What Is Medicaid and How Does It Help Caregivers

Medicaid is a government health coverage program for people with low income or a qualifying disability. In Virginia, it also funds long-term in-home care — and it can pay a family member or friend to provide that care.

What Medicaid Is

Medicaid is not private insurance. It is not Medicare. It is a joint program funded by the federal government and independently funded / administered in each state.

The federal government sets the basic rules, but each state has its own guidelines. Medicaid covers a range of health services — doctor visits, prescriptions, hospital care, and for eligible individuals, long-term in-home care.

For a comparison of Medicaid and Medicare, see: Medicare vs. Medicaid — What Caregivers Need to Know

Who Medicaid Is For

Medicaid is for people who meet Virginia's income and savings limits and have a qualifying medical need. Age alone does not determine eligibility.

The person receiving care must qualify for Medicaid. The caregiver does not need to meet income or savings limits.

To find out whether someone meets Virginia's eligibility requirements, see: How to Qualify for Medicaid in Virginia (Who Is Eligible?)

How Medicaid Funds In-Home Care

Not every Medicaid enrollee receives in-home care. Standard Medicaid covers medical services. In-home personal care is funded through a separate program called a Medicaid waiver.

A waiver is a state-run program that allows Medicaid dollars to pay for care at home instead of in a nursing facility. The waiver relevant to family caregivers providing in-home care in Virginia is the CCC Plus Waiver.

What the CCC Plus Waiver Does

The CCC Plus Waiver funds in-home care for people who require a nursing-facility level of care. It covers services like personal care, respite care, and adult day health care.

Inside the CCC Plus Waiver, there are two ways care can be delivered.

Consumer-Directed care — The person receiving care, or a designated representative acting as the Employer of Record, hires and manages their own caregiver. That caregiver can be a family member or friend. Pay is processed through a Fiscal/Employer Agent (F/EA).

Agency-directed care — A licensed home care agency assigns a caregiver and manages scheduling and administration.

Some families prefer to work with a home care agency that coordinates caregivers and handles administrative setup. This can simplify the process, but it may reduce the caregiver's hourly pay compared to managing Consumer-Directed care directly.

For more on how these two models compare, see: Agency Care vs. Consumer-Directed Care — Which Is Right for You?

For a full explanation of Consumer-Directed care, see: What Is Consumer-Directed Care?