VIRGINIA
FVirginia's system, honestly. A letter grade is a summary, not a verdict on your family — a low grade doesn't mean nothing is available, it means the path is narrower. What's behind it is below.
Do this first
Call your local Community Services Board — there are 40, covering every locality — and ask specifically for a Developmental Disability Waiver Screening, not a generic intake. The wording matters. The CSB completes the VIDES functional assessment and a Priority Needs Checklist, and that checklist decides your priority level. Virginia assigns slots by urgency, not by the date you applied, so how the checklist describes your hardest days is what determines when a slot reaches you.
Last verified 2026-07-03
HOW WE GRADE VIRGINIA
Full methodology (v2.1) →Virginia's strongest area is institutional vs. community balance; what pulls the grade down most is waitlist burden.
Waitlist Burden
30% of grade23/100174 people waiting per 100,000 residents
Nobody waiting scores 100. 225 per 100,000 scores 0.
Source:KFF State Health Facts, People Waiting for HCBS by Target … (FY2025 (KFF Medicaid HCBS Waiver Program Survey, FY 2025))US Census Bureau Vintage 2025 state population estimates (2025-07)
HCBS Spending Per Capita
25% of grade52/100$446 spent per resident
$200 per resident scores 0. $675 scores 100.
Source:CMS / Mathematica — Medicaid LTSS Annual Expenditures and … (CY2023)
Self-Direction Index
20% of grade42/10042 out of 100 on the self-direction index
Scored directly on its own 0–100 scale.
Source:CMS approved 1915(c) waiver application (2026-08-05)CMS approved 1915(c) waiver application (2026-08-05)
Waiver Program Count & Breadth
15% of grade35/10035 out of 100 on program breadth
Scored directly on its own 0–100 scale.
- No authoritative national roster of 1915(i) adopters exists; scored as absent where unconfirmed.
Source:Medicaid.gov State Waivers List, Authority=1915(c), Status… (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 2 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)KFF Medicaid Home Care (HCBS) in 2025, Appendix Table 1 (Section 1915(c) counts: Medicaid.gov State Waivers List retrieved 2026-08-05. Target populations & 1915(k): KFF Medicaid HCBS Survey 2025 (FY2025). 1915(i): CMS SPA database retrieved 2026-08-05.)
Each factor is scored against a fixed bar, not against the other states, so Virginia's grade moves when Virginia moves. Think we have it wrong? Every number above links to its source — email hello@spectrumpathways.ai and we will correct it in public.
WHAT THINGS ARE CALLED IN VIRGINIA
Use these exact words when you search, call, or fill out forms — they're what Virginia's own offices use.
- Medicaid here is
- Cardinal Care
- The DD agency is
- Division of Developmental Services (DBHDS)
- You contact
- Community Services Board
- The plan is
- Individual Support Plan (ISP)
- Self-direction is
- Consumer-Directed Servicescontrolling your own budget and hiring your own people
- A denial arrives as a
- Notice of Actionthe letter that gives you the right to appeal
WHO TO CONTACT, IN ORDER
Five different offices, and they don't talk to each other. Disability services, health coverage, and income each run through a separate agency — applying to one does not start the others. Ask each office for the name of the person you spoke to and write down the date; if something is later denied, that record is what an appeal is built on.
- 1
Developmental disability services
This is the office that decides whether your child is eligible for disability services. Ask for "intake" or "eligibility determination" by name. In Virginia, you contact Community Services Board.
- 2
Health coverage — Cardinal Care
Almost every waiver and personal-care route requires this first, and it is decided by a different office from the one above. Apply in parallel rather than waiting.
- 3
Help at home, and who can be paid for it
Unless you say otherwise, services come the traditional way: the agency picks and pays the providers. Self-direction — where you get a budget and hire your own people — is opt-in almost everywhere and is not offered automatically. Here it is called Consumer-Directed Services. Ask for it by that name.
- 4
Income — SSI
Federal, so it's the same everywhere: 1-800-772-1213 (TTY 1-800-325-0778). There is no minimum age — you can apply for a newborn. Until 18, the parents' income is deemed to the child, so an early denial is usually about that rather than the child's disability. In many states an SSI award also opens Medicaid automatically — ask when you call.
- 5
If you get told no
Every state has a Protection & Advocacy agency by federal law — free legal help on disability services and appeals. Most families never hear of it, and it is the number to have before a deadline, not after. Yours is disAbility Law Center of Virginia.
disAbility Law Center of Virginia · 1-800-552-3962
RUNNING IT YOURSELF
In many states you can control the budget and hire your own people — including, sometimes, family. Most families are never told this is an option. Here's what we've verified for Virginia; where we haven't verified an answer we say so — it does not mean the answer is no, and it is worth asking.
Can you control the budget?
Not verified yet — ask, don't assume the answer is no.
Can a family member be paid to provide care?
No for a parent or guardian of a minor, and no for an adult's spouse, on any Virginia DD waiver. Other relatives living under the same roof are paid only with written documentation of why no one else is available. Ask about the legally responsible individual policy, which reportedly opened a limited route in July 2025
Who is legally the employer of the people you hire?
You are — the Employer of Record recruits, hires, trains, supervises and fires the assistant. If the person is under 18, a parent or other responsible adult holds the role
How freely can money move between services?
Not verified yet — ask, don't assume the answer is no.
Can the budget buy things, not just staff time?
Not verified yet — ask, don't assume the answer is no.
Is your case manager independent of your providers?
Partly — Virginia's rule bars your paid services facilitator from also being your service provider, your spouse, the parent of a minor, or your Employer of Record. Your Support Coordinator is a separate role again
Deadlines reflect this state’s rules as researched; they can change — always confirm the current deadline with your state agency or Protection & Advocacy office before relying on it.
HOW TO GET SERVICES & APPEAL IN VIRGINIA
- Receive Notice of Action / Notice of Adverse Benefit Determination
- FFS/DD waiver: request State Fair Hearing within 30 days (+5 mailing = 35 total)
- Managed care: MCO internal appeal within 60 days (must exhaust)
- State Fair Hearing within 120 days after MCO final decision
- Hearing before DMAS Appeals Division
KEY AGENCIES & RESOURCES
NOTABLE WAIVERS
Family and Individual Supports (FIS) Waiver
SourcePeople with DD living with family or independently.
Waitlist: Priority 1-3 waitlist ~13,000 statewide; slot assignment via regional committees.
Community Living (CL) Waiver
SourcePeople with DD needing 24/7 residential supports.
Waitlist: Priority-based waitlist through CSBs.
Building Independence (BI) Waiver
SourceAdults with DD who live independently with minimal supports.
Waitlist: Priority-based waitlist.
CCC Plus Waiver (Commonwealth Coordinated Care Plus)
SourcePeople of any age needing nursing-facility level care, including tech-dependent children.
Waitlist: NO waitlist — eligibility-based entitlement.
Full milestone guide
View the Virginia Roadmap →
Six age-based stages — state-correct programs, benefits, and milestones from birth through adulthood.
