The care process
How Agency-Directed Personal Care Works in Virginia
Agency-directed personal care is arranged through a personal care agency. The agency’s role, the authorized care and the caregiver’s responsibilities should be clear before the first shift.
Virginia guidance · Reviewed
Agency direction and consumer direction.
DMAS describes agency-directed care as services provided by a personal care agency. Under consumer direction, the member or a designated representative acts as the employer of record, with help from a services facilitator to understand those responsibilities.
Certain waiver services can use either model or a combination. Availability depends on the program and service. Ask who will employ the aide, supervise care and manage documentation in the arrangement being offered.
The care plan comes before paid services.
Coverage review and the appropriate assessment establish which services can be requested. When the proposed aide is an LRI, the plan must identify extraordinary ADL support and why it exceeds ordinary care. Approval is separate from an inquiry or employment discussion.
RN agency supervision and coordination with the health plan or CSB support coordinator help monitor the LRI arrangement. Ask how care-plan changes and concerns will be handled for your family.
Ask for the practical details in writing.
First Choice’s specific employment, pay and operational arrangements need to be confirmed for your role. A general explanation of agency-directed care is not an employment offer or a guarantee of services.
- Employment terms, pay, required checks and training before accepting a role.
- The approved tasks, hours, start date and who provides RN supervision.
- How shifts are documented, corrected and submitted for payroll.
- Which electronic visit verification method is used and who helps if it fails.
- Who manages authorization renewals, Medicaid billing and reports of changing needs.
An upcoming EVV change for live-in caregivers.
Electronic Visit Verification (EVV) records information about a visit, including its start and end. DMAS states that from October 1, 2026, all agency-directed aides and consumer-directed personal-care attendants must use an approved EVV method for shifts, regardless of whether they live with the person receiving care.
This date is upcoming as of this guide’s September 10, 2026 review. Ask the agency which requirements apply to your start date and how to use its approved system.
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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