What Tasks Can a Paid Caregiver Do Under Virginia Medicaid?

The short answer: your loved one's Plan of Care decides

If a family member is about to be paid as a caregiver through Virginia Medicaid, this is usually the first practical question that comes up: what exactly am I allowed to do, and what am I not getting paid for? It matters, because the honest answer surprises most families. The program pays for help with your loved one — not for running their household, and not for keeping them company.

Every paid task flows from one document: the Plan of Care, recorded on the DMAS-97A/B form by the agency nurse or the services facilitator. If a task is on that plan, it is billable. If it isn't, it isn't — no matter how badly it needs doing. Below is what Virginia's CCC Plus Waiver rules actually allow a personal care aide or consumer-directed attendant to do, what they clearly exclude, and the handful of special rules that trip families up.

What a paid caregiver can do

Virginia's Department of Medical Assistance Services (DMAS) publishes an explicit list of allowable activities for personal care services in its CCC Plus Waiver provider manual. It groups roughly into four buckets.

1. Hands-on help with activities of daily living

This is the core of the job, and the reason the waiver exists. Covered ADL assistance includes:

• Bathing or showering
• Toileting and continence care
• Dressing
• Transferring — helping someone move from bed to chair, or stand up safely
• Assistance with eating
• Routine skin care, such as applying lotion to dry skin (nothing with an active ingredient)
• General support to keep the person safe

These tasks also drive how many hours get authorized. The screening and assessment score how dependent your loved one is across bathing, dressing, transfers, ambulation, eating and continence, and that score sets the level of care — which is why two families in similar circumstances can end up with very different weekly hours. We break that down in our guide to how many hours a week a family caregiver can get paid in Virginia.

2. Meals, housekeeping and errands — within limits

Instrumental activities of daily living (IADLs) are covered, but only the ones tied to your loved one's own care needs and written into the Plan of Care. DMAS gives examples: making the bed, dusting, vacuuming, laundry and grocery shopping. Meal preparation is covered along with cleaning the dishes and the eating area — for your loved one's meal.

The boundary is the part families miss. The manual limits this work to "those areas that are affected by the individual's direct use," and specifically to tasks not already expected of a primary caregiver who lives in the home. In practice that means cleaning your mother's bedroom and bathroom, washing her laundry, and cooking her lunch. It does not mean cleaning the family room everyone uses, or cooking dinner for four.

There's a volume limit too: DMAS states that only in very unusual, specifically documented circumstances would a Plan of Care include more than two hours per day of housekeeping and meal preparation combined. If an aide's day is mostly chores, something is off in the plan.

3. Health-related tasks — "special maintenance"

An aide is not a nurse, but a defined set of health tasks can be included in the plan, some of them only after a nurse has trained and delegated them. These include:

• Checking temperature, pulse, respiration and blood pressure, and recording the results
• Monitoring health status and physical condition
• Assisting with self-administered medication — never determining a dose, never administering it
• Routine, non-sterile wound care under an RN's instruction, with a physician's order
• Range-of-motion exercises, with a physician's order and hands-on training from the supervising RN
• Routine catheter care, after the RN documents that the aide was trained
• A bowel program, under nurse delegation and a current physician order, with significant exceptions

Each of these carries conditions. Range-of-motion, for example, means maintaining current movement without resistance — not strengthening or muscle retraining. Wound care means washing, drying and applying a dry dressing, not creams, ointments, sprays or occlusive dressings.

4. Getting out of the house

A paid caregiver can accompany your loved one to medical appointments and to social, recreational and community activities when personal care is needed along the way. In the agency-directed model, the agency's RN supervisor has to approve that. Aides can also work up to 16 hours in a calendar day, and must be awake for the entire shift — relevant for anyone considering overnight coverage.

What Virginia Medicaid will not pay a caregiver to do

Work for the rest of the household

DMAS is blunt about this: it pays only for services rendered to the waiver individual, not for services rendered to, or for the convenience of, other members of the household. The manual lists the examples outright — cleaning rooms used equally by everyone, cooking meals for the family, washing the family's dishes, doing the family's laundry. None of it is billable, even when you are the one doing all of it anyway.

Sitting and keeping company

This one genuinely catches people off guard. The manual states that social time cannot be used for an attendant to sit with or socialize with the individual at home. Supervision is a separate, narrowly defined component of personal care for people who meet specific criteria — it is not the same as companionship. If what your loved one most needs is presence, conversation and a reason to stay engaged, that is companion care, which is not one of the CCC Plus Waiver's covered services. It's typically arranged privately or alongside waiver hours.

Skilled nursing tasks

Personal care and respite services cannot include practical or professional nursing as defined in Virginia's Nurse Practice Act, except for specific tasks an RN has formally delegated under the Virginia Board of Nursing's delegation rules. Enemas and laxatives are off-limits even as part of an approved bowel program. Removing impacted material and digital stimulation must be done by a qualified health professional. If your loved one needs that level of care, the waiver's answer is private duty nursing, not a higher-paid aide.

Three special rules families ask about

If you're a spouse, or the parent of a child under 18

Virginia treats spouses, and parents or legal guardians of a minor, as "legally responsible individuals" (LRIs), and the rules for them are narrower. An LRI can be hired as a paid caregiver when the care needed is extraordinary — above and beyond what someone of that age would ordinarily need — and DMAS caps LRI reimbursement at 40 hours per week per minor child. Critically, LRIs are not reimbursed for IADL or supervision time at all. Their paid hours are hands-on care only.

One important clarification: a parent caring for an adult child is not an LRI under these rules, so the narrower LRI restrictions don't apply. Because this area has changed in recent years, confirm the current rules with DMAS or with us before you plan around them.

If two people in the home need care

When two household members receive personal care through the same agency or the same services facilitator, DMAS requires IADL tasks — meal prep, cleaning, laundry, shopping — to be done for both at the same time. Each person gets their own Plan of Care with separate ADL hours and shared IADL hours. Choose separate agencies and the hours are not shared.

If your loved one works or goes to school

Receiving waiver services doesn't mean staying home. An aide may go with your loved one to a job or to post-secondary school to help with personal care needs there. What DMAS won't pay for is the aide helping with the job or coursework itself, or general supervision during those hours — except where physical assistance is needed because of the disability.

A Virginia-specific note

Everything above comes from Virginia's own CCC Plus Waiver rules — the DMAS provider manual and the covered-services regulation at 12VAC30-120-924. Those rules are revised regularly, and your managed care plan and services facilitator apply them to your specific situation. 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 official DMAS CCC Plus Waiver page or our team.

One practical takeaway: if a task genuinely matters to your loved one's health or safety and it isn't on the Plan of Care, don't just absorb it quietly. Raise it at the next review. Plans can be rewritten whenever needs change, and a well-documented plan is the difference between unpaid work and paid work.

How Godaelli helps

Godaelli Health Care Services supports Northern Virginia families on both sides of this. If you want to be the paid caregiver, our consumer-directed care team helps you get through enrollment and makes sure the Plan of Care reflects the care you're actually providing — so your hours are authorized, documented and paid without surprises. If you'd rather hand the hands-on work to a trained, supervised aide, our personal care services cover Alexandria, Arlington, Fairfax, Loudoun, Prince William, Woodbridge, Stafford and the surrounding communities.

Either way, you shouldn't have to decode a provider manual to find out what you're entitled to. Get in touch with our team, call 703-870-0738, or email care@godaellihomecare.com, and we'll walk through your loved one's situation and what their plan should cover.