Self-Direction and FMS in Virginia
All states: self-direction map
In short: Consumer direction runs through two Fiscal/Employer Agents, CDCN and PPL, assigned by health plan; all attendants must use the agent's EVV app or IVR. Change ahead: The state has said EVV compliance penalties for consumer-directed attendants will not start before January 1, 2027. The penalty terms are not published.
Virginia self-direction at a glance
| Self-directed programs | CCC Plus Waiver, Community Living Waiver, Family and Individual Supports Waiver, EPSDT and Medicaid Works |
|---|---|
| FMS model | Fiscal/Employer Agent (F/EA) |
| FMS vendors | Two, assigned by payer: Consumer Direct Care Network (CDCN) and Public Partnerships LLC (PPL) |
| Who is the employer | The member or a designated Employer of Record (EOR) |
| Can family be paid | Yes, with limits. Spouses and parents or guardians of minors only for extraordinary care, up to 40 hours a week. The EOR cannot be the paid attendant. |
| EVV for self-directed workers | Yes. Every attendant, live-in included, clocks in and out on the F/EA's mobile app or phone line. |
| Budget authority | Not found. Hours are set in the plan of care and paid at the state rate. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Virginia offer self-direction?
Virginia offers self-direction in five places: the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, the Community Living Waiver, the Family and Individual Supports Waiver, and as an option under EPSDT and Medicaid Works. The state calls it consumer direction, or CD. Only three services can be consumer directed: personal care (called personal assistance in some programs), respite and companion services. In every program the member, or a person named to act for the member, hires and manages the attendants.
- CCC Plus Waiver, consumer-directed personal care, respite and companion: a 1915(c) waiver that serves older adults, people with physical disabilities, and people who would otherwise need nursing facility or long-stay hospital care. The Department of Medical Assistance Services (DMAS) runs it, and Cardinal Care managed care plans deliver it for their enrolled members. The member has employer authority. Members may combine agency-directed and consumer-directed care.
- Community Living (CL) Waiver, consumer-directed personal assistance, respite and companion: a 1915(c) Developmental Disability waiver that serves children and adults with developmental disabilities who usually need in-home supports at all times. DMAS runs it jointly with the Department of Behavioral Health and Developmental Services (DBHDS), and Community Services Boards are the entry point. The individual has employer authority.
- Family and Individual Supports (FIS) Waiver, consumer-directed personal assistance, respite and companion: a 1915(c) Developmental Disability waiver that serves children and adults with developmental disabilities who live with family, with friends or in their own homes. DMAS and DBHDS run it jointly, with Community Services Boards as the entry point. The individual has employer authority.
- EPSDT consumer-directed personal care: serves children and youth under 21 who qualify for personal care through Early and Periodic Screening, Diagnostic and Treatment. DMAS runs it, with Cardinal Care plans for enrolled members. A minor must have another person serve as the employer.
- Medicaid Works consumer-directed personal assistance: serves working adults with disabilities enrolled in the Medicaid Works benefit. DMAS runs it. The DMAS consumer-directed fact sheet confirms the option exists, and we found little other published detail.
Employer authority means the member recruits, hires, trains, supervises and, if needed, dismisses the attendants. Budget authority would mean the member also manages a set amount of money. The sources we read describe employer authority only: hours are authorized in the plan of care and paid at the DMAS fee schedule rate. We did not find a participant-managed budget described for any Virginia program, and we did not read the approved waiver documents, so ask DMAS before relying on that point. The third Developmental Disability waiver, Building Independence, is not listed as offering consumer direction.
Who handles financial management services (FMS) in Virginia?
Two companies handle financial management services for Virginia consumer direction: Consumer Direct Care Network (CDCN) and Public Partnerships LLC (PPL). Virginia uses a Fiscal/Employer Agent (F/EA) model, which means the F/EA runs background checks, payroll and employer taxes while the member or a designated Employer of Record stays the legal employer. The F/EA is tied to who pays for the member's care, so members are assigned an F/EA and do not pick one.
A Fiscal/Employer Agent is the organization that handles the paperwork side of being an employer. According to the DMAS fact sheet, it provides pre-employment background checks, processes shift entries and payroll, and files and pays state and federal employer taxes on behalf of the employer. Virginia regulation defines the F/EA as a state agency or other entity designated by DMAS and paid by DMAS under a contract or interagency agreement.
- Legal employer: the member, or a designated person called the Employer of Record (EOR). A minor, or a member who cannot manage the role, must have another person serve as EOR.
- CCC Plus Waiver, fee-for-service members: CDCN, since January 1, 2019.
- CCC Plus Waiver, managed care members: the DMAS Consumer Directed Services page assigns PPL to Anthem and UnitedHealthcare members, CDCN to Sentara members, and both PPL and CDCN to Aetna members.
- Developmental Disability waivers (CL and FIS) and EPSDT: CDCN lists these among the Virginia programs it serves on its services page. We did not find a DMAS page that names the F/EA for these programs.
- Medicaid Works: we did not find a source that names the F/EA.
Some points could not be confirmed. The DMAS page does not list Humana Healthy Horizons, and we did not find a state statement of which F/EA serves Humana members. We also did not find how Aetna members are divided between the two agents, or which F/EA serves EPSDT members in the plans assigned to PPL. For any of these, ask the member's health plan or the DMAS Office of Community Living at CDSF@dmas.virginia.gov.
In the Developmental Disability waivers a services facilitator is optional. A services facilitator is a paid helper who supports the employer with the consumer-directed role. If none is used, a family member or caregiver other than the EOR does those duties without pay.
Who can be a paid caregiver under self-direction in Virginia?
