What Is an Employer of Record in Virginia Consumer-Directed Care?

You have made the decision: your mother qualifies for Medicaid home care, and instead of an agency sending a rotating cast of aides, your family wants to hire the caregiver yourselves — maybe you, maybe your sister, maybe the neighbor she already trusts. Then the enrollment packet arrives, and a phrase you have never seen before is sitting on the first page: employer of record.

It sounds like paperwork jargon. It is actually the single most important role in Virginia's consumer-directed model, and choosing the wrong person for it is one of the most common reasons families stall out, lose hours, or get moved out of consumer direction entirely. Here is what the employer of record does, who is allowed to be one, and the handful of rules that decide whether the caregiver in your family actually gets paid.

What "employer of record" means in Virginia Medicaid

Virginia Medicaid pays for personal care and respite two ways. In the agency-directed model, a licensed home care agency employs the aide, schedules the shifts, supervises the work, and handles the payroll. In the consumer-directed model, that employer role moves to the family. As the Virginia Department of Medical Assistance Services (DMAS) puts it, consumer-directed services are a model "that empowers the member receiving services to employ an attendant to provide care."

Somebody has to be that employer on paper. That person is the employer of record, usually shortened to EOR. Medicaid still pays for the care, but the EOR is the one who hires the attendant, supervises them, approves their hours, and — if it ever comes to it — lets them go.

Three roles work together in this model, and families mix them up constantly:

• The employer of record (EOR) — hires, trains, supervises, and approves the attendant's time. Not a paid position.
• The fiscal employer agent (F/EA) — the state's contracted payroll agent. It enrolls the attendant, runs payroll, and handles employment taxes on the member's behalf.
• The services facilitator — the professional who trains the EOR, helps build the plan of care, visits regularly, and reviews the attendant's work shifts.

You are the boss. The F/EA is your payroll department. The services facilitator is your coach and your compliance check.

Who can be the employer of record?

The person receiving care serves as their own EOR whenever they are able to direct their own care. Plenty of Virginians on the CCC Plus Waiver do exactly that — they are physically limited but perfectly capable of hiring and managing an attendant.

When the person cannot direct their own care — advanced dementia, a serious stroke, a cognitive disability — they designate someone else, who must be an adult, to serve as EOR on their behalf. In practice that is usually an adult child, a spouse, a sibling, or a close family friend. If the person receiving care is a minor, a legally responsible individual serves as the EOR.

The rule that surprises almost everyone

Virginia regulations state plainly that the EOR "shall be prohibited from also being the Medicaid-reimbursed consumer-directed attendant for respite or personal care or the services facilitator for the individual" (12VAC30-120-935). In other words: you cannot be both the paid caregiver and the employer of record. One person cannot sign their own timesheets.

This is where families get stuck, and it is worth thinking through before you apply. If you are the one who wants to be paid to care for your dad, then your dad serves as EOR if he can direct his own care — or another relative steps in as EOR if he cannot. If you are caring for a parent with advanced dementia and you are the only relative involved, you have a real decision to make: find another trusted adult willing to take on the EOR role, or use the agency-directed model instead, where the agency carries all of it.

There is no shame in the second answer. Consumer direction gives you control; it also gives you an employer's responsibilities, and it genuinely does not fit every family.

What the employer of record is responsible for

Virginia spells out the EOR's duties, and DMAS publishes a full Consumer-Directed Employer of Record Manual that walks through each one. The core responsibilities are:

• Recruiting, interviewing, and hiring the attendant — including checking references and confirming they meet the basic qualifications.
• Completing EOR management training with the services facilitator before an attendant can be hired for Medicaid reimbursement.
• Training and supervising the attendant against the approved plan of care.
• Submitting and approving work shifts to the fiscal employer agent consistently and on time.
• Keeping a back-up plan for the days the attendant calls out, gets sick, or takes vacation. This is a requirement, not a suggestion.
• Ending the employment relationship if the arrangement is not working.

