite help in Virginia without Medicaid?

Yes. The National Family Caregiver Support Program provides respite through Virginia's 25 Area Agencies on Aging when the older person you care for meets the federal "frail" test. DARS also runs the state-funded Respite Care Initiative for caregivers of people 60 and older with Alzheimer's or a related dementia, and the Virginia Lifespan Respite Voucher Program, whose published funding period ended June 30, 2026. Call DARS at 1-800-552-3402 to confirm what is open.,

How do I find my regional Area Agency on Aging?

Call DARS at 1-800-552-3402, or dial 211 for the broader social-services network. DARS works with Virginia's 25 local Area Agencies on Aging.

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverHow to Get Paid as a Family Caregiver in VirginiaHow to get paid to care for a family member in Virginia in 2026: CCC Plus consumer direction, the LRI spouse-pay rule, DD waivers, and VA caregiver options. CaregiverRespite Care in VirginiaA 2026 guide to respite care in Virginia: CCC Plus waiver funding, NFCSP respite through 25 AAAs, dementia-caregiver programs, VA options, and who pays. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Aid and Attendance in VirginiaVA Aid and Attendance in Virginia for 2026: who qualifies, up to $2,874 a month for a married veteran, how to apply, and free help from Virginia DVS. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

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.

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