Relatives can be paid attendants in Virginia, with limits. Spouses and the parents or legal guardians of minors, which the state calls legally responsible individuals (LRIs), can be paid in the CCC Plus, Community Living and Family and Individual Supports waivers only for extraordinary care with activities of daily living, and for no more than 40 hours a week. The Employer of Record cannot also be the paid attendant.
Important: The published Virginia regulations (12VAC30-120-935 and 12VAC30-122-460) still say that spouses and parents or guardians of a minor are not reimbursed. The 2025 waiver amendments and the DMAS LRI page allow it under the extraordinary care conditions. Check current DMAS guidance before relying on the regulation text alone.
- Legally responsible individuals (CCC Plus, CL and FIS waivers): an LRI may be paid only for extraordinary care with activities of daily living, not for instrumental activities such as housekeeping or for supervision, and must meet the same requirements as any other attendant. The procedures took effect July 1, 2025, after federal approval of the waiver amendments on April 17, 2025, according to a DMAS bulletin.
- Hours and reviews for LRIs: the DMAS LRI page sets a limit of 40 hours a week, counted per child when the LRI is paid for more than one child. Respite is not available when a paid LRI provides the personal care, and services for a minor are reviewed every 90 days.
- Who is the employer when an LRI is paid: someone else must be the Employer of Record. It may be another LRI, such as the other parent or a step-parent. A services facilitator must be chosen, and a DMAS-95B questionnaire is completed for the EOR.
- Other family in the CCC Plus Waiver: family members who live in the member's home are paid for personal care or respite only when written documentation shows no other provider is available.
- Other family in the CL and FIS waivers: relatives may be paid for personal assistance if they meet all of the assistant qualifications.
- EPSDT and Medicaid Works: we did not find a statement on whether legally responsible individuals can be paid in these two programs. The DMAS bulletin covers only the three waivers. Ask DMAS at CDLRI@dmas.virginia.gov.
On hours, the CCC Plus regulation pays a single consumer-directed attendant the regular rate for up to 40 hours a week and one and a half times the regular rate for up to 16 more hours, unless the attendant is exempt from overtime under the federal Fair Labor Standards Act. We did not find a current DMAS statement on overtime for live-in attendants, so confirm that with the F/EA.
Does EVV apply to self-directed workers in Virginia?
Yes. Electronic visit verification (EVV) applies to consumer-directed attendants in Virginia, and since October 1, 2026 that includes live-in attendants and paid legally responsible individuals. Attendants clock in and out of each shift on their F/EA's mobile app or its phone system (IVR). A shift typed into the F/EA web portal does not count as EVV compliant.
- Whose system: each F/EA supplies its own tools. CDCN uses the CareAttend mobile app, which replaced CellTrak on January 1, 2025, and a CareAttend IVR line. PPL uses the Time4Care mobile app and an IVR line, and tells attendants that GPS must be on at clock-in and clock-out.
- Live-in attendants: the live-in exemption ended on October 1, 2026 under the 2026 Appropriation Act. A DMAS bulletin says no waiver amendment was needed.
- Does pay depend on it: DMAS's EVV page says attendants must follow EVV rules to be paid for approved care, that the EOR is responsible for attendant compliance, and that attendants who do not comply may no longer be eligible to work in the consumer-directed model. DMAS has also said there will be no compliance penalties before January 1, 2027, and it has not published what the penalties will be.
- Time limits: since January 1, 2025 attendants must document tasks for each shift and submit worked time to the F/EA within 30 days of the date of service to be eligible for payment, with listed exceptions.
We did not find EVV details written specifically for EPSDT or Medicaid Works attendants, although the DMAS rule says it covers all attendants. For EVV questions, write to EVV@dmas.virginia.gov or ask the F/EA.
What is changing next for self-direction in Virginia?
The item to watch is EVV enforcement. DMAS has said that compliance penalties for consumer-directed attendants will not start before January 1, 2027. That date is a floor, not a confirmed start date, and the penalty terms have not been published.
The statement appears in a DMAS one-page summary of the rule that every attendant must use the app or IVR. We did not find whether penalties would mean unpaid shifts, removal of an attendant or something else, or when they would begin. Until DMAS publishes the terms, the safest reading is that every shift should already be recorded by app or IVR, since the requirement itself has been in effect since October 1, 2026. Employers of Record and attendants should watch for notices from DMAS and their F/EA.
We did not find a published procurement or planned change of F/EA vendor as of the last check. The state procurement portal was not searched directly, so this is not a confirmed absence. Ask DMAS if a vendor change would affect your planning.
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Who to ask about self-direction in Virginia
Questions about self-direction in Virginia are best put to the state. Start with DMAS Consumer Directed (CD) Services. Published contact: CDSF@dmas.virginia.gov (DMAS Office of Community Living); CDLRI@dmas.virginia.gov for legally responsible individual questions; EVV@dmas.virginia.gov for EVV.
Virginia self-direction sources
- DMAS: Consumer Directed (CD) Services
- DMAS: Consumer-directed model fact sheet (March 2025)
- DMAS: Legally Responsible Individuals
- DMAS bulletin: legally responsible individuals as paid attendants (August 2025)
- DMAS: Electronic Visit Verification
- DMAS: EVV FAQ (revised August 28, 2026)
- DMAS bulletin: EVV live-in requirement effective October 1, 2026
- DMAS: EVV live-in requirements one-pager (August 2026)
- Virginia Administrative Code 12VAC30-120-935 (CCC Plus Waiver consumer direction)
Related reading
- Top 5 Challenges for Virginia Medicaid Home Care Agencies
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- Self-direction in every state (map)
- Virginia EVV requirements
Page history
- October 13, 2026: Page rewritten and checked against state sources.
This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.
Ankota provides software for FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
