TL;DR

Virginia's CCC Plus Waiver is the state's primary Medicaid program for funding home and community-based long-term care — personal care, adult day health, respite, skilled nursing, home modifications, and more — for elderly adults and people with physical disabilities who would otherwise need a nursing facility.

In 2026, the program serves tens of thousands of Virginians through five managed care organizations, with caregiver reimbursement rates continuing to rise and consumer direction remaining one of the most flexible and underused tools available to participants. Ankota works with home care agencies and fiscal/employer agents across Virginia who deliver CCC Plus services daily, and what follows is the guide we wish every family had before their first call to DMAS.

Here is how most families find out about the CCC Plus Waiver: a hospital social worker mentions it during a discharge conversation, or a neighbor says "have you looked into Medicaid waiver programs?" and you end up three hours later with fourteen browser tabs open, a printout of a DMAS guidance document from 2019, and the distinct feeling that you understand less than when you started.

That's not an accident. Virginia's Medicaid long-term services and supports system was designed by policy professionals, not by the people who have to use it under stress. The information is technically public. But it lives across DMAS guidance documents, MCO member handbooks, and DSS eligibility forms that were not written with a worried adult child in mind at 10pm on a Tuesday.

The CCC Plus Waiver is genuinely valuable — one of the more comprehensive Medicaid HCBS programs in the country, covering services that can keep an older adult or someone with a physical disability living safely at home for years. The coverage is real. The consumer direction model is genuinely flexible. The rates, while not private-pay levels, have been moving in the right direction through recent Virginia General Assembly sessions.

But the front door to all of that is a process that requires you to simultaneously apply for Medicaid, request a separate functional assessment, choose a managed care organization, and navigate a care coordination system — all while managing the immediate care needs of a family member who probably needed help last week. This guide is an attempt to make that front door easier to find and walk through.

What the CCC Plus Waiver Actually Is

CCC Plus stands for Commonwealth Coordinated Care Plus. It's Virginia's flagship Medicaid managed long-term services and supports (MLTSS) program, administered by the Department of Medical Assistance Services (DMAS) and delivered through contracted managed care organizations. It launched in 2017, replacing an older fee-for-service model, and by 2026 it's a mature, well-established program — one of the larger HCBS waiver programs in the country by enrollment.

The core promise of CCC Plus is straightforward: if you qualify for nursing facility-level care under Medicaid but can be safely supported at home or in the community, CCC Plus funds that community-based care instead. The state and federal government save money compared to nursing facility placement, you stay home, and a managed care organization coordinates your services.

A few things worth being clear about up front. CCC Plus is a Medicaid waiver program — it operates under a federal waiver of standard Medicaid rules, with its own eligibility criteria, covered services, and managed care structure. It is not available with private insurance as your primary coverage. And it is entirely separate from the DD Waiver (for individuals with intellectual and developmental disabilities), which has its own enrollment process, its own waitlist, and its own service structure. 

Since October 2023, CCC Plus and Medallion 4 merged under an umbrella program called Cardinal Care Managed Care (CCMC). The CCC Plus waiver itself still exists, but the managed care delivery sits under the Cardinal Care brand. Worth at least one mention so readers aren't confused if they see "Cardinal Care" on the DMAS site.

Who Qualifies: The Two Tests You Need to Pass

CCC Plus eligibility has two independent components, and you have to clear both. Most families discover the second one exists only after they've already started the first.

The financial test is Medicaid eligibility. For the populations CCC Plus serves — primarily adults 65 and older and adults with qualifying physical disabilities — Virginia uses modified income and asset rules. Income limits are based on federal poverty guidelines, and asset limits are strict, though a primary home, one vehicle, and certain personal property are typically exempt. If your income is too high to qualify outright, Virginia has a medically needy spend-down pathway, and spousal impoverishment protections apply for married couples, meaning a spouse at home doesn't have to be left with nothing. The application goes through CommonHelp, Virginia's online benefits portal, or through your local Department of Social Services. Plan for the process to take four to six weeks under normal circumstances.

The functional test is where most families get blindsided. Financial Medicaid eligibility alone does not get you into CCC Plus. You also have to be assessed as needing nursing facility level of care — meaning your functional limitations are significant enough that a nursing facility would typically be the alternative. In Virginia, this is determined through the Uniform Assessment Instrument (UAI), a structured assessment conducted by a trained assessor from your local Department of Social Services or a DMAS-contracted organization. The UAI evaluates activities of daily living, cognitive function, medical needs, and safety in the home environment. You need to request this assessment separately — it doesn't happen automatically when you apply for Medicaid, and that gap is where a lot of applications stall while families wait for something that was never scheduled.

