Can a Spouse Be Paid as a Caregiver in Virginia?

The short answer

In Virginia, a husband or wife may be paid to care for their spouse through Medicaid, in some cases. The rules changed in November 2023 and were revised again on 1 July 2025. Before that change, a spouse could not be paid. Now a spouse can be, if the care is more than a spouse would normally be expected to give, and if several conditions are met.

This is not automatic. Nobody may promise you it will happen. The Virginia Department of Medical Assistance Services, called DMAS, and the health plan decide who qualifies and how many hours are approved. An agency cannot decide it, and neither can this page.

Below is what the current rules say, what the limits are, and what to do first.

Which program pays family caregivers in Virginia

The money comes from a Medicaid waiver. In Virginia this is the Commonwealth Coordinated Care Plus Waiver, usually written as the CCC Plus Waiver. It pays for care at home for people who would otherwise need a nursing facility, including older adults, people with physical disabilities, and people who are chronically ill.

Two names, one program

On 1 October 2023, Virginia merged two managed care programs into one called Cardinal Care Managed Care. The CCC Plus Waiver still exists and still has that name. It now runs underneath Cardinal Care. So you will hear both names, and they refer to the same care. If a form says Cardinal Care and the caseworker says CCC Plus, you are in the right place.

What consumer direction means

The waiver gives you two ways to receive personal care and respite care.

Agency-directed care. A home care agency employs the caregiver, schedules the visits, handles payroll, and sends a nurse to review the plan. You do not hire anyone yourself.
Consumer-directed care. The person receiving care, or someone acting for them, becomes the employer. They choose the attendant, train them, set the schedule, approve the hours, and can let them go. A state contracted payroll company pays the wages and handles the taxes.

Paying a family member happens on the consumer-directed side. That is the route you are asking about when you ask whether a spouse can be paid.

The payroll company is called the fiscal or employer agent. For members in fee-for-service Medicaid this is Consumer Direct Care Network. For members enrolled in a health plan such as Aetna, Anthem, Molina, Sentara or UnitedHealthcare, it is Public Partnerships or Consumer Direct Care Network, depending on the plan.

Which relatives may be hired and paid

Under consumer direction, the following relatives may be hired as a paid attendant:

Adult children
Siblings
Nieces and nephews
Grandchildren
Spouses
Parents of a child under 18

Friends and neighbors may also be hired. The attendant does not have to be a relative at all.

Spouses and parents of minor children are treated differently from the rest of that list. Virginia calls them legally responsible individuals. Extra rules apply to them, and only to them.

The extra rules that apply to a spouse

If the paid attendant is the member’s husband or wife, these conditions apply:

The care must be extraordinary. DMAS says care given by a legally responsible individual must be above and beyond what that person is already obligated to provide. Cooking dinner and doing laundry for your own household is ordinary. Hands-on help with bathing, toileting, transfers and feeding, several times a day, is the kind of care that is being described.
Forty hours a week is the ceiling. A legally responsible individual may be paid for up to 40 hours per week. Care given beyond that is unpaid.
The file has to show why no one else can do it. The rules ask whether another person or provider is available to give the care. The paid spouse is meant to be the last option, and the reason has to be written down.
The employer of record rules are looser for a spouse than for a parent. The employer of record is the person who hires the attendant and approves the hours for payment. As a general rule that person cannot also be the paid attendant. DMAS states that these employer of record requirements do not apply to an adult member who hires a spouse to be the paid attendant. A parent of a child under 18 is treated more strictly. Ask your services facilitator to confirm the right setup for your case before anyone signs paperwork.
Daily documentation is required. The paid spouse records the tasks they did, each day, on a DMAS form. This is checked.
Services facilitation cannot be skipped. Families who use a legally responsible individual as the attendant must work with a services facilitator. That is not optional in these cases.

These rules run through the CCC Plus Waiver, the Community Living Waiver and the Family and Individual Supports Waiver. They do not apply to EPSDT services or to Medicaid Works.

The paperwork that supports all of this includes the plan of care, forms DMAS-97A and DMAS-97B, the community based care assessment, form DMAS-99, and the questionnaire about managing consumer-directed services, form DMAS-95B. Your services facilitator prepares these with you.

One practical warning. Wages are taxable income. Ask the services facilitator and your local Department of Social Services how the wages may affect the household’s Medicaid case before the first shift is worked, so there is no surprise later.

Who cannot be paid

The employer of record, in most cases. Whoever hires the attendant and approves the hours normally cannot also be the paid attendant. The exception is an adult member who hires their own spouse, where DMAS says this requirement does not apply.
The services facilitator, case manager or support coordinator for that member.
Anyone under 18.
Anyone who cannot pass the background check. Attendants go through a criminal history check with the Virginia State Police. A check with Child Protective Services is added when the member is a minor.
Anyone without work authorization. Attendants need a valid Social Security number and the legal right to work in the United States.

Attendants also need to be able to read, write and do basic arithmetic, because they keep records.

