Care & Medicaid Knowledge Center

Limitations

Nothing on this site guarantees eligibility, authorization, hours, a caregiver assignment, a start date, or in-network status with a named plan. 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.

• 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.
• 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.
• 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.
• 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.
• 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.

Plain-English summary

Verified public education on Virginia home care, Cardinal Care, waivers, personal care, respite, family caregivers, managed care, authorization, EVV, and client rights.

Plain-English overview

Home care in Virginia is a chain of separate decisions: Medicaid eligibility, waiver or program eligibility, service eligibility, service authorization, and authorized hours. “You have Medicaid” does not mean personal care has started.

What you can learn here

Each hub uses the same structure: what the program means, what is not guaranteed, process steps, family-caregiver rules, agency vs consumer-directed implications, official sources, and what Eden can and cannot decide.

• Getting care and the Eden journey
• Personal care / PCA and ADLs versus IADLs
• Respite and unpaid-caregiver relief
• Virginia Medicaid, Cardinal Care, and the CCC Plus Waiver
• Current managed-care plans (MCOs)
• Authorization, hours, denials, and appeals
• EVV / clock-in and clock-out
• Client rights and provider standards

Other states

Virginia is the detailed policy library. Other states are not copied from Virginia rules.

Important limitations

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.

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.