Hours & authorization
How the 40-Hour LRI Rule Works in Virginia
“Up to 40 hours” tells you the limit for qualifying paid LRI care. It does not tell you how many hours your child will be approved to receive.
Virginia guidance · Reviewed
A weekly ceiling and a care plan are different.
Virginia’s LRI guidance allows reimbursement for up to 40 hours per week for a qualifying child. An assessment must establish the extraordinary ADL care needed, and the care plan and service authorization determine the covered tasks and time.
A family should not plan on 40 paid hours before authorization. The child may need fewer qualifying hours, or the application may not meet the program requirements. Caregiver eligibility and applicable health-plan rules also matter.
Hours follow tasks, not a diagnosis.
Care planning looks at the assistance required with particular activities and the time involved. Ordinary supervision, parenting routines, shopping and household help should not be added as extraordinary LRI hours.
For a useful conversation, describe what happens during a typical day and where physical help is needed. Avoid turning the 40-hour ceiling into a target: the plan should accurately reflect the child’s needs and support their independence.
What if there is more than one child or caregiver?
DMAS describes up to 40 hours per week for each qualifying child when an LRI is paid to assist multiple children. Each child still needs their own qualifying care and authorization. This does not authorize overlapping claims for care that was not separately delivered.
If a non-LRI aide is needed as well, DMAS calls for a separate, coordinated plan submitted with the LRI plan. Ask the provider how the full schedule will be authorized and documented.
Check the full arrangement before starting.
Confirm the authorized tasks and hours, start date, documentation method and how to report changes. Respite should not be assumed to cover time outside the paid LRI’s shifts: DMAS describes a restriction when a paid LRI is providing personal care.
If hours are already approved, share that in the screening. An existing authorization must still be reviewed for the proposed caregiver and agency arrangement.
Official sources
These Virginia and local government resources explain the rules and the public programs described here.
This guidance and our preliminary screening do not guarantee Medicaid eligibility, paid caregiver employment or service authorization. First Choice Home Care does not make the final Medicaid or authorization decision. Your program and care plan determine which services may be approved.
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