Effective October 1, 2026, Virginia requires live-in caregivers who had previously been exempt.
For consumer direct care providers, this means using an approved mobile application or Interactive Voice Response system to clock in and clock out. When the mobile application is used, GPS must be enabled for the shift to be considered EVV compliant.
Why are we, home care providers, concerned? A live-in caregiver does not “visit” the home. It is their home. The traditional EVV model was designed to electronically verify that a worker arrived at a location, provided an authorized service, and left. Applying that same framework to someone who lives with the Medicaid member raises a fundamental question: What exactly is Virginia verifying when the caregiver and the person receiving services share the same residence?
Live-in caregiving also does not always fit neatly into a traditional shift model. Care needs do not necessarily begin when an application says “clock in,” nor do they disappear when the caregiver clocks out. This creates a system in which the electronic record may document Medicaid-reimbursable time without reflecting the full reality of caregiving occurring in the home.
This Is Also a Workforce Issue: Virginia should consider what additional administrative requirements mean for the workforce the Commonwealth depends on to keep people with disabilities and older adults living in their communities and not forced into institutionalization. DMAS states that an attendant who fails to comply with EVV requirements may eventually become ineligible to provide services to someone participating in consumer direction. That makes implementation more than an administrative inconvenience.
For a live-in provider, failure to properly use the technology could ultimately threaten the caregiver's ability to remain the person's paid attendant. For the individual receiving services, losing that attendant could mean losing the person who knows their routines, communication needs, medications, behaviors, mobility needs, and daily care.
The Regulatory Question Must Be Addressed: There is also an important issue requiring legislative clarification. The 2026 Appropriation Act directed DMAS to seek federal authority to eliminate the live-in caregiver EVV exemption and directed the agency to promulgate emergency regulations. The budget language also permits implementation following federal approval and before completion of the regulatory process.
DMAS subsequently reported that CMS advised Virginia that a 1915(c) waiver amendment was not necessary and announced the October 1 implementation. However, as of October 2, the published Virginia Administrative Code still expressly lists “live-in caregivers” among those exempt from EVV under 12VAC30-60-65(C)(4). Legislators should require a clear public explanation of the legal and regulatory status of this provision, the emergency regulatory process, and when Virginia's published regulations will reflect the policy now being enforced.
Questions Legislators Should Ask:
What problem is this policy intended to solve?
What Virginia-specific data demonstrated that live-in caregivers presented sufficient program-integrity concerns to justify eliminating their exemption?
What evidence was presented regarding fraud, waste, or abuse specifically involving live-in providers?
If fraud prevention is part of the justification, legislators should request measurable data not generalized concerns about Medicaid fraud. What will constitute success?
Virginia should establish measurable outcomes before imposing additional requirements on thousands of caregivers. How much improper payment is this policy expected to prevent? What is the baseline? How will DMAS report whether those savings actually occur?
What will happen when technology fails? What protections exist when GPS is inaccurate, the application fails, internet or cellular service is unavailable, a provider forgets to clock in while responding to an immediate care need, or an electronic record requires correction?
Will providers lose wages because of EVV errors? There should be safeguards preventing a technical or administrative failure from becoming an unpaid-work problem.
What protections exist for the person receiving care? No Medicaid member should lose a caregiver or experience an interruption in essential services because of a technological problem that can be corrected.
What We Are Asking: We ask legislators to exercise meaningful oversight of the elimination of Virginia's live-in EVV exemption.
Require DMAS to publicly report:
Most importantly, require an evaluation of whether this policy is accomplishing something that could not have been achieved through a less burdensome alternative. Home care providers are not asking Virginia to abandon accountability.
We are asking Virginia to ensure that accountability does not become another barrier to providing care.
If a policy intended to protect Medicaid instead drives experienced caregivers out of the workforce, delays their wages, disrupts authorized services, or makes it harder for people with disabilities and older adults to remain safely at home, then the General Assembly and the powers that be must be willing to reconsider that policy.