Navigating Medicaid can feel overwhelming, but understanding the basics makes the process much more manageable. Here’s what families need to know:

• Financial Eligibility: To qualify for Virginia Medicaid, your loved one must meet income and asset limits set by the state. Eligibility is determined by your local Department of Social Services (DSS) office. Income thresholds vary depending on whether the individual is applying as an aged, blind, or disabled adult.
• Functional Eligibility: To qualify for home care through Virginia’s CCC Plus Waiver, your loved one must meet the waiver’s nursing facility level-of-care requirements. A long-term services and supports (LTSS) screening evaluates their care needs and functional abilities. This is separate from the financial eligibility review for Medicaid.
• CCC Plus Waiver and Cardinal Care: The CCC Plus Waiver provides home and community-based services for people who meet Medicaid eligibility and the waiver’s level-of-care requirements. Cardinal Care is Virginia’s Medicaid program, which includes managed care health plans. For members enrolled in managed care, their health plan coordinates care and authorizes covered services. Medicaid enrollment alone does not mean someone has been approved for waiver services.
• Choosing a Home Care Agency: After enrollment, your loved one has the right to choose their home care provider. CareLiving is an approved Medicaid home care agency in Virginia. We work directly with MCOs to coordinate care authorization and services. For a breakdown of what care costs in Manassas and how families pay, see our home care cost guide for Manassas.
• How to Apply: Apply for Medicaid through your local Virginia DSS office or online at CommonHelp (commonhelp.virginia.gov). Once Medicaid is approved, contact us and we can help guide the next steps for getting care started under your managed care plan. Get Started and we’ll walk you through the process.

How to Qualify for Medicaid Home Care in Northern Virginia: Step by Step

1. Check financial eligibility. Virginia Medicaid uses income and asset limits set by the state. Your local Department of Social Services (DSS) office can review your situation, or you can screen online at CommonHelp (commonhelp.virginia.gov).
2. Submit your Medicaid application. Apply online at CommonHelp or in person at your local DSS office. Gathering proof of income, assets, and identity ahead of time helps avoid delays.
3. Request a long-term services and supports (LTSS) screening. Contact your local Department of Social Services to request a screening for the CCC Plus Waiver. If your loved one is hospitalized, ask the hospital discharge team about arranging it. The screening determines whether they meet the waiver’s required level of care. Needing help with daily activities alone does not establish eligibility.
4. Confirm your service authorization. Medicaid eligibility and approval for the CCC Plus Waiver do not automatically establish your home care hours. For members enrolled in managed care, the health plan reviews the care needs and authorizes covered services. Confirm the approved services, hours and authorization dates with your care coordinator before arranging care.
5. Arrange care with a participating home care agency. CareLiving provides Medicaid home care in Northern Virginia, subject to health plan participation and caregiver availability. We review your service authorization, assess your care needs and coordinate the proposed schedule. Your start date depends on completing the necessary assessment, confirming authorization and matching an available caregiver.

Medicaid Home Care Hours and 24-Hour Needs

CCC Plus Waiver personal care hours depend on assessed needs and service authorization. Virginia’s waiver regulations limit personal care to 56 hours per week. An exception can be considered when the individual has a qualifying level of care (Level B or C) and at least one documented condition: dependence in bathing, dressing, transferring, toileting and eating; dependence in both behavior and orientation; or a qualifying Adult Protective Services or Child Protective Services case that meets the regulation’s criteria (12VAC30-120-927). Meeting these criteria does not guarantee a particular number of hours.

Supervision can be included as part of personal care when someone has a documented need for an aide’s presence to stay safe at times when no other support is available. It is not an automatic addition of hours. Under the DMAS CCC Plus Waiver manual, supervision is limited to eight hours a day, must be authorized in advance and requires documentation that someone is with the person 24 hours a day. Living alone can affect whether supervision is authorized, but it does not by itself rule out Medicaid personal care.

Respite care, up to 480 hours a year, gives an unpaid family caregiver a break. A personal emergency response system can call for help after something happens, but it does not replace an awake caregiver.

Plan a Full Day Before You Talk With the Care Coordinator

Authorized hours often cover the busiest parts of the day, such as getting up, bathing, meals and bedtime, while evenings, nights or weekends are covered another way. Use this worksheet for a typical weekday and a weekend day, and fill it in over several days rather than from memory. To print it, use your browser’s print option; the worksheet prints with space to write in each box.

For night periods, keep a simple log for one to two weeks: the date and time, what happened, who helped and how long it took. Note any change in health, mobility, memory or behavior. Changes are the usual reason to ask for a reassessment.

Questions to Ask the Care Coordinator

• How many personal care hours are authorized, and for which days and times?
• Does the plan include supervision? If not, what would need to be documented for it to be considered?
• Could my loved one meet the criteria for an exception above 56 hours, and what documentation would be needed?
• Are respite hours available to the family caregiver, and how many remain?
• Would adult day health care or other waiver services help with any of the uncovered periods?
• When is the next reassessment, and how do we request one sooner if needs change?

If a health plan denies or reduces services, its written notice explains how to ask the plan to reconsider. After the plan’s final decision, you can appeal to DMAS within 120 days. See DMAS’s summary of the client appeals process.

Already Approved for Medicaid Home Care?

If you or your loved one already has Medicaid-authorized personal care hours, CareLiving can review your health plan, care needs and requested schedule to determine whether we can provide care.

Whether you are arranging services for the first time or looking to change agencies, we can explain the next steps. Starting care depends on plan participation, service authorization and caregiver availability.

Call 571-599-7467 to discuss your approved hours and care needs.

Don’t Qualify for Medicaid? You Still Have Options

Many Northern Virginia families don’t meet Medicaid’s income limits but still need dependable support at home. CareLiving also serves private pay families across Northern Virginia — the same nurse-supervised caregivers and personalized care plans, from a few hours a week to 24-hour and live-in care. We also work with long-term care insurance. Review our home care costs guide and payment options, or call 571-599-7467 for a free in-home assessment.

Areas We Serve for Medicaid Home Care in Northern Virginia

CareLiving provides Medicaid personal care for eligible individuals across Fairfax County, Loudoun County, Prince William County, Arlington and Alexandria.

Our service area includes Herndon, Reston, Fairfax, Ashburn, Alexandria, Arlington, Sterling, Gainesville, Manassas and Woodbridge. Services depend on health plan participation, individual authorization and caregiver availability.

Whether your loved one is newly approved for personal care or already has authorized hours, our team can review their care needs and explain the next steps.