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Getting paid to care for a parent in Virginia

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: Virginia's door is Consumer-Directed (CD) Services under the Commonwealth Coordinated Care Plus (CCC+) Waiver, run by Virginia Department of Medical Assistance Services (DMAS), with Cardinal Care managed-care health plans; fiscal agents are Consumer Direct Care Network (CDCN) and Public Partnerships (PPL). Pay: $13.88/hr in most of Virginia; $17.97/hr in Northern Virginia — the DMAS consumer-directed personal care rate (billing code S5126) set on July 1, 2025 and still the current rate as of August 2026. There was no July 1, 2026 increase. In consumer-directed care this rate is what the attendant actually gets paid as gross hourly wages: the family cannot top it up, and the employer payroll taxes and the fiscal agent's fee are covered by Medicaid on top of it rather than taken out of it. Agency-directed care bills more — $20.23 rest of state, $23.81 Northern Virginia — but that money goes to the agency and the aide keeps only part of it, which is why hiring family through the consumer-directed route usually pays the caregiver more. A raise for both agency- and consumer-directed personal care, respite and companion care was funded in the 2026-2028 state budget, and legislative and county analyses put it at January 1, 2027, with a second step a year later. DMAS has not published the new dollar figures yet, so watch for a DMAS rate bulletin — and note this one lands mid-year, not on the usual July 1 schedule.

Who can be the paid caregiver

Adult children, siblings, grandchildren, other relatives, and friends can all be hired as the paid attendant, including family who live in the same house. The attendant must be 18+, legally able to work in the US, pass a criminal background check (Virginia's "barrier crimes" list disqualifies), and cannot simultaneously be the employer of record (EOR) — so if the parent can't manage the paperwork, a second family member usually serves as EOR while the caregiver gets paid.

The spouse question

Yes, since July 1, 2025 — permanently, with strings. CMS approved Virginia's amendments (April 17, 2025) letting "legally responsible individuals" (spouses, and parents of minor children) be paid attendants in the CCC+, CL, and FIS waivers. Conditions: capped at 40 paid hours/week; pay is only for hands-on help with Activities of Daily Living that is "extraordinary" — cooking, errands, and general supervision (IADLs) do not count; the family loses paid respite while a spouse is the paid attendant; and needs are re-checked at least every 90 days. Note: an adult child caring for a parent is NOT a legally responsible individual — none of these restrictions apply to them.

Waitlist reality

For an aging parent, effectively none: the CCC+ Waiver has no waiting list — if the parent passes the financial test and the nursing-facility level-of-care screening, services start. The wait that exists is bureaucratic: the local DSS screening and Medicaid approval commonly take 1-3 months. Virginia's DD Waivers (for lifelong developmental disability, not typical elder care) are a different story — the state's own count as of November 25, 2025 was 14,258 people waiting, only 2,727 of them in the urgent 'Priority One' group, and the wait runs for years.

Worth knowing: Disqualifiers to say out loud: the parent must qualify for Medicaid (strict income/asset limits — a house and one car are generally exempt for long-term care rules, but savings mostly are not) AND must need nursing-facility level of care; someone who only needs reminders, cooking, and rides will fail the LTSS screening. The caregiver cannot be paid for hours the parent is in a hospital, nursing home, or adult day program billed separately, and cannot be both attendant and employer of record. Barrier-crime convictions block hiring. All hours must be clocked via EVV — paper timesheets are gone. Recent changes that matter: spouse pay became permanent July 1, 2025 (after a 2023-2024 fight over DMAS restrictions that briefly threatened family caregivers — the 40-hour cap and 'extraordinary care/ADL-only' rules are the settled compromise, and they apply to spouses/parents-of-minors, NOT to adult children). Do not assume rates change every July: nothing changed on July 1, 2026, so the July 1, 2025 figures are still the live ones as of August 2026, and the next raise — funded in the 2026-2028 state budget — is expected in January 2027 with another step the year after. Watch the DMAS provider bulletins for the actual dollar amounts instead of waiting for a July announcement. NOVA rate region = Planning District 8 (Fairfax, Arlington, Alexandria, Loudoun, Prince William area); everywhere else gets the lower rate. Two useful DMAS mailboxes: cdsf@dmas.virginia.gov for timesheet and authorization questions, CDLRI@dmas.virginia.gov for spouse-as-paid-attendant questions.

Other doors in Virginia

ProgramWhat to know
Veteran-Directed Care (VDC)For veterans enrolled in VA health care: a monthly flexible budget the veteran uses to hire caregivers, including family. Available through some Virginia VA Medical Centers partnered with Area Agencies on Aging (e.g., Prince William AAA, Peninsula Agency on Aging). Ask the parent's VA social worker.
VA caregiver benefits (federal)Aid & Attendance pension add-on (cash the veteran can use to pay a family caregiver) and the Program of Comprehensive Assistance for Family Caregivers (monthly stipend, mostly for those with service-connected disability).
DD Waivers (CL, FIS, BI)Consumer-directed attendants for people with developmental disabilities — relevant only if your 'parent care' situation is really lifelong disability. Years-long waitlist through the local Community Services Board.
Area Agency on Aging caregiver support / Lifespan Respite (DARS)Not caregiver pay — small respite grants and support services, funding-dependent. Virginia has NO structured family caregiving per-diem program for elder care; the hourly CD model above is the door.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Apply for Virginia Medicaid for your parent: online at commonhelp.virginia.gov or call Cover Virginia at 1-833-522-5582 (TDD 1-888-221-1590).
  2. 2. Call your parent's local Department of Social Services and request a "Long-Term Services and Supports (LTSS) screening" — a nurse and social worker assess whether your parent meets nursing-facility level of care. This is the gate to the CCC+ Waiver.
  3. 3. Once approved, your parent picks a Cardinal Care managed-care health plan and tells the care coordinator they want CONSUMER-DIRECTED personal care (not agency care).
  4. 4. A services facilitator (e.g., Moms In Motion or another enrolled facilitator) trains the family on employer duties; your parent (or another relative) signs on as employer of record.
  5. 5. You, the caregiver, enroll as the attendant with the fiscal agent (CDCN or PPL, depending on the health plan), pass the background check, and start logging hours through electronic visit verification (EVV) to get paid every two weeks.

Where to start: Local Department of Social Services (LTSS screening) — find yours via Cover Virginia, 1-833-522-5582; DMAS consumer-directed services questions: cdsf@dmas.virginia.gov; program info: dmas.virginia.gov/for-members/benefits-and-services/waivers/consumer-directed-services/

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

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Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.