What If Someone's In-Home Care (CCC+) Application Is Denied in Virginia?

If someone was denied CCC+ in-home care, it means Virginia determined the person does not meet the required level of care for services.

You can either:

• Appeal the denial
• Request a new screening if care needs have increased

Why Was CCC+ In-Home Care Denied?

Most denials happen because the screening determined the person does not require nursing-facility level care. Virginia approves CCC+ personal care hours only if the individual:

• Needs help with activities of daily living (ADLs) such as bathing, dressing, toileting, or eating (learn more about ADLs: Activities of Daily Living (ADLs))
• Requires ongoing supervision due to cognitive impairment
• Has medical needs that require regular assistance

How to Appeal a CCC+ Denial

You have 30 days from the date on the denial notice to request a fair hearing. You can request a hearing:

• Online through the Virginia Medicaid Appeals (AIMS) portal
• By phone at 804-371-8488
• By email at appeals@dmas.virginia.gov
• By fax at 804-452-5454

Appeal if:

• The screening did not reflect the person's actual limitations
• Medical information was missing that should have been taken into account
• The assessment report understated how much assistance is required

When to Request a New Screening Instead

If the person's condition has worsened since the original assessment, you can request a new screening. A new screening makes sense when:

• Mobility has declined
• Memory or supervision needs have increased
• Medical needs have changed

What This Means for Paid Family Caregiving

Paid caregiving through CCC+ only begins after in-home care is approved.

If CCC+ services are denied, caregiver pay cannot begin unless:

• The denial is overturned on appeal, or
• A later screening approves in-home care