The general answer
If your parent qualifies for Medicaid long-term care, most states offer a Home and Community-Based Services (HCBS) waiver that lets them stay at home instead of moving to a nursing facility — and many of these waivers include a consumer-directed(sometimes called "self-directed") option, where the Medicaid recipient (or their representative) hires their own caregiver instead of using an agency. That caregiver can often be a family member, including an adult child.
Whether a spouse can be paid, which relatives qualify, and how much the pay is all vary significantly by state — this is genuinely one of the most state-specific parts of Medicaid, so what's true in one state may not be true in the next.
How the payment actually works
Regardless of state, the mechanics tend to follow the same shape:
- A care needs assessment determines how many hours of care are authorized per month.
- The family member becomes the paid attendant for those hours — not a blank check, a specific authorized amount.
- A third-party fiscal/employer agent (a financial management company, not the family) handles the actual payroll: tax withholding and issuing pay.
Virginia specifics: the CCC+ Waiver
In Virginia, this program is the CCC+ Waiver (also called Cardinal Care). Under its consumer-directed option, an adult child, sibling, grandchild, niece, or nephew can become the paid caregiver. A spouse cannot be paid for personal care under this specific program. A Services Facilitator assesses care needs and authorizes monthly attendant hours, and a Fiscal/Employer Agent handles the payroll paperwork. This only covers personal care and respite services — not every CCC+ benefit is available this way.
The waiver has no waitlist in Virginia, which is unusual — if your parent meets the nursing-facility level of care and financial eligibility, they can start the process without waiting years for a slot to open.
If you're outside Virginia
Every state calls its version of this something different, and the details (eligible relatives, whether a spouse qualifies, pay rates, waitlists) genuinely differ. The fastest way to find your state's answer is to search "[your state] Medicaid consumer-directed care" or call your state's Medicaid office directly and ask specifically about paid family caregiver options under their HCBS waiver.