How to Switch Home Care Agencies: Private Pay and Virginia Medicaid

Families change home care agencies for many reasons. Shifts are missed. Caregivers change too often. Care needs grow beyond what the current agency can staff, or the family simply wants a better fit. Whatever the reason, the goal is the same: move to a new agency without leaving your loved one without help.

This guide explains how switching works when you pay privately, how it works under Virginia Medicaid, how changing agencies differs from changing health plans or care models, and how to plan the handover. A checklist at the end brings it together.

Before You Switch: Talk to the Current Agency

Sometimes a problem can be fixed without a move. If the issue is one caregiver, a schedule or a task that keeps being missed, tell the agency’s office in writing and ask what they will change and by when. If that does not work, or trust has gone, it is reasonable to switch.

Either way, do not cancel current care until the new agency has confirmed it can start. A gap of even a few days can be hard on someone who needs help to bathe, eat or move safely.

Switching When You Pay Privately

With private pay, the agreement between your family and the agency sets the rules. Work through these steps in order.

1. Review your current agreement

Find the service agreement you signed. Look for:

• Notice and cancellation terms: how much notice the agency asks for, how it must be given (email, letter or a form) and whether any fees apply.
• Billing: when the final invoice is issued and how deposits, prepaid hours or credits are handled.
• Caregiver terms: some agreements say what happens if a family wants to hire an agency’s caregiver directly or through another agency. Read this before assuming a caregiver can move with your loved one.

If anything is unclear, ask the agency to explain it in writing.

2. Confirm the new agency’s availability

Before you give notice, ask the new agency:

• Can you cover the days and hours we need, including weekends or overnights?
• Which care tasks will your caregivers help with, such as personal care, meals or mobility?
• When could care realistically start, and what needs to happen first?
• Will we meet the caregiver before care begins?

Our guide to choosing a caregiver covers what to ask about the caregiver match, and our guide to choosing a home care agency in Virginia lists questions for the agency itself.

3. Share the care plan, with consent

The current care plan, medication list and notes about routines help the new agency start well. Ask your loved one, or the person who makes decisions for them, to agree before you share it. You can share copies you already hold, or ask the current agency to release records to the new one with written permission.

4. Arrange the handover

Agree a last day with the current agency and a first day with the new one. Where possible, have the new agency’s first visit happen before the old agency’s last shift, or on the same day, so there is no gap. Plan who will be home for the first shift to introduce the caregiver and walk through the routine.

Switching Under Virginia Medicaid

This section applies to Virginia Medicaid only. Rules in other states, including Pennsylvania, are different.

In Virginia, eligible members may receive personal care and respite at home through the Commonwealth Coordinated Care Plus (CCC Plus) Waiver. Coverage and hours depend on eligibility, assessment and service authorization. Our Medicaid home care in Virginia page explains the basics.

The authorization is tied to the provider

Medicaid pays for waiver services through a service authorization. The Department of Medical Assistance Services (DMAS) CCC Plus Waiver provider manual says a valid authorization names the individual, the service, the units, the dates and the provider. When a member moves from one agency to another, the transfer needs its own service authorization, and the new provider may not begin services before the date it is authorized to start.

In practice, that means:

• Your loved one’s current hours do not move to a new agency automatically.
• The new agency has to accept the referral and be authorized before its caregivers start.
• Hours under the new authorization depend on your loved one’s assessed needs. They may stay the same or change.

Who to contact first

Many Virginia Medicaid members receive their benefits through a Cardinal Care health plan. DMAS notes that every plan has care coordinators or care managers. If your loved one is in a health plan, call the plan’s member services line and ask for the care coordinator. Tell them you want to change personal care agencies, name the agency you want to move to, and ask:

• Is the new agency in the plan’s network?
• What does the plan need from us, from the new agency and from the current agency?
• How long does the change usually take, and how do we avoid a gap in care?
• Will a reassessment be needed, and could the authorized hours change?

If your loved one is not enrolled in a health plan, ask the new agency and your local department of social services what steps are needed.

Keep the current agency in place until the new agency, and the care coordinator where there is one, confirm the start date.

Changing Agencies Is Not the Same as Changing Plans or Care Models

Families sometimes mix up three different changes. Each has its own process.

• Changing agencies. Your loved one keeps the same health plan and the same agency-directed care, but a different home care agency provides it. This is what most of this guide covers.
• Changing health plans. This means moving from one Cardinal Care health plan to another. Members can change plans for any reason in the first 90 days of enrollment and during their region’s annual open enrollment period, through the Cardinal Care Managed Care Helpline at 1-800-643-2273 (TTY 1-800-817-6608). DMAS has said a new plan must let members see their current providers for up to 30 days after a change. Ask the new plan how that applies to home care before you switch.
• Moving between agency-directed and consumer-directed care. Under the CCC Plus Waiver, members can choose agency-directed care, consumer-directed care or both. In agency-directed care, the agency employs and supervises the aide. In consumer-directed care, the member or a chosen representative becomes the employer of record and hires, trains and manages the attendant, with help from a services facilitator. Moving between the two is a bigger change than switching agencies, so talk it through with the care coordinator first.

Planning for Continuity of Care

The most important part of any switch is making sure care does not stop. A few habits help:

• Overlap rather than gap. Keep current care going until the new start date is confirmed in writing.
• Write down the routine. Wake-up and bedtime, bathing days, meals and drinks, medication reminder times, mobility help and what calms or upsets your loved one.
• Keep key contacts in one place. Doctors, pharmacy, the health plan care coordinator if there is one, and family members.
• Be ready for some adjustment. A new caregiver needs a few visits to learn the routine. Share small preferences early.
• Check in during the first two weeks. Tell the new agency’s office what is working and what is not.

Do not plan on everything carrying over. Authorizations do not transfer automatically, hours may change after a reassessment, start dates depend on staffing and approvals, and a caregiver from the old agency cannot simply be assumed to follow.

Transition Checklist

• Write down the problems with current care and decide whether they can be fixed.
• Find your current service agreement and note the notice, cancellation and billing terms (private pay).
• Call the health plan’s care coordinator before making changes (Virginia Medicaid).
• Confirm the new agency can cover the days, hours and tasks you need.
• For Medicaid, confirm the new agency is in the plan’s network and ask what authorization steps are needed.
• Get consent to share the care plan, medication list and routines with the new agency.
• Agree a confirmed start date with the new agency before giving notice or ending current care.
• Give written notice to the current agency, following the agreement.
• Plan who will be home for the first shift with the new caregiver.
• Review how care is going after the first week and again after two weeks.

How CareLiving Can Help

CareLiving provides home care in Northern Virginia and Greater Pittsburgh, including personal care, companion care, respite care, overnight and 24-hour care. We work with private pay and long-term care insurance, and in Virginia with Medicaid through participating managed care plans. Ask us whether we participate with your loved one’s plan.

If you are thinking about switching, we start with a free in-home consultation. We talk through your loved one’s needs and current schedule, explain what would need to happen before we could start, and write a care plan that sets out the tasks, schedule and routines agreed with your family. Our caregivers are screened before they are matched with families.

Call (571) 599-7467 in Northern Virginia or (412) 900-8761 in Greater Pittsburgh, or choose your caregiver online. Start dates depend on the care assessment, caregiver availability and any required service authorization.