Both criteria have to be met and documented before CCC Plus enrollment can proceed. If you're in a hospital or nursing facility setting and transitioning to home, the timeline pressure is real — starting both processes simultaneously rather than sequentially saves weeks.

What CCC Plus Actually Covers in 2026

The service list under CCC Plus is broader than most families expect, and several of the most useful services are the ones that go unmentioned in the initial enrollment conversation. Here is what the program covers for eligible participants:

Personal care services — assistance with activities of daily living including bathing, dressing, grooming, meal preparation, and medication management. Available as both agency-directed care (the agency assigns and manages your caregiver) and consumer-directed care (you choose and manage your own caregiver). This is typically the highest-volume service in any CCC Plus care plan.

Respite care — temporary relief for family caregivers, delivered in the home or in a facility setting. Chronically underused and chronically needed. If a family member is providing unpaid care and burning out, respite is often the service that prevents a crisis.

Adult day health care — structured programming and health services in a licensed adult day center, typically several days per week. Meaningful for participants who benefit from social engagement and activity, and equally meaningful for family caregivers who need reliable daytime coverage to maintain employment.

Skilled nursing and home health — licensed nurse visits, physical therapy, occupational therapy, and speech therapy delivered in the home based on medical need and physician order.

Durable medical equipment and supplies — including mobility aids, hospital beds, wound care supplies, and other medically necessary equipment.

Non-emergency medical transportation — to and from medical appointments. More significant than it sounds for participants who can't drive and don't have reliable family transportation.

Assistive technology and environmental modifications — grab bars, ramps, widened doorways, remote monitoring systems. The home modification benefit is one of the most practically impactful and least-publicized services in the program, because it's often the difference between safe independent living and a forced facility transition.

Personal Emergency Response Systems (PERS) — emergency call buttons and, increasingly, activity monitoring versions that detect patterns of movement and inactivity.

Caregiver training and support — formal training for family members or informal caregivers on specific care techniques, medication management, and safety protocols.

What's not covered: room and board, non-medical services that aren't in the approved care plan, and services that duplicate Medicare coverage. If a participant has both Medicare and Medicaid (dual eligible), Medicare is always primary, and CCC Plus wraps around it for LTSS and services Medicare doesn't cover.

Consumer Direction: The Option Most Families Never Hear About

Consumer direction is, without exaggeration, the feature of CCC Plus that transforms the program for many families — and it's the one most consistently underexplained during enrollment.

Under the agency-directed model, your MCO authorizes a set of personal care hours, and a contracted home care agency assigns and manages the caregiver who delivers those hours. The agency handles scheduling, backup coverage, and supervision. You get a caregiver. You don't choose who it is, and your control over the relationship is limited.

Under the consumer-directed model, you are the employer. You recruit, interview, hire, train, schedule, and — if necessary — fire your own personal care attendant. The MCO still authorizes the hours and the care plan, but the staffing decision is yours. A Fiscal/Employer Agent (FEA) — a third-party organization — handles the payroll, tax withholding, workers' compensation, and administrative compliance so you don't have to figure out how to be a payroll processor. Your caregiver gets paid, you stay in control, and the FEA handles the paperwork.
  

The practical implications of this are significant. Under consumer direction, you can hire a neighbor, a trusted family friend, or in many cases a family member (adult children are permitted; spouses are typically not). You can set the schedule that actually fits your life rather than waiting for agency availability windows. And perhaps most importantly for an older adult with established routines and preferences, you don't have rotating caregivers — you have the person you chose showing up consistently.

Consumer direction isn't right for every situation. It requires someone — the participant, a family member, or a designated representative — who has the capacity and time to manage an employment relationship. If that's not realistic, agency-directed care is the right fit. But if consumer direction is viable, it's worth asking about explicitly during the MCO enrollment process, because it is not always proactively offered.

For agencies operating as FEAs in Virginia's self-direction ecosystem, the administrative complexity of managing payroll, tax compliance, and EVV under CCC Plus consumer direction is substantial. It's one of the core reasons Ankota's self-direction FMS platform exists — the paperwork that enables participant choice shouldn't become its own burden.

