Getting paid to care for a family member in Virginia
Depends.
In Virginia, whether a family member can be paid depends on the program's rules, which are below with their sources. Whether a spouse can be paid depends on conditions set out below with their sources.
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Medicaid waiver
Commonwealth Coordinated Care Plus (CCC Plus) Waiver
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Who qualifies
Older adults, people who have a physical disability, and people who are chronically ill or severely impaired and need substantial and ongoing skilled nursing care, who without the waiver would need a nursing facility or a long stay in a hospital or specialized care nursing facility. You must be eligible for Medicaid.
DMAS's Waivers page says the waiver serves all ages and does not have a waiting list.
CCC Plus Waiver members who meet the long-term services and supports screening criteria. You, or a family member, caregiver or designated person if you cannot direct your own care, act as the employer of record: you hire, train, supervise and if necessary fire your personal care attendant. A DMAS-enrolled services facilitator supports you, and a fiscal/employer agent handles payroll.
In the CCC Plus Waiver, personal care and respite can be consumer-directed. The services facilitator cannot be your spouse or your employer of record.
Depends.
Yes, with limits. Family members approved to be paid for personal care or respite must meet the same qualifications as any other attendant. A family member who lives under the same roof as you can be paid for personal care or respite only if there is objective written documentation of why no other person or provider is available.
The nurse supervisor or services facilitator makes that determination first and documents it in your record.
Depends.
Not for most adults, but the official sources do not agree. Virginia's approved CCC Plus Waiver counts a spouse as a legally responsible individual, lets legally responsible individuals be paid only for extraordinary personal care, and says that care may only be used to meet the extraordinary needs of a participant under the age of 18. The same waiver elsewhere describes a legally responsible individual being paid for up to 40 hours a week to care for a spouse. Virginia's regulation, 12VAC30-120-935, says DMAS shall not pay for any waiver services provided by the waiver individual's spouse.
DMAS's Legally Responsible Individuals page and the CCC Plus provider manual (revised 9/02/2026) repeat the under-18 limit. DMAS took public comment until October 18, 2026 on waiver amendments proposed to take effect January 1, 2027, including corrections to the rules for paid legally responsible individuals under consumer direction; they are not yet approved, so re-check in January 2027.
Commonwealth Coordinated Care Plus (CCC Plus) Waiver
How to apply
Request a long-term services and supports (LTSS) Screening through your local Department of Social Services. A community-based screening team (a social worker and a health department nurse) meets with you and a family member or caregiver. If you are in the hospital, a discharge planner can do the screening there. Apply for Medicaid online at CommonHelp.virginia.gov, by phone with Cover Virginia, or with a paper application (ask for Appendix D) from your local Department of Social Services.
Once you are approved for Medicaid and screened and approved for the CCC Plus Waiver, you choose your waiver services, and the screening team helps you find providers. Waiver members may choose consumer-directed care, agency-directed care, or both.
