The Commonwealth Coordinated Care Plus (CCC Plus) Waiver is a Medicaid program that provides home and community-based services to eligible individuals who need a hospital or nursing home level of care. The CCC Plus Waiver aims to help these individuals live in the community and avoid institutionalization while improving their health outcomes and quality of life. The CCC Plus Waiver is one of Virginia's largest and most comprehensive Medicaid waivers, serving over 200,000 individuals as of 2023.
The CCC Plus Waiver is critical because it offers an alternative to costly and restrictive institutional care for many people who need long-term services and support. By providing these services in the community, the CCC Plus Waiver can help individuals maintain their independence, dignity, and choice. The CCC Plus Waiver can also benefit caregivers, who often face physical, emotional, and financial challenges when caring for their loved ones. The CCC Plus Waiver can provide caregivers respite, training, and compensation for their valuable work.
The CCC Plus Waiver is a Medicaid program that provides home and community-based services to individuals who meet specific eligibility requirements. The CCC Plus Waiver is administered by the Department of Medical Assistance Services (DMAS), which contracts with six managed care organizations (MCOs) to deliver the services. The MCOs are:
The CCC Plus Waiver covers medical and non-medical services designed to help individuals live safely and comfortably in their homes or other community settings. Some of the services covered by the CCC Plus Waiver are:
The CCC Plus Waiver also covers other Medicaid benefits, such as primary and specialty care, hospital care, prescription drugs, behavioral health, dental, and transportation services.
The CCC Plus Waiver serves individuals aged 65 or older, or under 65 and disabled, who need a hospital or nursing home level of care. The CCC Plus Waiver also helps individuals who are enrolled in one of the following programs:
The CCC Plus Waiver has a target population of over 200,000 individuals as of 2023. The majority of these individuals are aged 65 or older (about 70%), followed by individuals with physical disabilities (about 20%), and individuals with developmental disabilities (about 10%)4.
To be eligible for the CCC Plus Waiver, an individual must meet the following requirements:
The income limit for Medicaid long-term care in Virginia is $2,382 per month for an individual and $4,764 per month for a couple in 2023. The resource limit is $2,000 for an individual and $3,000 for a couple in 2023. Resources include cash, bank accounts, stocks, bonds, life insurance policies, real estate (other than the primary residence), vehicles (other than one used for transportation), and other assets that can be converted to cash.
Some individuals may qualify for the CCC Plus Waiver even if their income or resources exceed these limits. For example:
The CCC Plus Waiver provides various services and supports that can help individuals live in the community and avoid institutionalization. The services and supports are based on the individual's needs, preferences, and goals, as identified in a person-centered service plan. The person-centered service plan is developed by the individual, their family, their MCO care coordinator, and other support team members.
Some of the services and supports available under the CCC Plus Waiver are:
The CCC Plus Waiver offers an option for caregivers to receive compensation for providing personal assistance or respite care to their loved ones. This option is called consumer-directed services (CDS), which allows individuals to hire their workers instead of using an agency. CDS workers can be family members (except spouses or legal guardians), friends, neighbors, or other individuals chosen by the individual.
The MCO pays CDS workers through a fiscal employer agent (FEA), which handles payroll taxes, insurance, and background checks. CDS workers must complete an application, a criminal history check, and a tuberculosis test before they can start working. CDS workers must also complete training on topics like infection control, emergency procedures, and record keeping.
CDS workers are paid according to the rates set by DMAS and the MCO. The rates vary depending on the type of service, the level of care, and the region. The rates are adjusted annually to reflect inflation and market changes. As of 2023, the average hourly rate for CDS workers in Virginia is $10.50.
CDS workers are not considered employees of the individual or the MCO but independent contractors. Therefore, CDS workers are responsible for paying their own income taxes and social security taxes. CDS workers are also not eligible for health insurance, paid leave, or retirement plans.
CDS workers are subject to the same rules and regulations as agency workers, such as service authorization, service limits, service documentation, and quality monitoring. CDS workers must report changes in the individual's condition, needs, or preferences to the MCO care coordinator. CDS workers must also comply with the individual's person-centered service plan and respect their rights and privacy.
If you are interested in applying for or accessing the CCC Plus Waiver or have any questions or concerns, please get in touch with your local Department of Social Services (DSS) or your MCO care coordinator. You can also fill out this form to determine if you may be eligible for compensation as a caregiver. We will get back to you as soon as possible with more information and guidance.