The MCOs: Who's Managing Your Care and What That Means

Once CCC Plus eligibility is established, participants enroll in one of Virginia's contracted managed care organizations. In 2026, the active MCOs in the CCC Plus program are Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Optima Health Community Care (operating under the Sentara brand), and United Healthcare Community Plan of Virginia. Availability varies by region — not all MCOs operate in every part of the state — and the service area maps are worth checking before making a selection.

What the MCO actually does is more than just manage billing. Your MCO assigns you a care coordinator — a person who conducts your initial care assessment, develops your care plan, authorizes services, monitors your care over time, and serves as your point of contact when something needs to change. The quality of that care coordination relationship matters. A good care coordinator knows the service options, advocates for appropriate authorizations, and catches problems before they become crises. A care coordinator who is carrying too large a caseload may be harder to reach when you need them.

Most families approach this with less information than they'd like, and the honest reality is that the MCOs are difficult to distinguish from the outside before you're in one. Asking your care agency, discharge planner, or social worker which MCOs they have the strongest working relationships with in your area is a reasonable shortcut. After enrollment, you have the right to switch MCOs once per year during an open enrollment period, or at any time if you have good cause.

One practical note: your home care agency or adult day provider needs to be contracted with your MCO to be reimbursed for your services. If you have a preferred provider, confirm their MCO contracts before you finalize your MCO choice. A mismatch here means either switching MCOs or switching providers — neither is painless.

How to Apply: The Real Step-by-Step

Here is the actual sequence, written for the way the process works in practice rather than the way it looks on a flow chart:

Step 1: Apply for Medicaid. If the person needing care is not already on Medicaid, apply through CommonHelp at commonhelp.virginia.gov or in person at your local DSS office. You'll need financial documentation — income, assets, bank statements, proof of residence. For elderly and disabled populations, the DMAS-96 form is the standard application. Expect the financial determination to take four to six weeks.

The Cardinal Care enrollment broker number is 1-800-643-2273 (Mon–Fri, 8:30am–6pm)

Step 2: Request aUAI — separately, at the same time. Don't wait for the Medicaid determination to start this. Contact your local DSS office and request a Uniform Assessment Instrument evaluation for long-term services and supports. This is the functional assessment that determines nursing facility level of care, and it has its own scheduling lead time. If you wait until after Medicaid is approved to request the UAI, you add weeks to the process unnecessarily.
  

Step 3: The UAI happens in the home. An assessor comes to wherever the person lives. The assessment typically takes an hour to ninety minutes. They'll ask about activities of daily living, cognitive status, medical conditions, medications, and the home environment. One piece of advice worth passing on: be honest about the hard days, not the good days. Assessors are trained to evaluate functional status, but if your family member is having a relatively good day and downplays their limitations, the assessment may not reflect the support they actually need.

Step 4: DMAS issues an eligibility determination. Once both the financial and functional criteria are documented, DMAS issues a formal eligibility determination and notifies the applicant of their CCC Plus eligibility and the 30-day window to choose an MCO.

Step 5: Choose your MCO. Use the resources above. Make provider contract calls. Pick the one that works for your situation.

Step 6: Care coordinator assignment and care plan development. Your MCO assigns a care coordinator, who contacts you to schedule an initial assessment and develop the care plan that authorizes your specific services. This is the conversation where consumer direction should come up — if it doesn't, ask.

Step 7: Services begin. Providers are authorized, schedules are set, and care starts.

Total timeline from first application to first caregiver visit: realistically eight to twelve weeks under normal circumstances, faster if both processes are started simultaneously and documentation is clean.

 Here's what I've learned watching thousands of CCC Plus cases move through agencies on our platform: the families who get to services fastest are the ones who started the Medicaid application and the UAI on the same day. The families who wait the longest are the ones who assumed those were the same process. That's not a knock on anyone applying. It's a design problem with how the front door is built, and it's the kind of friction we try to take out of the work for the agencies on the receiving end. - Ken Accardi, Ankota 

What's New and Relevant in 2026

CCC Plus is a mature program by 2026 — nine years in, past its rocky early-implementation phase, and operating with a level of institutional stability that wasn't there in 2018 or 2019. That stability matters because it means care coordinators are more experienced, provider networks are more developed, and the MCOs have more data on what works. Here's what's worth paying attention to in the current landscape.

