What Is Consumer-Directed Care?

Consumer-Directed care is a model of in-home care where the person receiving care chooses and manages their own caregiver. In Virginia, it is available through the CCC Plus Waiver — the Medicaid program that funds in-home care for people who would otherwise need to live in a nursing facility.

Under this model, a family member or friend can be hired as the paid caregiver.

How Consumer-Directed Care Differs From Agency Care

Virginia Medicaid offers two ways to receive in-home care through the CCC Plus Waiver.

Under agency-directed care, a licensed home care agency assigns a caregiver and manages the administrative process.

Under Consumer-Directed care, the person receiving care or a designated representative acts as the Employer of Record. They choose their own caregiver, set the schedule, and manage the working relationship directly. It also opens the door to hiring a family member or friend as the paid caregiver.

Some families prefer the agency model because it reduces the administrative responsibility placed on the household.

For a full comparison of both models, see: Agency Care vs. Consumer-Directed Care — Which Is Right for You?

The Employer of Record

The Employer of Record is responsible for:

• Choosing the caregiver
• Setting the work schedule
• Reviewing and approving timesheets
• Managing the caregiving relationship day to day

If the person receiving care cannot manage these responsibilities themselves, a family member or trusted representative can serve as the Employer of Record on their behalf. This person will receive training from the CD services facilitator to learn how to perform these duties.

The Payroll Company

The Employer of Record does not handle payroll directly. That is handled by a payroll company called the Fiscal/Employer Agent, or F/EA. The F/EA pays the caregiver directly.

The caregiver enrolls with the F/EA before the first paycheck is issued. Enrollment includes a background check, payroll forms, and setup of the time-tracking system used to record shifts.

The Services Facilitator

After Consumer-Directed care is approved, the Employer of Record selects a Services Facilitator from the approved provider list. For more information, see: Find a Virginia Medicaid provider.

The Services Facilitator:

• Conducts an in-home assessment
• Develops the care plan — a written document that lists the approved tasks and hours
• Submits the request for approved care hours to the person's Medicaid health plan
• Provides ongoing support to the Employer of Record

The Services Facilitator does not choose the caregiver, manage the caregiver's schedule, or arrange backup coverage.

The Caregiver

Under Consumer-Directed care, the caregiver can be a family member, friend, neighbor — or anyone as long as they are over 18, pass a background check, and can perform the tasks listed in the care plan.

In Virginia, a spouse can be a paid caregiver under the CCC Plus Waiver. A parent can also be paid to care for a minor child who qualifies for the CCC Plus Waiver.

For more on who can be a paid caregiver, see: Can You Really Get Paid to Care for Family or Friends in Virginia?

How Caregiver Pay Works

The caregiver's pay rate is set by Virginia Medicaid. The Employer of Record approves timesheets, and the F/EA processes payment on a regular payroll schedule.

Caregivers record their hours through the F/EA's app or website after each shift. The system records the time, location, and tasks completed. Hours not recorded this way are not reimbursed.

For current pay rates, see: What Virginia Caregivers Actually Earn

What Consumer-Directed Care Does Not Cover

Consumer-Directed care pays for personal care and respite care hours approved in the care plan. It does not pay for:

• Hours worked outside the approved schedule
• Medical or skilled nursing care
• Room and board
• Care provided before caregiver enrollment is complete