Keep Parent at Home With Medicaid Virginia — Home and Community-Based Services

Nursing home placement is not the only Medicaid-funded option in Virginia. If your parent meets the nursing facility level of care — the same clinical standard required for institutional Medicaid — they can receive Medicaid-funded services at home through Virginia's home and community-based services (HCBS) programs.

For many families, keeping a parent at home is both the preferred outcome and the more affordable one. Virginia's HCBS programs cover personal care, adult day services, home modifications, and even pay family members to provide care.

What Virginia HCBS Programs Cover

Virginia delivers home and community-based services primarily through the Commonwealth Coordinated Care Plus (CCC Plus) waiver, administered by Cardinal Care managed care organizations (MCOs). The covered services include:

Personal care services. A personal care aide assists with activities of daily living — bathing, dressing, grooming, toileting, transferring, and meal preparation. Hours are authorized based on the parent's individual care plan, assessed through the Uniform Assessment Instrument (UAI).

Adult day health care. Structured daytime programs that provide supervision, social activities, meals, and health monitoring for seniors who cannot be safely left alone during the day. This is especially valuable for families where the primary caregiver works during business hours.

Respite care. Temporary relief for family caregivers, covering up to 480 hours per year. Respite can be provided in the home, at an adult day program, or in a facility for short stays.

Assistive technology and home modifications. Medicaid can fund wheelchair ramps, grab bars, stair lifts, bathroom modifications, and medical alert systems that make the home safer for an aging parent. Environmental modifications are capped but can significantly extend how long a parent can live independently.

Transition services. If a parent is currently in a nursing home and wants to return to the community, Virginia Medicaid covers transition coordination, including security deposits, utility setup, and essential furnishings.

Family Members as Paid Caregivers

Virginia permanently authorized the Legally Responsible Individuals (LRI) caregiver provision effective July 1, 2025. This means that under certain conditions, family members can be paid through Medicaid to provide personal care.

For adult children, siblings, and grandchildren, the process is straightforward. These non-spouse relatives can enroll as consumer-directed personal care attendants without meeting an extraordinary care threshold. The parent (or their authorized representative) acts as the employer, setting the caregiver's schedule and duties. An independent Employer of Record (EOR) manages timesheets and payroll through the state's fiscal agent, PPL. Caregivers log hours using the Time4Care mobile app.

For spouses and parents of minor children, the requirements are stricter. The care provided must be "extraordinary" — exceeding what would normally be expected in a marriage or parent-child relationship. Reimbursement is capped at 40 hours per week, and the spouse or parent cannot serve as the EOR.

Eligibility Requirements

The eligibility criteria for HCBS are identical to institutional Medicaid in most respects:

• Clinical: the parent must meet the nursing facility level of care, established through the LTSS Pre-Admission Screening and the UAI assessment. This means needing help with at least two activities of daily living or having a cognitive impairment that requires supervision.
• Financial: countable assets at or below $2,000 for a single applicant, income at or below $2,982 per month (or qualifying via the medically needy spend-down).
• The community spouse resource allowance applies: if the parent is married, the at-home spouse can retain up to $162,660 in assets.

The key difference: HCBS recipients retain a higher personal maintenance allowance than nursing home residents. Under the CCC Plus waiver, the parent keeps $1,641 per month to cover rent, utilities, and living expenses — compared to just $40 in a nursing home. This means more of the parent's income stays with the family.

How to Request HCBS

The entry point is the same as for institutional Medicaid: contact the local Department of Social Services to request a Pre-Admission Screening. When the screening team conducts the UAI assessment, the family should clearly express a preference for home and community-based services rather than facility placement.

If the parent is found to meet the nursing facility level of care, the local DSS and the parent's Cardinal Care MCO will develop a person-centered care plan that specifies which HCBS services the parent needs, how many hours of personal care are authorized, and which providers will deliver the services.

Families can choose between two service delivery models:

• Consumer-directed: the parent or their representative hires, trains, and manages the caregiver directly. This model offers maximum flexibility and allows family members to serve as paid caregivers.
• Agency-directed: a home health agency assigns, trains, and supervises the personal care aide. Less family management required, but less flexibility in scheduling and caregiver choice.

The Cost Advantage of Keeping a Parent Home

Virginia Medicaid's HCBS programs cost the state significantly less than nursing home placement — roughly $2,000 to $4,000 per month for in-home services versus $8,669 or more for a nursing home bed. For families, the financial impact is even more dramatic: the parent retains $1,641 per month for living expenses instead of $40, and the family home continues to be used rather than sitting empty.

The Virginia Medicaid Long-Term Care & Asset Protection Guide includes a side-by-side comparison of institutional versus HCBS Medicaid, showing the financial impact on both the parent's income and the family's assets, plus a step-by-step guide to requesting and setting up consumer-directed home care.

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