What Does a Services Facilitator Do in Virginia Consumer-Directed Care?

The third name in your consumer-directed paperwork

You chose consumer direction so your family could pick the caregiver — maybe you are the caregiver. Then a title you have never heard shows up in the packet: your services facilitator. Someone is going to visit your mother's home, write a plan of care, and keep coming back every few months, and nobody has explained why.

Here is the short version. In Virginia's CCC Plus Waiver, consumer-directed personal care and respite require a services facilitator — it is not an optional add-on you can decline. But the facilitator is not your boss, and they are not the payroll company. They are the person Medicaid pays to make sure the family running the care knows how to be an employer, and that the plan on paper still matches what is happening in the house. This guide covers what yours actually does, what they are not allowed to do, how often you should see them, and how to switch if the relationship isn't working.

What a services facilitator is

A services facilitator (you will see it abbreviated "SF") is an enrolled Medicaid provider — sometimes an individual, sometimes a company — whose job is to give the training and guidance a family needs to employ a caregiver under consumer-directed care in Virginia. The Virginia Department of Medical Assistance Services (DMAS) spells the role out in the CCC Plus Waiver provider manual, which anyone can read in the DMAS provider manuals library.

It helps to see the three roles side by side, because families mix them up constantly:

• The employer of record (EOR) — you, or the family member designated to act on your loved one's behalf. You hire, train, schedule, supervise, and if necessary fire the attendant. We cover that role in depth in our guide to what an employer of record does in Virginia.
• The fiscal/employer agent (F/EA) — the payroll company DMAS contracts with. It processes work shifts, issues the attendant's pay, withholds and files employment taxes, and keeps the payment records on the employer's behalf.
• The services facilitator — the one who assesses needs, writes the plan of care, trains the employer of record, visits the home on a set schedule, and tells the authorizing entity when the plan needs to change.

Do you have to have one?

For the CCC Plus Waiver, yes. DMAS's provider manual states plainly that all consumer-directed services must be service-authorized and require the services of a facilitator. There is no version of consumer direction under this waiver where a family simply handles everything alone.

One related rule catches people off guard: services facilitation by itself does not keep someone enrolled in the waiver. The waiver requires at least one "standalone" service — personal care, respite, adult day health care, or private duty nursing — delivered at least once every 30 days. A long gap with no attendant hours can put eligibility at risk, so tell your facilitator early if care is about to pause.

Virginia's developmental disability waivers (Community Living and Family & Individual Supports) are written differently, and the facilitator's role there is not identical. If your family is in a DD waiver rather than CCC Plus, confirm the rules that apply to you with your support coordinator.

What your facilitator does before care starts

The comprehensive home visit

Before any attendant starts a paid shift, the facilitator must make an initial comprehensive visit — in the home, in person. They look at the actual living space, work with you and your loved one to identify every support need, decide whether consumer direction is a safe fit, and build the plan of care from what they find. That plan is the document everything else is measured against, so this is the visit to prepare for. Make a list of the hard days, not the good ones.

Employer training within seven days

After the comprehensive visit, the facilitator has seven days to deliver face-to-face training to whoever is serving as employer of record, using the DMAS Consumer-Directed Employer of Record Manual and a required training checklist. You will sign participation agreements acknowledging your legal responsibilities as an employer, and those signatures have to be in place before your attendant can be employed in the program.

A detail that surprises nearly every family: the facilitator trains you, not your caregiver. Training the attendant on how your mother likes to be transferred, what time her medications are set out, which stairs she struggles with — that is the employer of record's job, and the facilitator is specifically not permitted to do it for you.

What they do once your caregiver is working

Visits on a schedule, always in person

After the comprehensive visit, DMAS recommends two routine in-home visits during the first 60 days while the family finds its footing. From there, the facilitator must meet face to face with your loved one at least every 90 days, and conduct a fuller reassessment at least every six months.

These visits cannot be done by phone or video. DMAS has been explicit about it — all CCC Plus services facilitation visits must be face-to-face, because the facilitator needs to see the home. If yours keeps proposing a phone call instead of a visit, that is not a scheduling preference; it is outside the rules.