Two things the EOR is not: paid, and alone. The role itself carries no Medicaid reimbursement — the attendant is paid for hours worked, the EOR is not paid for managing them. But the services facilitator is assigned to support you, and a good home care team will walk you through every form the first time.

Who actually issues the paycheck

The fiscal employer agent does. It administers payroll on behalf of the member, handles the employer's salary payment and tax reporting functions for the attendant, and processes the attendant's enrollment paperwork. DMAS, its contractor, or the F/EA also requests the criminal record check on the consumer-directed attendant and reports the findings back to the EOR.

Which F/EA your family works with depends on the plan your loved one is enrolled in, so confirm it with your health plan or on the DMAS consumer-directed services page rather than assuming. The important part for you is the sequence: the attendant records their hours, you approve them, the F/EA pays and withholds. Nobody gets paid for time that was never approved.

Where the services facilitator fits

You do not have to figure this out cold. The services facilitator makes an initial comprehensive home visit, helps build the plan of care, and provides EOR management training within seven days of that visit. After that, you agree together on a visit schedule — routine visits happen at least every 90 days — and the facilitator conducts a face-to-face reassessment every six months to review how the services are working.

The facilitator also reviews work shift entries against the hours approved in the plan of care. If something does not line up, they are required to raise it with you and notify the fiscal employer agent. Treat them as an ally: it is far better to hear "these hours look off" from your facilitator than to find out at payroll.

Five mistakes that cost Virginia families money

1. Starting care before the authorization is in place. Services provided before Medicaid authorizes them are not reimbursable — and the family can be left owing the attendant for that time.
2. Submitting shifts late. Under DMAS's consumer-directed work shift requirements effective January 1, 2025, shifts must be submitted within 30 calendar days of the date the service was provided, with narrow exceptions for things like pending background checks or enrollment delays.
3. Billing hours during a hospital or nursing facility stay. Consumer-directed attendant services are not reimbursed while your loved one is admitted, and you are expected to notify the services facilitator of any admission.
4. Having no back-up plan. When the attendant is out and there is no plan, care gaps put your loved one at risk — and an unworkable back-up plan can make someone ineligible to continue in consumer direction.
5. Approving shifts carelessly. A pattern of discrepancies in the attendant's work shift entries, or ongoing non-compliance with EOR requirements, can lead to involuntary disenrollment from consumer direction and a transfer to agency-directed care.

None of these are traps. They are all avoidable with a calendar reminder and one honest conversation about who has the time to do this job well.

Is consumer direction the right fit for your family?

Consumer direction is the right call when you want to choose the caregiver, set the schedule around your family's life, and keep the money inside the household. It asks for administrative follow-through in return: hiring, supervising, approving time, and keeping records — every week, indefinitely.

If you are weighing the two, our comparison of agency-directed and consumer-directed care in Virginia lays out the trade-offs side by side. It is also worth knowing how the hours themselves are set before you commit — our guide to how many hours a week a family caregiver can be paid in Virginia covers the limits that apply to a single attendant, and our walkthrough of the Virginia Medicaid LTSS screening explains the assessment that determines eligibility in the first place.

A Virginia note before you act

Everything above reflects Virginia's consumer-directed rules for Medicaid waiver services such as the CCC Plus Waiver under Cardinal Care. Program requirements, forms, and the assigned fiscal employer agent can change, and your loved one's health plan may add its own steps. This information is for general guidance only and isn't legal or medical advice — program rules and figures change, so confirm current details with the DMAS consumer-directed services page linked above or with our team.

How Godaelli helps

Godaelli Home Care works with Northern Virginia families through this exact moment every week. We help you figure out who in your family should be the employer of record, what that person is signing up for, and whether consumer-directed services in Virginia or an agency-directed arrangement fits your situation better. If your family needs coverage while you sort it out — or a break once you are up and running — we also provide respite care across Alexandria, Arlington, Fairfax, Loudoun, Prince William, and beyond.

If you are staring at an enrollment packet and are not sure who should sign where, reach out to our team. Call 703-870-0738 or email care@godaellihomecare.com, and we will walk you through it — no cost, no pressure.