What a services facilitator does

A services facilitator is a person paid by Medicaid to help you run the consumer-directed arrangement. They are not the caregiver and they are not the health plan. Their job is to:

Visit the home and assess what help is needed
Teach the employer of record how to be an employer: hiring, training, timesheets, what to do if the attendant does not turn up
Write the plan of care with you and record why extraordinary care is needed
Come back and review the plan at least every 90 days
Check the work shift records
Watch for signs of neglect or harm and report them

You choose which services facilitator to work with. If the relationship is not working, you can ask for a different one.

How the hiring works, step by step

Ask for a screening. Call your local Department of Social Services and ask for a Long Term Services and Supports screening. If your family member is in a hospital or nursing facility, the screening team there can do it. This screening decides whether the level of need matches the waiver.
Apply for Medicaid. Apply at CommonHelp.virginia.gov, by phone on 1-833-522-5582, or on paper. Financial eligibility is decided separately from the screening. Both have to be in place.
Say the words “consumer directed”. Once waiver services are approved, tell the care coordinator at the health plan that you want the consumer-directed model for personal care or respite care. If you do not say it, the default is usually an agency.
Choose a services facilitator. The health plan gives you a list. You pick.
Enroll with the payroll company. The employer paperwork is signed and the attendant, including a spouse, completes the background check, the tax forms and the enrollment packet.
Get the plan of care approved. The services facilitator writes it, documents the extraordinary care, and submits it. Hours come from the assessment, not from what the family asks for.
Start recording shifts. The attendant logs the hours and the daily tasks. The hours are approved for payment, and the payroll company pays.

Nothing here happens in a day. The screening, the Medicaid decision, the plan of care and the enrollment each take their own time. Families often wait weeks, sometimes longer.

What a family does first

If you are reading this at night and want one action, make it this one: call your local Department of Social Services in the morning and ask for the Long Term Services and Supports screening. Everything else waits on that.

While you wait, do three things.

Write down what care is happening now. How many times a night. How long the bathing takes. Who lifts. This is the evidence the assessment runs on, and nobody can reconstruct it later.
Work out who the employer of record will be. If an adult is hiring their own spouse, the usual restriction does not apply, so ask the services facilitator what your household needs before you name anyone.
Ask what happens in the meantime. Care is needed before any of this is approved. That gap is real, and it is worth planning for rather than absorbing.

What this page cannot tell you

It cannot tell you whether your family member qualifies. It cannot tell you the hourly rate, because that is set by the health plan and changes. It cannot tell you how many hours will be approved, because that comes out of the assessment. Anyone who tells you those numbers before the screening is guessing.

If someone tells you a spouse cannot be paid

You may run into this. The older regulation text, Virginia Administrative Code 12VAC30-120-935, still says DMAS will not reimburse for waiver services when the spouse of the waiver individual is the one providing the service. That section was last amended on 19 June 2024, which is after the bulletin that changed the policy. The DMAS bulletins and the approved waiver amendments are the operative policy. If someone tells you no and points at the regulation, ask your services facilitator or your health plan’s care coordinator to check the current DMAS bulletin on legally responsible individuals. Both bulletins are linked in the sources below.

Talk to a care coordinator

Millennium is enrolled with Virginia Medicaid for both models, agency-directed and consumer-directed. That matters for the question this page is about, because many agencies only do agency-directed care and will tell you they cannot help with a family member being paid.

The split most families end up wanting

There is a third option that families rarely know exists, and it is the one we most often set up. The family member stays the paid attendant for part of the week, and our aides cover the rest.

The reason is simple. Being your husband’s or your mother’s paid caregiver does not stop you being their husband or their daughter. Forty hours of hands-on care a week, on top of that relationship, is how people end up exhausted, and exhaustion is what ends home care arrangements and sends someone to a facility. A split keeps the income and the trust of a family caregiver, and gives that person real time off, on a schedule, with someone trained covering it.

It also covers the days a family member cannot. Illness, work, a funeral, a trip back home. Care does not stop because one person is unavailable.

What we will tell you on the phone

Tell us what is happening at home and we will explain which of the three arrangements fits, in plain language. We will also tell you quickly if your situation does not fit what we do, rather than leaving you waiting.

Licensed by the Virginia Department of Health, license HCO-14982
Enrolled Virginia Medicaid provider, NPI 1043640360
Contracted with all four Cardinal Care plans: Anthem HealthKeepers, Sentara, Humana and Aetna Better Health
Accepting new Medicaid clients now across our service area
We respond the same day, and care can start within 48 hours
Caregivers speak Amharic, Tigrinya and English, with Spanish available

Call (703) 941-8412, Monday to Friday, 9:00 am to 5:00 pm, or ask for a free in-home assessment. There is no cost and no obligation. We work with families across Annandale, Alexandria, Arlington, Falls Church, Fairfax and Springfield.

Millennium Home Health Care, 4200 Evergreen Lane, Suite 312, Annandale, VA 22003.

Sources

Rules and program names change. This page was written in August 2026. Check the DMAS pages above, or ask your health plan’s care coordinator, before you act on it.