Home Care / Medicaid Glossary

Limitations

Glossary entries are educational summaries, not statute text. Eden educational resources are not a substitute for official Medicaid, waiver, or health-plan determinations. Rules vary by program, assessment, authorization, and plan. Confirm current details with DMAS, your MCO, and Eden intake.

Important definitions

Short definitions used on this page. Program manuals may phrase lists slightly differently.

• ADL: Activities of Daily Living — basic self-care tasks such as bathing, dressing, grooming, toileting, eating/feeding when applicable, mobility, and transfers. Exact lists can vary by program.
• IADL: Instrumental Activities of Daily Living — household or community tasks such as meals, shopping, laundry, or light housekeeping. Whether an IADL is covered depends on the specific program and authorization. Do not assume every IADL is reimbursable.
• PCA / personal care aide: A worker who assists with authorized personal care. Programs may also say attendant, personal assistance, or aide. Titles are not interchangeable across every payer.
• Personal care / personal assistance: Hands-on or cueing help with authorized ADLs and, when the program allows, certain IADLs. Coverage requires eligibility plus service authorization — Medicaid enrollment alone is not enough.
• Attendant: A common consumer-directed term for the worker hired by the member or representative to provide authorized assistance.
• Respite: Temporary relief for an unpaid primary caregiver. It is a different service from personal care and has its own eligibility and authorization rules.
• LRI: Legally Responsible Individual — in Virginia DMAS waiver guidance, a parent or legal guardian of a minor, or the participant's spouse. Not every parent of an adult is an LRI under this definition.
• CCC Plus Waiver: Virginia's CCC Plus 1915(c) home- and community-based services waiver. This is a waiver program, not the current name of Virginia's Medicaid managed-care program.

Plain-English summary

Short definitions of ADL, IADL, PCA, LRI, Cardinal Care, CCMC, MCO, EVV, authorization, and related terms used on Eden's public knowledge pages.

ADL

Activities of Daily Living — basic self-care tasks such as bathing, dressing, grooming, toileting, eating/feeding when applicable, mobility, and transfers. Exact lists can vary by program.

IADL

Instrumental Activities of Daily Living — household or community tasks such as meals, shopping, laundry, or light housekeeping. Whether an IADL is covered depends on the specific program and authorization. Do not assume every IADL is reimbursable.

PCA / personal care aide

A worker who assists with authorized personal care. Programs may also say attendant, personal assistance, or aide. Titles are not interchangeable across every payer.

Personal care / personal assistance

Hands-on or cueing help with authorized ADLs and, when the program allows, certain IADLs. Coverage requires eligibility plus service authorization — Medicaid enrollment alone is not enough.

Attendant

A common consumer-directed term for the worker hired by the member or representative to provide authorized assistance.

Respite

Temporary relief for an unpaid primary caregiver. It is a different service from personal care and has its own eligibility and authorization rules.

LRI

Legally Responsible Individual — in Virginia DMAS waiver guidance, a parent or legal guardian of a minor, or the participant's spouse. Not every parent of an adult is an LRI under this definition.

CCC Plus Waiver

Virginia's CCC Plus 1915(c) home- and community-based services waiver. This is a waiver program, not the current name of Virginia's Medicaid managed-care program.

Cardinal Care

Virginia's Medicaid and FAMIS program brand. All Medicaid managed-care and fee-for-service members are part of Cardinal Care.

Cardinal Care Managed Care (CCMC)

Virginia's current Medicaid managed-care program, effective July 1, 2025. It combined the historic CCC Plus managed-care and Medallion 4.0 programs. Do not confuse CCMC with the CCC Plus Waiver.

MCO

Managed Care Organization — the health plan that coordinates covered services for many Cardinal Care members.

LTSS

Long-Term Services and Supports — including personal care, respite, adult day health, and related community services when authorized.

FFS

Fee-for-service — Medicaid coverage administered by DMAS rather than an MCO. Some members remain in FFS; most are in managed care.

Service authorization / prior authorization

The payer's approval of a specific service, amount, and period. Authorization is not the same as Medicaid eligibility or waiver enrollment.

Plan of care

The documented service plan that describes authorized supports. Hours cannot exceed what the payer authorized.

EVV

Electronic Visit Verification — a federal and Virginia requirement to record visit facts such as member, service, caregiver, date, location, and start/end time for many personal care, respite, and companion visits.

Care coordinator / care manager

A plan or program staff member who helps coordinate covered services. They do not replace the payer's authorization rules.

Services facilitator

In consumer-directed models, a professional who supports the member/representative with employer-of-record tasks. Eden does not automatically fill this role for every case.

Employer of record

In consumer-directed services, the member or representative who hires, schedules, and supervises the attendant, with fiscal-agent support.

Agency-directed

A licensed agency hires, schedules, and supervises aides. The agency — not the family — is the employer.

Consumer-directed

The member or representative is the employer of the attendant, with services-facilitator and fiscal-agent support where the waiver allows.

Appeal

A request to review a coverage decision such as a denial, reduction, or termination. Deadlines come from the official notice.

Grievance

A complaint about quality, access, or customer service that is not necessarily a dispute of a coverage determination.

Reassessment

A later review of needs that can change authorized services or hours. Frequency depends on the program and payer.

Eligibility and applicability

Program rules, assessments, and payer authorization decide what can start. Medicaid enrollment, waiver enrollment, service eligibility, service authorization, and authorized hours are not the same status.

Assessment and documentation

Depending on the program and service, an assessment and supporting documentation may be required. A nurse does not automatically visit first for every request.

Authorization and approval

When authorization is required, the payer or MCO reviews the requested service and hours. Outcomes can include approval, partial approval, a request for more information, or denial. Eden does not approve the benefit.

Hours and limits

Requested, assessed, authorized, scheduled, and EVV-verified hours can all differ. This site does not invent a universal hour number.

How services can interact

Personal care, respite, companion, adult day, and transportation follow separate rules. A plan may authorize one, more than one, or none.

Family caregiver implications

A parent or spouse is not automatically a paid caregiver. Virginia LRI rules apply only in defined relationships and only when the current official policy and authorization allow it.

Agency-directed vs consumer-directed

Agency-directed: a licensed agency is the employer. Consumer-directed: the member or representative is the employer of record, with services-facilitator support where the waiver allows. Eden's typical public role is agency-directed care.

Insurance and MCO implications

Managed-care members usually follow their plan's authorization and appeal process. Fee-for-service members follow DMAS processes. A plan existing on the official roster does not mean Eden is in-network.