Checking the work against the plan

At least quarterly, your facilitator reviews the attendant's submitted work shifts and documented tasks against the approved plan of care. If the hours or the tasks don't line up, they come back to you to sort it out — and if the mismatch is because your loved one's needs have genuinely changed, that is the trigger to revise the plan and request different hours. Hours above the program's standard weekly limit require specific documentation, which we explain in our post on how many hours a week a paid caregiver can work in Virginia.

Electronic visit verification

In an August 2025 bulletin on consumer-directed services facilitation requirements, DMAS reminded facilitators that electronic visit verification applies to every attendant except those who live with the member, and that attendants who don't live in must clock in and out using the fiscal agent's mobile app or phone system. The same bulletin warns that a member or employer of record who refuses to comply with EVV must be referred to agency-directed services. In other words, EVV is not paperwork you can quietly skip — it is a condition of staying in the consumer-directed model.

Being reachable

Your facilitator is required to be available by phone during normal business hours, to have voicemail, and to return your call within one business day. They are also mandated reporters, which means suspected abuse, neglect, or exploitation goes to Adult or Child Protective Services.

What a services facilitator does not do

• They don't supervise your caregiver. The manual is blunt: the facilitator has no authority in hiring or firing attendants, and the employer of record is solely responsible for supervision.
• They don't pay anyone. Payroll, taxes, and pay dates belong to the fiscal/employer agent.
• They can't be your employer of record — or your paid attendant. Those roles are kept separate on purpose, so no one is reviewing their own work.
• They don't train the attendant. See above. That one is on you.

If what your family actually wants is someone to recruit, train, supervise, and cover a no-show shift, that is agency-directed care, not consumer direction with a facilitator attached. Plenty of Virginia families switch models once they see the difference clearly — and switching is allowed.

Questions worth asking before you pick one

You get to choose your facilitator, and the choice matters more than families expect. Before you sign on, ask:

1. Are you enrolled with my loved one's health plan? If they are in a Cardinal Care managed care plan, that plan handles service authorization, and your facilitator has to be set up to work with it.
2. How quickly do you submit authorization requests and reauthorizations? This is the question that protects your paycheck. DMAS has warned facilitators that late authorization requests can leave an attendant unpaid for work already done.
3. How many families do you carry, and who covers when you're out? Facilitators who can't meet requirements for their caseload are expected to reduce it.
4. Will you come in person on schedule? Ask how they handle a visit that has to be rescheduled.
5. Who do I call first when something goes wrong — a missed shift, a pay problem, a hospital admission?

How to change your services facilitator

You are not stuck. Families switch facilitators over missed visits, slow authorizations, or calls that never get returned. The process is a transfer rather than a resignation: the outgoing facilitator supplies the new one with the most recent plan of care, the discharge paperwork, and the screening documents, and the new facilitator completes a fresh assessment, writes a new plan of care, and submits a transfer request to the authorizing entity.

The practical advice: line up the new facilitator before you end things with the old one. Authorizations run through the facilitator, and a gap between providers is the most common way families accidentally interrupt their own attendant's pay.

A Virginia note before you act

Everything above reflects Virginia's CCC Plus Waiver rules as DMAS publishes them, and DMAS updates its provider manuals and bulletins regularly — the chapter governing these services has been revised more than once in the past two years. 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 source at dmas.virginia.gov, your loved one's managed care plan, or our team.

How Godaelli helps

Godaelli Health Care Services works with families across Alexandria, Arlington, Fairfax, Loudoun, Prince William, and the rest of Northern Virginia who are trying to get a loved one's care paid for and keep it steady. We help families understand where the facilitator's job ends and theirs begins, what to have ready for a comprehensive visit or a 90-day review, and whether consumer direction or agency-directed care is the better fit in the first place. When agency-directed care is the right answer, we provide the caregivers, the supervision, and the backup coverage ourselves.

If you're staring at a packet of forms and a facilitator's business card and you're not sure what happens next, get in touch with our team. Call 703-870-0738 or email care@godaellihomecare.com, and we'll walk you through your options for free — no pressure, no obligation.