Caregiver rate increases. Virginia's General Assembly has passed incremental rate increases for Medicaid home care workers over several consecutive legislative sessions, responding to the workforce shortage that affects every HCBS program in the country. By 2026, Virginia's personal care reimbursement rates are meaningfully higher than they were five years ago — not at private-pay parity, but trending in the right direction. This matters for participants because it affects the pool of caregivers willing to work under CCC Plus rates, and it matters for agencies because the margin conversation looks different than it did in 2020.

EVV is fully operational and monitored. Electronic Visit Verification — the requirement that home care visits be electronically verified in real time — has been mandatory under Virginia CCC Plus since the federal 21st Century Cures Act mandate took full effect. By 2026, EVV compliance is actively monitored by MCOs, and agencies with inconsistent EVV data face authorization and payment complications. If you're a home care agency serving CCC Plus members without a solid EVV workflow, this is not a future problem — it's a current one.

Telehealth in care coordination. MCOs have expanded the use of telehealth for care coordination check-ins and some clinical consultations, a shift accelerated by the pandemic and now embedded in standard practice. This means more flexibility for participants in rural areas where in-person coordinator visits required significant travel, and faster response times for routine care plan adjustments.

Continued prior authorization pressure. Prior authorization requirements under managed care remain one of the primary friction points for both providers and participants. Virginia has been working through DMAS and the MCO contracting process to reduce unnecessary authorization delays for established services — progress is incremental, but the direction is positive. Providers who document care plans clearly and maintain strong relationships with MCO care coordinators navigate this more smoothly than those who treat authorization as a back-office function.

Waiver renewal and federal oversight. Virginia's CCC Plus waiver operates under a federal approval that requires periodic renewal with CMS. The renewal process involves review of program outcomes, quality metrics, and compliance data. In a renewal year, families and providers may see temporary administrative changes or enhanced reporting requirements — checking DMAS announcements for the current renewal status is worth doing if you're planning around multi-year service continuity.

What Home Care Agencies and FMS Providers Need to Know

If you're operating a home care agency or fiscal/employer agent serving CCC Plus members in Virginia, the operational picture in 2026 is more complex than it was five years ago — and the agencies doing it well have built systems that reflect that complexity rather than papering over it.

EVV compliance is non-negotiable and actively enforced. Every home visit needs to be verified in real time with accurate location and timing data. Gaps, late submissions, or pattern anomalies trigger MCO review. The agencies with the fewest EVV complications are the ones whose caregivers understand why it matters and whose scheduling systems make compliant check-in the default behavior rather than an afterthought. Ankota's EVV platform is built for exactly this — EVV that works as part of the care workflow rather than as a separate step that caregivers resent.

Authorization tracking is where agencies most commonly lose revenue they've already earned. CCC Plus services are delivered against authorized hours, service codes, and date ranges. When a caregiver delivers a service outside the authorized parameters — wrong service code, expired authorization, hours above the approved level — that visit may not be paid. A scheduling and billing system that surfaces authorization status in real time, before the visit happens rather than after the claim is denied, is the operational difference between a well-run CCC Plus program and a billing reconciliation nightmare at the end of every month.

For FMS providers operating in the consumer-directed space, the administrative burden is distinct. You're managing payroll for participants' self-hired caregivers, handling tax compliance across a large variable workforce, maintaining EVV on visits that weren't scheduled by your organization, and satisfying MCO reporting requirements — all while keeping the participant experience simple enough that the whole point of consumer direction (participant control) doesn't get buried under paperwork. Ankota's self-direction FMS software was built for this operational reality, supporting FEAs who need to manage that complexity without it becoming the bottleneck that slows down care.

Multi-service providers — agencies that operate home care alongside adult day or other HCBS services — have a structural advantage in the CCC Plus environment that is worth actively leveraging. A participant whose care plan includes both personal care hours and adult day attendance is seen in two different service contexts each week. That means two independent windows into how they're doing, two opportunities to catch early signs of health changes or family stress, and two data points that can support a care coordinator's case for adjusted authorizations when needs change. The programs that operate these service lines on a single connected platform rather than siloed systems turn that visibility into a real care quality advantage.

Frequently Asked Questions

Ankota's mission is to enable the Heroes who keep older and disabled people living at home to focus on care because we take care of the tech. If you need software for home care, EVV, I/DD Services, Self-Direction FMS, Adult Day Care centers, or Caregiver Recruiting, please Contact Ankota. And if you're ready to see how the most innovative agencies are using AI to empower their caregivers and automate the rest, meet your new companion at www.kota.care.